CLINICIAN EDUCATOR - MhChem · – Patches – Gels – Tablets (stick to the gums) – Pellets –...

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Transcript of CLINICIAN EDUCATOR - MhChem · – Patches – Gels – Tablets (stick to the gums) – Pellets –...

Page 1: CLINICIAN EDUCATOR - MhChem · – Patches – Gels – Tablets (stick to the gums) – Pellets – Pills (in some countries outside the United States) • The best method depends
Page 2: CLINICIAN EDUCATOR - MhChem · – Patches – Gels – Tablets (stick to the gums) – Pellets – Pills (in some countries outside the United States) • The best method depends

CLINICIAN EDUCATORDiagnosis and Treatment of Male Hypogonadism

Patient 2B Patient 3B Patient 4B Patient 5B Patient 6B Patient 7B

PATIENT GUIDEDiagnosis and Treatment of Male Hypogonadism

Sponsored by and developed by in collaboration with

Support for this activity has been provided through an educational grant from

What is the role of testosterone in men’s health?•Testosteroneisthemostimportantsexhormoneinmen•Itisresponsiblefortypicalmalecharacteristicsandhelps

maintainsexdrive,spermproduction,muscle,bone,andpubicandbodyhair

•Testosteroneisproducedbythetesticlesunderthecontrolofhormonesproducedbythehypothalamus(inthebrain)andthepituitarygland(asmallglandatthebottomofthebrain)

•Lowtestosteronelevels(alsocalledhypogonadism)cancause: –Adropinsexdrive –Poorerections(erectiledysfunction[ED]) –Lowspermcount –Enlargedbreastsand/orbreasttenderness•Overtime,lowtestosteronemaycauseamantolosemuscle

bulk,strength,andbodyhair;accumulatebodyfat;andhaveweakerbones(osteoporosis),moodchanges,lessenergy,andsmallertesticles

•Symptomsvaryfrompersontopersonandaccordingtolengthandseverityofhypogonadism

What causes low testosterone?

•Lowtestosteronecanbecausedbytesticularinjury(trauma,castration,radiation,orchemotherapy)orinfection,pituitarydisorders(pituitarytumorsordiseases),orotherdiseasesthataffectthewholebody(HIV/AIDS,chronicliverandkidneydisease,obesity,andtype2diabetes)

•Somemedications(includingstrongpainkillerssuchasmethadoneormorphineandanti-inflammatorydrugssuchasprednisone)andgeneticconditions(forexample,Klinefeltersyndrome,hemochromatosis)alsocancauselowtestosterone

•Manyoldermenhavelowtestosteronelevels

Hypothalamic-Pituitary-Testicular Axis Effects of Low Testosterone How is low testosterone diagnosed?• Adiagnosisshouldbemadeonlywhenthere

are(a)symptomsandsignsthatcouldbecausedbylowtestosteroneand(b)consistentlylowbloodlevelsoftestosterone(measuredontwoormoreoccasionsbetween7:00and10:00am, whenlevelsarehighest)

• Diagnosisinvolvesamedicalhistory,inwhichyourdoctormayaskabout:

–Puberty(sexualdevelopment) –Pastorpresentmajorillnessesandnutritionaldeficiency –Allprescriptionandnonprescriptiondrugscurrentlybeingtaken –Relationshipproblems,suchassexualproblems –Recentmajorillnessesanddepression –Familyhistoryoflowtestosterone –Recentchangesinbodycharacteristics(forexample,breastenlargement) –Problemswithyourtesticles• Diagnosisinvolvesaphysicalexamination,inwhichyourdoctormay

assess: –Amountofbodyhair –Presenceofbreastenlargement/tenderness –Sizeandconsistencyofthetesticles;sizeofthepenis –Changesinperipheralvisionandvisualacuity(whichcouldindicatea

pituitarytumor,ararecauseoflowtestosterone)• Diagnosisinvolvesmeasurementoftestosterone –Normalrangeofbloodtotaltestosteroneisgenerally300to

1,000ng/dL(dependingonthelaboratorythatconductsthetest) –Illness,malnutrition,andcertainmedications(asnotedpreviously)

canreducetestosteronetemporarily,soyourdoctormayneedtowaituntilafteryourecoverorstoptakingsuchamedicationbeforeheorshecantakethemeasurement

–Yourdoctormayorderatesttomeasure“free”testosterone,atestthatmanyexpertsthinkisbetterthantotaltestosteroneincertaininstances

–Measurementoftestosteroneisrecommendedinthemorning;morethanonebloodtestandpossiblyothertestsofpituitaryglandhormonesmaybeneeded

How is low testosterone treated?

•Testosteronereplacementtherapycanimprovesexualinterest,erectilefunction,moodandenergy,bodyhairgrowth,bonedensity,andmusclemass

•Thereareseveralwaystoreplacetestosterone: –Injections –Patches –Gels –Tablets(sticktothegums) –Pellets –Pills(insomecountriesoutsidetheUnitedStates)

•Thebestmethoddependsonyourpreferenceandtolerance,aswellascost

•Theoverallgoaloftestosteronetherapyistoincreasetestosteronelevelsuptothemiddleofthenormalrange

•Toachieveyourtreatmentgoals,takeyourrecommendedmedicationasprescribed,keepregularappointmentswithyourdoctor,andadoptahealthylifestylethatincludesregularexerciseandgoodnutrition

Therapeutic Goals of Testosterone Therapy

•Improveandmaintainmasculinecharacteristics

•Improvesexdrive(libido)anderections

•Increaseenergyandwell-being

•Improvemusclemassandstrength

•Improvebonemineraldensity

BhasinS,MatsumotoAM,eds.The Hormone Foundation’s Patient Guide to Androgen Deficiency Syndromes in Adult Men.2nded.ChevyChase,MD:TheHormoneFoundation;2010.Reproducedwithpermission.

CunninghamGR,MatsumotoAM,SwedloffR,eds.Low Testosterone and Men’s Health.4thed.ChevyChase,MD:TheHormoneFoundation;March2010.

Are there any risks associated with testosterone treatment?• Groupsathigherriskofprostatecancer(includingAfricanAmerican

men,menover40whohavecloserelativeswithprostatecancer,andallmenover50)shouldbeofferedtestingforprostatecancerduringtestosteronetreatment

• Menwithbreastcancerorknownorsuspectedprostatecancershouldnotreceivetestosteronetherapy

• Testsyourdoctorwillperformbeforeandduringtestosteronetherapyinclude:

– Bloodteststodetermineyourhematocrit(thepercentageofredbloodcellsinyourblood)andyourtestosteronelevels

– Mostdoctorswillalsorecommendteststocheckforprostatecancer,including:

• Digitalrectalexam(DRE),inwhichthedoctorinsertsafingerintotherectumtofeelforabnormalitiesoftheprostateglandthatmightindicatecancer

• Bloodprostate-specificantigen(PSA)test,whichmightindicateanabnormalityoftheprostate

• Youshouldseeyourdoctor3to6monthsafteryoustarttreatmenttoevaluatewhetheryouareimprovingandifyouarehavinganyproblemsorsideeffects;aDRE,PSAtest,andbloodcountshouldbedoneatthattime;afterthisappointment,similarannualcheck-upsarerecommended

• Menwithosteoporosisorpastbonefracturewithlittletraumashouldreceiveabonemineraldensitytestofthespineandhipareabeforestartingtestosteronetreatmentandthen1or2yearsafterward

Possible Risks of Testosterone Treatment

•Highredbloodcellcount•Acne•Breastenlargement•Increaseinprostateenlargementordifficultywithurination•Increaseinprostatecancerdetection•Occasionaltemporarystoppingofbreathingduringsleep,called

sleep apnea(rarely)•Fluidbuild-upinankles,feetandlegs,callededema(rarely)

What should you do with this information?

