Question

Work-up required before starting androgen therapy.

Hint:

Ensure that there are no contraindications or elevated risks before initiating testosterone therapy.

Answer 1

Before starting androgen therapy, several tests and evaluations are necessary to ensure that the treatment is safe and appropriate.
Step 1: Exclude Contraindications:
- Perform a digital rectal exam (DRE) and serum prostate-specific antigen (PS testing to rule out prostate cancer.
- Testosterone therapy is contraindicated in men with prostate cancer or breast cancer.
Step 2: Cardiovascular Risk Assessment:
- Evaluate cardiovascular health as testosterone therapy may increase the risk of cardiovascular events. This includes measuring cholesterol levels, assessing for hypertension, and evaluating for a history of heart disease.
Step 3: Hematocrit and Hemoglobin Levels:
- Measure hematocrit and hemoglobin to check for polycythemia, which can be induced by testosterone therapy. Elevated hematocrit levels can increase the risk of thromboembolic events.
Step 4: Liver Function Tests:
- Liver function tests should be performed as testosterone therapy can cause hepatic toxicity in rare cases, particularly with oral forms.