Thank you for referring [Name].
Chronic rhinitis is the major complaint. He sneezes year round and has nasal congestion year round and has some nasal itch, seemingly better in the summertime and perhaps slightly in the fall, as well. He states that he started having allergy-type symptoms that were bothersome somewhere in the late 1970 's, but it is very hard to say. He has seen multiple medical doctors, Dr. [Name] included, several years ' ago and had nasal and sinus surgery. We do not have all the records, but on physical examination, I do believe, he has had a turbinectomy. When I asked whether his dry nose, as he describes it and as I see it on physical exam, might be related to low testosterone. He states that his muscle strength, libido are quite normal and not decreased. I agree that his muscle strength is quite good, and therefore, of those patients with dry noses with low testosterone, I rather doubt that
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They are somewhat purplish-brownish discolorations, serpiginous, oval in shape, about a 1/4 of an inch to a 1/2 inch in size. This may be easy bruisability because it is so flat, but I am hard pressed to make a diagnosis. They are non-itchy, and I rather doubt that he has a drug allergy because of this.
He has been told by his ophthalmologist that he has dry eyes, but he does not have a dry mouth, so Sjögren syndrome does not seem likely. No other signs of collagen vascular disorder, such as Raynaud phenomenon. He enjoys good health. May have some slight tinnitus, which he attributes to loud noises in his past. He also has nocturia 3 to 4 times a night without pain, and I really would question whether he might have a sleep problem. I asked him to speak to Dr. [Name], just to make sure there was no other reason to wake up at night. He says he wakes up refreshed in the morning and has a good