•Discussanysymptomsoflowtestosteronewithyourdoctor

•Yourdoctormayreferyoutoanendocrinologist,adoctorthatspecializesinhormonedisorders

•Beopenwithyourdoctoraboutyourmedicalhistory,sexualproblems,andanymajorchangesinyourlife

•Bringallprescriptionandnonprescriptiondrugsyouarenowtakingtoeachdoctorvisit

•Youshouldtellyourdoctorhowwelltreatmentishelpingyoursymptomsandanysideeffectsyouarehaving

GnRH,gonadotropin-releasinghormone;LH,luteinizinghormone;FSH,follicle-stimulatinghormone

ALSO AVAILABLE

TheinteractiveiPhoneappcomponentoftheclinicianeducatorDiagnosis and Treatment of Male Hypogonadismisnowavailable.Thisappincludesthefollowingfeatures:

•Contentpresentedinaneasilynavigableformat

•Convenientdesignforuseduringtime-constrainedofficevisits

•Linkstorelevantriskcalculators

•LinktoposttestforCMEcredit

ObtainthisfreeiPhoneappinanyofthefollowingways:

•Downloadtheappathttp://www.curatiocme.com/hypogonadism/iPhone

•ScantheQRcodebelow

Page 3: CLINICIAN EDUCATOR - MhChem · – Patches – Gels – Tablets (stick to the gums) – Pellets – Pills (in some countries outside the United States) • The best method depends

CLINICIAN EDUCATORDiagnosis and Treatment of Male Hypogonadism

Patient 2B Patient 3B Patient 4B Patient 5B Patient 6B Patient 7B

PATIENT GUIDEDiagnosis and Treatment of Male Hypogonadism

Sponsored by and developed by in collaboration with

Support for this activity has been provided through an educational grant from

What is the role of testosterone in men’s health?•Testosteroneisthemostimportantsexhormoneinmen•Itisresponsiblefortypicalmalecharacteristicsandhelps

maintainsexdrive,spermproduction,muscle,bone,andpubicandbodyhair

•Testosteroneisproducedbythetesticlesunderthecontrolofhormonesproducedbythehypothalamus(inthebrain)andthepituitarygland(asmallglandatthebottomofthebrain)

•Lowtestosteronelevels(alsocalledhypogonadism)cancause: –Adropinsexdrive –Poorerections(erectiledysfunction[ED]) –Lowspermcount –Enlargedbreastsand/orbreasttenderness•Overtime,lowtestosteronemaycauseamantolosemuscle

bulk,strength,andbodyhair;accumulatebodyfat;andhaveweakerbones(osteoporosis),moodchanges,lessenergy,andsmallertesticles

•Symptomsvaryfrompersontopersonandaccordingtolengthandseverityofhypogonadism

What causes low testosterone?

•Lowtestosteronecanbecausedbytesticularinjury(trauma,castration,radiation,orchemotherapy)orinfection,pituitarydisorders(pituitarytumorsordiseases),orotherdiseasesthataffectthewholebody(HIV/AIDS,chronicliverandkidneydisease,obesity,andtype2diabetes)

•Somemedications(includingstrongpainkillerssuchasmethadoneormorphineandanti-inflammatorydrugssuchasprednisone)andgeneticconditions(forexample,Klinefeltersyndrome,hemochromatosis)alsocancauselowtestosterone

•Manyoldermenhavelowtestosteronelevels

Hypothalamic-Pituitary-Testicular Axis Effects of Low Testosterone How is low testosterone diagnosed?• Adiagnosisshouldbemadeonlywhenthere

are(a)symptomsandsignsthatcouldbecausedbylowtestosteroneand(b)consistentlylowbloodlevelsoftestosterone(measuredontwoormoreoccasionsbetween7:00and10:00am, whenlevelsarehighest)

• Diagnosisinvolvesamedicalhistory,inwhichyourdoctormayaskabout:

–Puberty(sexualdevelopment) –Pastorpresentmajorillnessesandnutritionaldeficiency –Allprescriptionandnonprescriptiondrugscurrentlybeingtaken –Relationshipproblems,suchassexualproblems –Recentmajorillnessesanddepression –Familyhistoryoflowtestosterone –Recentchangesinbodycharacteristics(forexample,breastenlargement) –Problemswithyourtesticles• Diagnosisinvolvesaphysicalexamination,inwhichyourdoctormay

assess: –Amountofbodyhair –Presenceofbreastenlargement/tenderness –Sizeandconsistencyofthetesticles;sizeofthepenis –Changesinperipheralvisionandvisualacuity(whichcouldindicatea

pituitarytumor,ararecauseoflowtestosterone)• Diagnosisinvolvesmeasurementoftestosterone –Normalrangeofbloodtotaltestosteroneisgenerally300to

1,000ng/dL(dependingonthelaboratorythatconductsthetest) –Illness,malnutrition,andcertainmedications(asnotedpreviously)

canreducetestosteronetemporarily,soyourdoctormayneedtowaituntilafteryourecoverorstoptakingsuchamedicationbeforeheorshecantakethemeasurement

–Yourdoctormayorderatesttomeasure“free”testosterone,atestthatmanyexpertsthinkisbetterthantotaltestosteroneincertaininstances

–Measurementoftestosteroneisrecommendedinthemorning;morethanonebloodtestandpossiblyothertestsofpituitaryglandhormonesmaybeneeded

How is low testosterone treated?

•Testosteronereplacementtherapycanimprovesexualinterest,erectilefunction,moodandenergy,bodyhairgrowth,bonedensity,andmusclemass

•Thereareseveralwaystoreplacetestosterone: –Injections –Patches –Gels –Tablets(sticktothegums) –Pellets –Pills(insomecountriesoutsidetheUnitedStates)

•Thebestmethoddependsonyourpreferenceandtolerance,aswellascost

•Theoverallgoaloftestosteronetherapyistoincreasetestosteronelevelsuptothemiddleofthenormalrange

•Toachieveyourtreatmentgoals,takeyourrecommendedmedicationasprescribed,keepregularappointmentswithyourdoctor,andadoptahealthylifestylethatincludesregularexerciseandgoodnutrition

Therapeutic Goals of Testosterone Therapy

•Improveandmaintainmasculinecharacteristics

•Improvesexdrive(libido)anderections

•Increaseenergyandwell-being

•Improvemusclemassandstrength

•Improvebonemineraldensity

BhasinS,MatsumotoAM,eds.The Hormone Foundation’s Patient Guide to Androgen Deficiency Syndromes in Adult Men.2nded.ChevyChase,MD:TheHormoneFoundation;2010.Reproducedwithpermission.

