-Hematocrit should be monitored during testosterone replacement.
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Case by Dr. T
Pt with testosterone of 6.8. Hx of fatigue, stress, ED/decreased libido, male pattern baldness.
*Starting patient on testosterone replacement is like putting a patient on thyroid replacement. It requires frequent f/u, at 2-3 mo, then 6mo, then yearly to f/u. It also requires screening for prostate and breast cancer.
* Tx:
We counseled patient about the problem, alternatives, and risks
We started patient on Celexa 10mg to treat symptoms of depression
F/u in 6 weeks
Patient’s testosterone wasn’t that low.
Any positive testosterone should be repeated as 30% of repeat measurements are normal. Get another AM total testosterone level. Also send for LH/FSH, PRL +- estradiol, and SHBG
If repeat testosterone significantly low and or SSRI trial doesn’t relieve symptoms, refer the patient to an endocrinologist.
“The best initial test for the diagnosis of male hypogonadism is measurement of total testosterone in serum in a morning sample. Low concentrations of testosterone in serum should be confirmed by repeatmeasurement. If abnormalities in concentrations of sex hormone–binding globulin are suspected, measurement of free or bioavailable testosterone is indicated. Examples of conditions associated with altered sex hormone–binding globulin include liver disease, obesity, and diabetes mellitus.” ABFM
References
Am Fam Physician. 2017 Oct 1;96(7):441-449. http://www.aafp.org/afp/2017/1001/p441.html
Male hypogonadism. Lancet 2014;383(9924):1250-1263.