By switaschek, 20 July, 2020 If pt wishes to preserve fertility, aromatase inhibitors, hCG, SERMs may be used w/ TRT, but evidence is limited1
By switaschek, 20 July, 2020 Counsel pt re: costs, transference of gels/creams;1 IM preps preferred to transdermal due to equivalent efficacy, 10x cost difference2
By switaschek, 19 July, 2020 TRT link to changes in prostate CA, VTE, & CV risk is inconclusive;1,3 continued prostate CA screening is shared decision1,3
By switaschek, 19 July, 2020 TRT risks: ↓sperm production/fertility; ↑Hct; acne; detection of subclinical prostate CA or growth of metastatic prostate CA; gynecomastia; male pattern balding; growth of breast CA; OSA; local reactions3
By switaschek, 19 July, 2020 TRT benefits: Per ACP, consider TRT only for sexual dysfxn, not to ↑energy, vitality, physical fxn or cognition;2 per AUA, TRT may improve sexual fxn, anemia, BMD, lean body mass, depressive sx1
By switaschek, 19 July, 2020 Don’t use TRT if: trying to conceive in near term; breast or prostate CA; palpable prostate nodule/induration; severe untreated OSA; severe LUTS (AUA/IPSS >19); uncontrolled CHF; thrombophilia;3 recent MI/stroke (
By switaschek, 19 July, 2020 Check DRE, PSA (if >40 yo) & Hct prior to TRT;1,3 don’t start TRT w/o eval if PSA >4 (>3 in high-risk pt) or ↑Hct1,3
By switaschek, 19 July, 2020 Start testosterone replacement tx TRT only if multiple levels and s sx of low T counsel about risk benefits uncertainties counsel all pts about benefits of lifestyle modifications 1 select IM TRT over gels creams patch due to cost2