CunninghamGR,MatsumotoAM,SwedloffR,eds.Low Testosterone and Men’s Health.4thed.ChevyChase,MD:TheHormoneFoundation;March2010.

Are there any risks associated with testosterone treatment?• Groupsathigherriskofprostatecancer(includingAfricanAmerican

men,menover40whohavecloserelativeswithprostatecancer,andallmenover50)shouldbeofferedtestingforprostatecancerduringtestosteronetreatment

• Menwithbreastcancerorknownorsuspectedprostatecancershouldnotreceivetestosteronetherapy

• Testsyourdoctorwillperformbeforeandduringtestosteronetherapyinclude:

– Bloodteststodetermineyourhematocrit(thepercentageofredbloodcellsinyourblood)andyourtestosteronelevels

– Mostdoctorswillalsorecommendteststocheckforprostatecancer,including:

• Digitalrectalexam(DRE),inwhichthedoctorinsertsafingerintotherectumtofeelforabnormalitiesoftheprostateglandthatmightindicatecancer

• Bloodprostate-specificantigen(PSA)test,whichmightindicateanabnormalityoftheprostate

• Youshouldseeyourdoctor3to6monthsafteryoustarttreatmenttoevaluatewhetheryouareimprovingandifyouarehavinganyproblemsorsideeffects;aDRE,PSAtest,andbloodcountshouldbedoneatthattime;afterthisappointment,similarannualcheck-upsarerecommended

• Menwithosteoporosisorpastbonefracturewithlittletraumashouldreceiveabonemineraldensitytestofthespineandhipareabeforestartingtestosteronetreatmentandthen1or2yearsafterward

Possible Risks of Testosterone Treatment

•Highredbloodcellcount•Acne•Breastenlargement•Increaseinprostateenlargementordifficultywithurination•Increaseinprostatecancerdetection•Occasionaltemporarystoppingofbreathingduringsleep,called

sleep apnea(rarely)•Fluidbuild-upinankles,feetandlegs,callededema(rarely)

What should you do with this information?

•Discussanysymptomsoflowtestosteronewithyourdoctor

•Yourdoctormayreferyoutoanendocrinologist,adoctorthatspecializesinhormonedisorders

•Beopenwithyourdoctoraboutyourmedicalhistory,sexualproblems,andanymajorchangesinyourlife

•Bringallprescriptionandnonprescriptiondrugsyouarenowtakingtoeachdoctorvisit

•Youshouldtellyourdoctorhowwelltreatmentishelpingyoursymptomsandanysideeffectsyouarehaving

GnRH,gonadotropin-releasinghormone;LH,luteinizinghormone;FSH,follicle-stimulatinghormone

ALSO AVAILABLE

TheinteractiveiPhoneappcomponentoftheclinicianeducatorDiagnosis and Treatment of Male Hypogonadismisnowavailable.Thisappincludesthefollowingfeatures:

•Contentpresentedinaneasilynavigableformat

•Convenientdesignforuseduringtime-constrainedofficevisits

•Linkstorelevantriskcalculators

•LinktoposttestforCMEcredit

ObtainthisfreeiPhoneappinanyofthefollowingways:

•Downloadtheappathttp://www.curatiocme.com/hypogonadism/iPhone

•ScantheQRcodebelow

Page 4: CLINICIAN EDUCATOR - MhChem · – Patches – Gels – Tablets (stick to the gums) – Pellets – Pills (in some countries outside the United States) • The best method depends

CLINICIAN EDUCATORDiagnosis and Treatment of Male Hypogonadism

Patient 2B Patient 3B Patient 4B Patient 5B Patient 6B Patient 7B

PATIENT GUIDEDiagnosis and Treatment of Male Hypogonadism

Sponsored by and developed by in collaboration with

Support for this activity has been provided through an educational grant from

What is the role of testosterone in men’s health?•Testosteroneisthemostimportantsexhormoneinmen•Itisresponsiblefortypicalmalecharacteristicsandhelps

maintainsexdrive,spermproduction,muscle,bone,andpubicandbodyhair

•Testosteroneisproducedbythetesticlesunderthecontrolofhormonesproducedbythehypothalamus(inthebrain)andthepituitarygland(asmallglandatthebottomofthebrain)

•Lowtestosteronelevels(alsocalledhypogonadism)cancause: –Adropinsexdrive –Poorerections(erectiledysfunction[ED]) –Lowspermcount –Enlargedbreastsand/orbreasttenderness•Overtime,lowtestosteronemaycauseamantolosemuscle

bulk,strength,andbodyhair;accumulatebodyfat;andhaveweakerbones(osteoporosis),moodchanges,lessenergy,andsmallertesticles

•Symptomsvaryfrompersontopersonandaccordingtolengthandseverityofhypogonadism

What causes low testosterone?

•Lowtestosteronecanbecausedbytesticularinjury(trauma,castration,radiation,orchemotherapy)orinfection,pituitarydisorders(pituitarytumorsordiseases),orotherdiseasesthataffectthewholebody(HIV/AIDS,chronicliverandkidneydisease,obesity,andtype2diabetes)

•Somemedications(includingstrongpainkillerssuchasmethadoneormorphineandanti-inflammatorydrugssuchasprednisone)andgeneticconditions(forexample,Klinefeltersyndrome,hemochromatosis)alsocancauselowtestosterone

•Manyoldermenhavelowtestosteronelevels

Hypothalamic-Pituitary-Testicular Axis Effects of Low Testosterone How is low testosterone diagnosed?• Adiagnosisshouldbemadeonlywhenthere

are(a)symptomsandsignsthatcouldbecausedbylowtestosteroneand(b)consistentlylowbloodlevelsoftestosterone(measuredontwoormoreoccasionsbetween7:00and10:00am, whenlevelsarehighest)

• Diagnosisinvolvesamedicalhistory,inwhichyourdoctormayaskabout:

–Puberty(sexualdevelopment) –Pastorpresentmajorillnessesandnutritionaldeficiency –Allprescriptionandnonprescriptiondrugscurrentlybeingtaken –Relationshipproblems,suchassexualproblems –Recentmajorillnessesanddepression –Familyhistoryoflowtestosterone –Recentchangesinbodycharacteristics(forexample,breastenlargement) –Problemswithyourtesticles• Diagnosisinvolvesaphysicalexamination,inwhichyourdoctormay

assess: –Amountofbodyhair –Presenceofbreastenlargement/tenderness –Sizeandconsistencyofthetesticles;sizeofthepenis –Changesinperipheralvisionandvisualacuity(whichcouldindicatea

pituitarytumor,ararecauseoflowtestosterone)• Diagnosisinvolvesmeasurementoftestosterone –Normalrangeofbloodtotaltestosteroneisgenerally300to

