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Testosterone (hormone) evaluation and management

Testosterone evaluation and management focus on assessing and treating low testosterone levels, a condition known as hypogonadism. Symptoms of low testosterone include fatigue, reduced libido, erectile dysfunction, depression, and muscle loss.

Testosterone (hormone) evaluation and management

Diagnosis typically involves blood tests to measure total and free testosterone levels, often done in the morning when levels are highest. If low testosterone is confirmed, management options may include lifestyle changes, such as weight loss and exercise, or hormone replacement therapies like testosterone injections, topical gels, or patches. Regular monitoring is necessary to assess effectiveness and avoid potential side effects, such as cardiovascular risks or prostate issues.

Treatment

Evaluation of Testosterone Deficiency:

Clinical Assessment:

Symptoms: Common symptoms include reduced libido, erectile dysfunction, decreased muscle mass, fatigue, depression, and diminished cognitive function.
Medical History: A thorough history should assess for factors such as testicular injury, infections, medications, and systemic diseases that may contribute to low testosterone levels.
Laboratory Testing:

Total Testosterone Measurement: Blood samples should be collected in the morning (between 7 AM and 11 AM) when testosterone levels are at their peak. It's recommended to confirm low levels with at least two separate measurements taken on different days.

Free Testosterone: In cases where total testosterone levels are borderline or when conditions affecting sex hormone-binding globulin (SHBG) are present, measuring free testosterone can provide additional insight.

Additional Tests: Assessments of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin levels can help determine whether the hypogonadism is primary (testicular) or secondary (pituitary/hypothalamic).
Management of Testosterone Deficiency:

Testosterone Replacement Therapy (TRT):

Indications: TRT is recommended for men with clinical symptoms of testosterone deficiency and consistently low testosterone levels.
Administration Methods:
Intramuscular Injections: Administered every 1 to 2 weeks.
Transdermal Patches or Gels: Applied daily to the skin.
Subcutaneous Pellets: Implanted under the skin every 3 to 6 months.
Monitoring: Regular follow-ups are essential to monitor testosterone levels, hematocrit, prostate-specific antigen (PSA), and to assess symptom improvement and potential side effects.

Alternative Treatments:

Clomiphene Citrate: This selective estrogen receptor modulator can stimulate the body's natural testosterone production and is an option for men wishing to preserve fertility.
Human Chorionic Gonadotropin (hCG): hCG can stimulate testosterone production in men with secondary hypogonadism, particularly those desiring fertility preservation.

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