1,000ng/dL(dependingonthelaboratorythatconductsthetest) –Illness,malnutrition,andcertainmedications(asnotedpreviously)

canreducetestosteronetemporarily,soyourdoctormayneedtowaituntilafteryourecoverorstoptakingsuchamedicationbeforeheorshecantakethemeasurement

–Yourdoctormayorderatesttomeasure“free”testosterone,atestthatmanyexpertsthinkisbetterthantotaltestosteroneincertaininstances

–Measurementoftestosteroneisrecommendedinthemorning;morethanonebloodtestandpossiblyothertestsofpituitaryglandhormonesmaybeneeded

How is low testosterone treated?

•Testosteronereplacementtherapycanimprovesexualinterest,erectilefunction,moodandenergy,bodyhairgrowth,bonedensity,andmusclemass

•Thereareseveralwaystoreplacetestosterone: –Injections –Patches –Gels –Tablets(sticktothegums) –Pellets –Pills(insomecountriesoutsidetheUnitedStates)

•Thebestmethoddependsonyourpreferenceandtolerance,aswellascost

•Theoverallgoaloftestosteronetherapyistoincreasetestosteronelevelsuptothemiddleofthenormalrange

•Toachieveyourtreatmentgoals,takeyourrecommendedmedicationasprescribed,keepregularappointmentswithyourdoctor,andadoptahealthylifestylethatincludesregularexerciseandgoodnutrition

Therapeutic Goals of Testosterone Therapy

•Improveandmaintainmasculinecharacteristics

•Improvesexdrive(libido)anderections

•Increaseenergyandwell-being

•Improvemusclemassandstrength

•Improvebonemineraldensity

BhasinS,MatsumotoAM,eds.The Hormone Foundation’s Patient Guide to Androgen Deficiency Syndromes in Adult Men.2nded.ChevyChase,MD:TheHormoneFoundation;2010.Reproducedwithpermission.

CunninghamGR,MatsumotoAM,SwedloffR,eds.Low Testosterone and Men’s Health.4thed.ChevyChase,MD:TheHormoneFoundation;March2010.

Are there any risks associated with testosterone treatment?• Groupsathigherriskofprostatecancer(includingAfricanAmerican

men,menover40whohavecloserelativeswithprostatecancer,andallmenover50)shouldbeofferedtestingforprostatecancerduringtestosteronetreatment

• Menwithbreastcancerorknownorsuspectedprostatecancershouldnotreceivetestosteronetherapy

• Testsyourdoctorwillperformbeforeandduringtestosteronetherapyinclude:

– Bloodteststodetermineyourhematocrit(thepercentageofredbloodcellsinyourblood)andyourtestosteronelevels

– Mostdoctorswillalsorecommendteststocheckforprostatecancer,including:

• Digitalrectalexam(DRE),inwhichthedoctorinsertsafingerintotherectumtofeelforabnormalitiesoftheprostateglandthatmightindicatecancer

• Bloodprostate-specificantigen(PSA)test,whichmightindicateanabnormalityoftheprostate

• Youshouldseeyourdoctor3to6monthsafteryoustarttreatmenttoevaluatewhetheryouareimprovingandifyouarehavinganyproblemsorsideeffects;aDRE,PSAtest,andbloodcountshouldbedoneatthattime;afterthisappointment,similarannualcheck-upsarerecommended

• Menwithosteoporosisorpastbonefracturewithlittletraumashouldreceiveabonemineraldensitytestofthespineandhipareabeforestartingtestosteronetreatmentandthen1or2yearsafterward

Possible Risks of Testosterone Treatment

•Highredbloodcellcount•Acne•Breastenlargement•Increaseinprostateenlargementordifficultywithurination•Increaseinprostatecancerdetection•Occasionaltemporarystoppingofbreathingduringsleep,called

sleep apnea(rarely)•Fluidbuild-upinankles,feetandlegs,callededema(rarely)

What should you do with this information?

•Discussanysymptomsoflowtestosteronewithyourdoctor

•Yourdoctormayreferyoutoanendocrinologist,adoctorthatspecializesinhormonedisorders

•Beopenwithyourdoctoraboutyourmedicalhistory,sexualproblems,andanymajorchangesinyourlife

•Bringallprescriptionandnonprescriptiondrugsyouarenowtakingtoeachdoctorvisit

•Youshouldtellyourdoctorhowwelltreatmentishelpingyoursymptomsandanysideeffectsyouarehaving

GnRH,gonadotropin-releasinghormone;LH,luteinizinghormone;FSH,follicle-stimulatinghormone

ALSO AVAILABLE

TheinteractiveiPhoneappcomponentoftheclinicianeducatorDiagnosis and Treatment of Male Hypogonadismisnowavailable.Thisappincludesthefollowingfeatures:

•Contentpresentedinaneasilynavigableformat

•Convenientdesignforuseduringtime-constrainedofficevisits

•Linkstorelevantriskcalculators

•LinktoposttestforCMEcredit

ObtainthisfreeiPhoneappinanyofthefollowingways:

•Downloadtheappathttp://www.curatiocme.com/hypogonadism/iPhone

•ScantheQRcodebelow

Page 5: CLINICIAN EDUCATOR - MhChem · – Patches – Gels – Tablets (stick to the gums) – Pellets – Pills (in some countries outside the United States) • The best method depends

CLINICIAN EDUCATORDiagnosis and Treatment of Male Hypogonadism

Patient 2B Patient 3B Patient 4B Patient 5B Patient 6B Patient 7B

PATIENT GUIDEDiagnosis and Treatment of Male Hypogonadism

Sponsored by and developed by in collaboration with

Support for this activity has been provided through an educational grant from

What is the role of testosterone in men’s health?•Testosteroneisthemostimportantsexhormoneinmen•Itisresponsiblefortypicalmalecharacteristicsandhelps

maintainsexdrive,spermproduction,muscle,bone,andpubicandbodyhair

•Testosteroneisproducedbythetesticlesunderthecontrolofhormonesproducedbythehypothalamus(inthebrain)andthepituitarygland(asmallglandatthebottomofthebrain)

•Lowtestosteronelevels(alsocalledhypogonadism)cancause: –Adropinsexdrive –Poorerections(erectiledysfunction[ED]) –Lowspermcount –Enlargedbreastsand/orbreasttenderness•Overtime,lowtestosteronemaycauseamantolosemuscle

bulk,strength,andbodyhair;accumulatebodyfat;andhaveweakerbones(osteoporosis),moodchanges,lessenergy,andsmallertesticles

•Symptomsvaryfrompersontopersonandaccordingtolengthandseverityofhypogonadism

What causes low testosterone?

•Lowtestosteronecanbecausedbytesticularinjury(trauma,castration,radiation,orchemotherapy)orinfection,pituitarydisorders(pituitarytumorsordiseases),orotherdiseasesthataffectthewholebody(HIV/AIDS,chronicliverandkidneydisease,obesity,andtype2diabetes)

•Somemedications(includingstrongpainkillerssuchasmethadoneormorphineandanti-inflammatorydrugssuchasprednisone)andgeneticconditions(forexample,Klinefeltersyndrome,hemochromatosis)alsocancauselowtestosterone

•Manyoldermenhavelowtestosteronelevels

Hypothalamic-Pituitary-Testicular Axis Effects of Low Testosterone How is low testosterone diagnosed?• Adiagnosisshouldbemadeonlywhenthere

are(a)symptomsandsignsthatcouldbecausedbylowtestosteroneand(b)consistentlylowbloodlevelsoftestosterone(measuredontwoormoreoccasionsbetween7:00and10:00am, whenlevelsarehighest)

• Diagnosisinvolvesamedicalhistory,inwhichyourdoctormayaskabout:

–Puberty(sexualdevelopment) –Pastorpresentmajorillnessesandnutritionaldeficiency –Allprescriptionandnonprescriptiondrugscurrentlybeingtaken –Relationshipproblems,suchassexualproblems –Recentmajorillnessesanddepression –Familyhistoryoflowtestosterone –Recentchangesinbodycharacteristics(forexample,breastenlargement) –Problemswithyourtesticles• Diagnosisinvolvesaphysicalexamination,inwhichyourdoctormay

assess: –Amountofbodyhair –Presenceofbreastenlargement/tenderness –Sizeandconsistencyofthetesticles;sizeofthepenis –Changesinperipheralvisionandvisualacuity(whichcouldindicatea

pituitarytumor,ararecauseoflowtestosterone)• Diagnosisinvolvesmeasurementoftestosterone –Normalrangeofbloodtotaltestosteroneisgenerally300to

1,000ng/dL(dependingonthelaboratorythatconductsthetest) –Illness,malnutrition,andcertainmedications(asnotedpreviously)

canreducetestosteronetemporarily,soyourdoctormayneedtowaituntilafteryourecoverorstoptakingsuchamedicationbeforeheorshecantakethemeasurement

–Yourdoctormayorderatesttomeasure“free”testosterone,atestthatmanyexpertsthinkisbetterthantotaltestosteroneincertaininstances

–Measurementoftestosteroneisrecommendedinthemorning;morethanonebloodtestandpossiblyothertestsofpituitaryglandhormonesmaybeneeded

How is low testosterone treated?

•Testosteronereplacementtherapycanimprovesexualinterest,erectilefunction,moodandenergy,bodyhairgrowth,bonedensity,andmusclemass

•Thereareseveralwaystoreplacetestosterone: –Injections –Patches –Gels –Tablets(sticktothegums) –Pellets –Pills(insomecountriesoutsidetheUnitedStates)

•Thebestmethoddependsonyourpreferenceandtolerance,aswellascost

•Theoverallgoaloftestosteronetherapyistoincreasetestosteronelevelsuptothemiddleofthenormalrange

•Toachieveyourtreatmentgoals,takeyourrecommendedmedicationasprescribed,keepregularappointmentswithyourdoctor,andadoptahealthylifestylethatincludesregularexerciseandgoodnutrition

Therapeutic Goals of Testosterone Therapy

•Improveandmaintainmasculinecharacteristics

•Improvesexdrive(libido)anderections

•Increaseenergyandwell-being

•Improvemusclemassandstrength

•Improvebonemineraldensity

BhasinS,MatsumotoAM,eds.The Hormone Foundation’s Patient Guide to Androgen Deficiency Syndromes in Adult Men.2nded.ChevyChase,MD:TheHormoneFoundation;2010.Reproducedwithpermission.

CunninghamGR,MatsumotoAM,SwedloffR,eds.Low Testosterone and Men’s Health.4thed.ChevyChase,MD:TheHormoneFoundation;March2010.

Are there any risks associated with testosterone treatment?• Groupsathigherriskofprostatecancer(includingAfricanAmerican

men,menover40whohavecloserelativeswithprostatecancer,andallmenover50)shouldbeofferedtestingforprostatecancerduringtestosteronetreatment

• Menwithbreastcancerorknownorsuspectedprostatecancershouldnotreceivetestosteronetherapy

• Testsyourdoctorwillperformbeforeandduringtestosteronetherapyinclude:

– Bloodteststodetermineyourhematocrit(thepercentageofredbloodcellsinyourblood)andyourtestosteronelevels

– Mostdoctorswillalsorecommendteststocheckforprostatecancer,including:

• Digitalrectalexam(DRE),inwhichthedoctorinsertsafingerintotherectumtofeelforabnormalitiesoftheprostateglandthatmightindicatecancer

• Bloodprostate-specificantigen(PSA)test,whichmightindicateanabnormalityoftheprostate

• Youshouldseeyourdoctor3to6monthsafteryoustarttreatmenttoevaluatewhetheryouareimprovingandifyouarehavinganyproblemsorsideeffects;aDRE,PSAtest,andbloodcountshouldbedoneatthattime;afterthisappointment,similarannualcheck-upsarerecommended

• Menwithosteoporosisorpastbonefracturewithlittletraumashouldreceiveabonemineraldensitytestofthespineandhipareabeforestartingtestosteronetreatmentandthen1or2yearsafterward

Possible Risks of Testosterone Treatment

•Highredbloodcellcount•Acne•Breastenlargement•Increaseinprostateenlargementordifficultywithurination•Increaseinprostatecancerdetection•Occasionaltemporarystoppingofbreathingduringsleep,called

sleep apnea(rarely)•Fluidbuild-upinankles,feetandlegs,callededema(rarely)

What should you do with this information?

•Discussanysymptomsoflowtestosteronewithyourdoctor

•Yourdoctormayreferyoutoanendocrinologist,adoctorthatspecializesinhormonedisorders

•Beopenwithyourdoctoraboutyourmedicalhistory,sexualproblems,andanymajorchangesinyourlife

•Bringallprescriptionandnonprescriptiondrugsyouarenowtakingtoeachdoctorvisit

•Youshouldtellyourdoctorhowwelltreatmentishelpingyoursymptomsandanysideeffectsyouarehaving

GnRH,gonadotropin-releasinghormone;LH,luteinizinghormone;FSH,follicle-stimulatinghormone

ALSO AVAILABLE

TheinteractiveiPhoneappcomponentoftheclinicianeducatorDiagnosis and Treatment of Male Hypogonadismisnowavailable.Thisappincludesthefollowingfeatures:

•Contentpresentedinaneasilynavigableformat

•Convenientdesignforuseduringtime-constrainedofficevisits

•Linkstorelevantriskcalculators

•LinktoposttestforCMEcredit

ObtainthisfreeiPhoneappinanyofthefollowingways:

•Downloadtheappathttp://www.curatiocme.com/hypogonadism/iPhone

•ScantheQRcodebelow

Page 6: CLINICIAN EDUCATOR - MhChem · – Patches – Gels – Tablets (stick to the gums) – Pellets – Pills (in some countries outside the United States) • The best method depends

CLINICIAN EDUCATORDiagnosis and Treatment of Male Hypogonadism

Patient 2B Patient 3B Patient 4B Patient 5B Patient 6B Patient 7B

PATIENT GUIDEDiagnosis and Treatment of Male Hypogonadism

Sponsored by and developed by in collaboration with

Support for this activity has been provided through an educational grant from

What is the role of testosterone in men’s health?•Testosteroneisthemostimportantsexhormoneinmen•Itisresponsiblefortypicalmalecharacteristicsandhelps

maintainsexdrive,spermproduction,muscle,bone,andpubicandbodyhair

•Testosteroneisproducedbythetesticlesunderthecontrolofhormonesproducedbythehypothalamus(inthebrain)andthepituitarygland(asmallglandatthebottomofthebrain)

•Lowtestosteronelevels(alsocalledhypogonadism)cancause: –Adropinsexdrive –Poorerections(erectiledysfunction[ED]) –Lowspermcount –Enlargedbreastsand/orbreasttenderness•Overtime,lowtestosteronemaycauseamantolosemuscle

bulk,strength,andbodyhair;accumulatebodyfat;andhaveweakerbones(osteoporosis),moodchanges,lessenergy,andsmallertesticles

•Symptomsvaryfrompersontopersonandaccordingtolengthandseverityofhypogonadism

What causes low testosterone?

•Lowtestosteronecanbecausedbytesticularinjury(trauma,castration,radiation,orchemotherapy)orinfection,pituitarydisorders(pituitarytumorsordiseases),orotherdiseasesthataffectthewholebody(HIV/AIDS,chronicliverandkidneydisease,obesity,andtype2diabetes)

•Somemedications(includingstrongpainkillerssuchasmethadoneormorphineandanti-inflammatorydrugssuchasprednisone)andgeneticconditions(forexample,Klinefeltersyndrome,hemochromatosis)alsocancauselowtestosterone

•Manyoldermenhavelowtestosteronelevels

Hypothalamic-Pituitary-Testicular Axis Effects of Low Testosterone How is low testosterone diagnosed?• Adiagnosisshouldbemadeonlywhenthere

are(a)symptomsandsignsthatcouldbecausedbylowtestosteroneand(b)consistentlylowbloodlevelsoftestosterone(measuredontwoormoreoccasionsbetween7:00and10:00am, whenlevelsarehighest)

• Diagnosisinvolvesamedicalhistory,inwhichyourdoctormayaskabout:

–Puberty(sexualdevelopment) –Pastorpresentmajorillnessesandnutritionaldeficiency –Allprescriptionandnonprescriptiondrugscurrentlybeingtaken –Relationshipproblems,suchassexualproblems –Recentmajorillnessesanddepression –Familyhistoryoflowtestosterone –Recentchangesinbodycharacteristics(forexample,breastenlargement) –Problemswithyourtesticles• Diagnosisinvolvesaphysicalexamination,inwhichyourdoctormay

assess: –Amountofbodyhair –Presenceofbreastenlargement/tenderness –Sizeandconsistencyofthetesticles;sizeofthepenis –Changesinperipheralvisionandvisualacuity(whichcouldindicatea

pituitarytumor,ararecauseoflowtestosterone)• Diagnosisinvolvesmeasurementoftestosterone –Normalrangeofbloodtotaltestosteroneisgenerally300to

1,000ng/dL(dependingonthelaboratorythatconductsthetest) –Illness,malnutrition,andcertainmedications(asnotedpreviously)

canreducetestosteronetemporarily,soyourdoctormayneedtowaituntilafteryourecoverorstoptakingsuchamedicationbeforeheorshecantakethemeasurement

–Yourdoctormayorderatesttomeasure“free”testosterone,atestthatmanyexpertsthinkisbetterthantotaltestosteroneincertaininstances

–Measurementoftestosteroneisrecommendedinthemorning;morethanonebloodtestandpossiblyothertestsofpituitaryglandhormonesmaybeneeded

How is low testosterone treated?

•Testosteronereplacementtherapycanimprovesexualinterest,erectilefunction,moodandenergy,bodyhairgrowth,bonedensity,andmusclemass

•Thereareseveralwaystoreplacetestosterone: –Injections –Patches –Gels –Tablets(sticktothegums) –Pellets –Pills(insomecountriesoutsidetheUnitedStates)

•Thebestmethoddependsonyourpreferenceandtolerance,aswellascost

•Theoverallgoaloftestosteronetherapyistoincreasetestosteronelevelsuptothemiddleofthenormalrange

•Toachieveyourtreatmentgoals,takeyourrecommendedmedicationasprescribed,keepregularappointmentswithyourdoctor,andadoptahealthylifestylethatincludesregularexerciseandgoodnutrition

Therapeutic Goals of Testosterone Therapy

•Improveandmaintainmasculinecharacteristics

•Improvesexdrive(libido)anderections

•Increaseenergyandwell-being

•Improvemusclemassandstrength

•Improvebonemineraldensity

BhasinS,MatsumotoAM,eds.The Hormone Foundation’s Patient Guide to Androgen Deficiency Syndromes in Adult Men.2nded.ChevyChase,MD:TheHormoneFoundation;2010.Reproducedwithpermission.

CunninghamGR,MatsumotoAM,SwedloffR,eds.Low Testosterone and Men’s Health.4thed.ChevyChase,MD:TheHormoneFoundation;March2010.

Are there any risks associated with testosterone treatment?• Groupsathigherriskofprostatecancer(includingAfricanAmerican

men,menover40whohavecloserelativeswithprostatecancer,andallmenover50)shouldbeofferedtestingforprostatecancerduringtestosteronetreatment

• Menwithbreastcancerorknownorsuspectedprostatecancershouldnotreceivetestosteronetherapy

• Testsyourdoctorwillperformbeforeandduringtestosteronetherapyinclude:

– Bloodteststodetermineyourhematocrit(thepercentageofredbloodcellsinyourblood)andyourtestosteronelevels

– Mostdoctorswillalsorecommendteststocheckforprostatecancer,including:

• Digitalrectalexam(DRE),inwhichthedoctorinsertsafingerintotherectumtofeelforabnormalitiesoftheprostateglandthatmightindicatecancer

• Bloodprostate-specificantigen(PSA)test,whichmightindicateanabnormalityoftheprostate

• Youshouldseeyourdoctor3to6monthsafteryoustarttreatmenttoevaluatewhetheryouareimprovingandifyouarehavinganyproblemsorsideeffects;aDRE,PSAtest,andbloodcountshouldbedoneatthattime;afterthisappointment,similarannualcheck-upsarerecommended

• Menwithosteoporosisorpastbonefracturewithlittletraumashouldreceiveabonemineraldensitytestofthespineandhipareabeforestartingtestosteronetreatmentandthen1or2yearsafterward

Cunningham GR, Matsumoto AM, Swedloff R, eds. Low Testosterone and Men’s Health.Low Testosterone and Men’s Health.

Possible Risks of Testosterone Treatment

•Highredbloodcellcount•Acne•Breastenlargement•Increaseinprostateenlargementordifficultywithurination•Increaseinprostatecancerdetection•Occasionaltemporarystoppingofbreathingduringsleep,called

sleep apnea(rarely)•Fluidbuild-upinankles,feetandlegs,callededema(rarely)

What should you do with this information?

•Discussanysymptomsoflowtestosteronewithyourdoctor

•Yourdoctormayreferyoutoanendocrinologist,adoctorthatspecializesinhormonedisorders

•Beopenwithyourdoctoraboutyourmedicalhistory,sexualproblems,andanymajorchangesinyourlife

•Bringallprescriptionandnonprescriptiondrugsyouarenowtakingtoeachdoctorvisit

•Youshouldtellyourdoctorhowwelltreatmentishelpingyoursymptomsandanysideeffectsyouarehaving

GnRH,gonadotropin-releasinghormone;LH,luteinizinghormone;FSH,follicle-stimulatinghormone

ALSO AVAILABLE

TheinteractiveiPhoneappcomponentoftheclinicianeducatorDiagnosis and Treatment of Male Hypogonadismisnowavailable.Thisappincludesthefollowingfeatures:

•Contentpresentedinaneasilynavigableformat

•Convenientdesignforuseduringtime-constrainedofficevisits

•Linkstorelevantriskcalculators

•LinktoposttestforCMEcredit

ObtainthisfreeiPhoneappinanyofthefollowingways:

•Downloadtheappathttp://www.curatiocme.com/hypogonadism/iPhone

•ScantheQRcodebelow

Page 7: CLINICIAN EDUCATOR - MhChem · – Patches – Gels – Tablets (stick to the gums) – Pellets – Pills (in some countries outside the United States) • The best method depends

CLINICIAN EDUCATORDiagnosis and Treatment of Male Hypogonadism

Patient 2B Patient 3B Patient 4B Patient 5B Patient 6B Patient 7B

PATIENT GUIDEDiagnosis and Treatment of Male Hypogonadism

Sponsored by and developed by in collaboration with

Support for this activity has been provided through an educational grant from

What is the role of testosterone in men’s health?•Testosteroneisthemostimportantsexhormoneinmen•Itisresponsiblefortypicalmalecharacteristicsandhelps

maintainsexdrive,spermproduction,muscle,bone,andpubicandbodyhair

•Testosteroneisproducedbythetesticlesunderthecontrolofhormonesproducedbythehypothalamus(inthebrain)andthepituitarygland(asmallglandatthebottomofthebrain)

•Lowtestosteronelevels(alsocalledhypogonadism)cancause: –Adropinsexdrive –Poorerections(erectiledysfunction[ED]) –Lowspermcount –Enlargedbreastsand/orbreasttenderness•Overtime,lowtestosteronemaycauseamantolosemuscle

bulk,strength,andbodyhair;accumulatebodyfat;andhaveweakerbones(osteoporosis),moodchanges,lessenergy,andsmallertesticles

•Symptomsvaryfrompersontopersonandaccordingtolengthandseverityofhypogonadism

What causes low testosterone?

•Lowtestosteronecanbecausedbytesticularinjury(trauma,castration,radiation,orchemotherapy)orinfection,pituitarydisorders(pituitarytumorsordiseases),orotherdiseasesthataffectthewholebody(HIV/AIDS,chronicliverandkidneydisease,obesity,andtype2diabetes)

•Somemedications(includingstrongpainkillerssuchasmethadoneormorphineandanti-inflammatorydrugssuchasprednisone)andgeneticconditions(forexample,Klinefeltersyndrome,hemochromatosis)alsocancauselowtestosterone

•Manyoldermenhavelowtestosteronelevels

Hypothalamic-Pituitary-Testicular Axis Effects of Low Testosterone How is low testosterone diagnosed?• Adiagnosisshouldbemadeonlywhenthere

are(a)symptomsandsignsthatcouldbecausedbylowtestosteroneand(b)consistentlylowbloodlevelsoftestosterone(measuredontwoormoreoccasionsbetween7:00and10:00am, whenlevelsarehighest)

• Diagnosisinvolvesamedicalhistory,inwhichyourdoctormayaskabout:

–Puberty(sexualdevelopment) –Pastorpresentmajorillnessesandnutritionaldeficiency –Allprescriptionandnonprescriptiondrugscurrentlybeingtaken –Relationshipproblems,suchassexualproblems –Recentmajorillnessesanddepression –Familyhistoryoflowtestosterone –Recentchangesinbodycharacteristics(forexample,breastenlargement) –Problemswithyourtesticles• Diagnosisinvolvesaphysicalexamination,inwhichyourdoctormay

assess: –Amountofbodyhair –Presenceofbreastenlargement/tenderness –Sizeandconsistencyofthetesticles;sizeofthepenis –Changesinperipheralvisionandvisualacuity(whichcouldindicatea

pituitarytumor,ararecauseoflowtestosterone)• Diagnosisinvolvesmeasurementoftestosterone –Normalrangeofbloodtotaltestosteroneisgenerally300to

1,000ng/dL(dependingonthelaboratorythatconductsthetest) –Illness,malnutrition,andcertainmedications(asnotedpreviously)

canreducetestosteronetemporarily,soyourdoctormayneedtowaituntilafteryourecoverorstoptakingsuchamedicationbeforeheorshecantakethemeasurement

–Yourdoctormayorderatesttomeasure“free”testosterone,atestthatmanyexpertsthinkisbetterthantotaltestosteroneincertaininstances

–Measurementoftestosteroneisrecommendedinthemorning;morethanonebloodtestandpossiblyothertestsofpituitaryglandhormonesmaybeneeded

How is low testosterone treated?

•Testosteronereplacementtherapycanimprovesexualinterest,erectilefunction,moodandenergy,bodyhairgrowth,bonedensity,andmusclemass

•Thereareseveralwaystoreplacetestosterone: –Injections –Patches –Gels –Tablets(sticktothegums) –Pellets –Pills(insomecountriesoutsidetheUnitedStates)

•Thebestmethoddependsonyourpreferenceandtolerance,aswellascost

•Theoverallgoaloftestosteronetherapyistoincreasetestosteronelevelsuptothemiddleofthenormalrange

•Toachieveyourtreatmentgoals,takeyourrecommendedmedicationasprescribed,keepregularappointmentswithyourdoctor,andadoptahealthylifestylethatincludesregularexerciseandgoodnutrition

Therapeutic Goals of Testosterone Therapy

•Improveandmaintainmasculinecharacteristics

•Improvesexdrive(libido)anderections

•Increaseenergyandwell-being

•Improvemusclemassandstrength

•Improvebonemineraldensity

BhasinS,MatsumotoAM,eds.The Hormone Foundation’s Patient Guide to Androgen Deficiency Syndromes in Adult Men.2nded.ChevyChase,MD:TheHormoneFoundation;2010.Reproducedwithpermission.

CunninghamGR,MatsumotoAM,SwedloffR,eds.Low Testosterone and Men’s Health.4thed.ChevyChase,MD:TheHormoneFoundation;March2010.

Are there any risks associated with testosterone treatment?• Groupsathigherriskofprostatecancer(includingAfricanAmerican

men,menover40whohavecloserelativeswithprostatecancer,andallmenover50)shouldbeofferedtestingforprostatecancerduringtestosteronetreatment

• Menwithbreastcancerorknownorsuspectedprostatecancershouldnotreceivetestosteronetherapy

• Testsyourdoctorwillperformbeforeandduringtestosteronetherapyinclude:

– Bloodteststodetermineyourhematocrit(thepercentageofredbloodcellsinyourblood)andyourtestosteronelevels

– Mostdoctorswillalsorecommendteststocheckforprostatecancer,including:

• Digitalrectalexam(DRE),inwhichthedoctorinsertsafingerintotherectumtofeelforabnormalitiesoftheprostateglandthatmightindicatecancer

• Bloodprostate-specificantigen(PSA)test,whichmightindicateanabnormalityoftheprostate

• Youshouldseeyourdoctor3to6monthsafteryoustarttreatmenttoevaluatewhetheryouareimprovingandifyouarehavinganyproblemsorsideeffects;aDRE,PSAtest,andbloodcountshouldbedoneatthattime;afterthisappointment,similarannualcheck-upsarerecommended

• Menwithosteoporosisorpastbonefracturewithlittletraumashouldreceiveabonemineraldensitytestofthespineandhipareabeforestartingtestosteronetreatmentandthen1or2yearsafterward

Possible Risks of Testosterone Treatment

•Highredbloodcellcount•Acne•Breastenlargement•Increaseinprostateenlargementordifficultywithurination•Increaseinprostatecancerdetection•Occasionaltemporarystoppingofbreathingduringsleep,called

sleep apnea(rarely)•Fluidbuild-upinankles,feetandlegs,callededema(rarely)

What should you do with this information?

•Discussanysymptomsoflowtestosteronewithyourdoctor

•Yourdoctormayreferyoutoanendocrinologist,adoctorthatspecializesinhormonedisorders

•Beopenwithyourdoctoraboutyourmedicalhistory,sexualproblems,andanymajorchangesinyourlife

•Bringallprescriptionandnonprescriptiondrugsyouarenowtakingtoeachdoctorvisit

•Youshouldtellyourdoctorhowwelltreatmentishelpingyoursymptomsandanysideeffectsyouarehaving

GnRH,gonadotropin-releasinghormone;LH,luteinizinghormone;FSH,follicle-stimulatinghormone

ALSO AVAILABLE

TheinteractiveiPhoneappcomponentoftheclinicianeducatorDiagnosis and Treatment of Male Hypogonadismisnowavailable.Thisappincludesthefollowingfeatures:

•Contentpresentedinaneasilynavigableformat

•Convenientdesignforuseduringtime-constrainedofficevisits

•Linkstorelevantriskcalculators

•LinktoposttestforCMEcredit

ObtainthisfreeiPhoneappinanyofthefollowingways:

•Downloadtheappathttp://www.curatiocme.com/hypogonadism/iPhone

•ScantheQRcodebelow


The mhchem Bundle - University of Texas at Austinmirror.utexas.edu/ctan/macros/latex/contrib/mhchem/mhchem.pdfThe mhchem Bundle Documentation for the LATEX Packages mhchem v4.08, hpstatement

The mhchem Bundle - University of Texas at Austinmirror.utexas.edu/ctan/macros/latex/contrib/mhchem/mhchem.pdfThe mhchem Bundle Documentation for the LATEX Packages mhchem v4.08, hpstatement

IFT 2017 - TIC Gums

IFT 2017 - TIC Gums

DIET PILLS Jennifer Qing. What are diet pills? Pills that claim to make you lose weight.

DIET PILLS Jennifer Qing. What are diet pills? Pills that claim to make you lose weight.

The mhchem Bundle - TeXdoctexdoc.net/texmf-dist/doc/latex/mhchem/mhchem.pdf · The mhchem Bundle Documentation for the LATEX Packages mhchem v4.08, hpstatement v1.02 and rsphrase

The mhchem Bundle - TeXdoctexdoc.net/texmf-dist/doc/latex/mhchem/mhchem.pdf · The mhchem Bundle Documentation for the LATEX Packages mhchem v4.08, hpstatement v1.02 and rsphrase

Fenugreek Seed Gums

Fenugreek Seed Gums

Confrontation Pills

Confrontation Pills

Looking after my Teeth and Gums - Surrey Health Action after my teeth and gums... · keep your teeth and gums healthy. Even if you have no teeth it is important to brush your gums.

Looking after my Teeth and Gums - Surrey Health Action after my teeth and gums... · keep your teeth and gums healthy. Even if you have no teeth it is important to brush your gums.

Happy Pills

Happy Pills

Hydrocolloids and gums

Hydrocolloids and gums

Gums for singles

Gums for singles

Worst Pills, Best Pills News Now Available Online!

Worst Pills, Best Pills News Now Available Online!

Gums Disease

Gums Disease

The mhchem Bundle - mirrors.sorengard.commirrors.sorengard.com/ctan/macros/latex/contrib/mhchem/mhchem.pdf · The mhchem package provides commands for typesetting chemical mo-lecular

The mhchem Bundle - mirrors.sorengard.commirrors.sorengard.com/ctan/macros/latex/contrib/mhchem/mhchem.pdf · The mhchem package provides commands for typesetting chemical mo-lecular

HEALTHY TEETH · 2010. 11. 17. · Gums may bleed and feel tender. Cleaning your teeth and massaging your gums will help keep your gums healthy. Some illnesses can cause gums problems.

HEALTHY TEETH · 2010. 11. 17. · Gums may bleed and feel tender. Cleaning your teeth and massaging your gums will help keep your gums healthy. Some illnesses can cause gums problems.

GUMS - Murmur 3 (2014)

GUMS - Murmur 3 (2014)

Top 20 Gums

Top 20 Gums

No more bleeding gums

No more bleeding gums

Problem Set #6 - MhChem

Problem Set #6 - MhChem

Visualizing Concepts - MhChem

Visualizing Concepts - MhChem

What Causes Receding Gums?

What Causes Receding Gums?