Male Testosterone Hormone Replacement Therapy Consent Form

Testosterone replacement has been used for decades. I realize that some of the reported benefits of testosterone for men include:

a) behavioral changes such decreasing depression, decreasing anxiety and irritability, increasing energy and motivation, stabilizing moods, allowing one to cope better; improving one's self-image and self-worth, and enhancing one's stamina

b) improvement in one's cognitive function so one is no longer operating "in a fog," improving short-term memory and allowing one to stay focused to complete a task

c) physical effects such as decreasing total body fat, increasing lean body mass, increasing muscle mass, and increasing bone

d) sexual benefits such as increasing libido, increasing early morning erections, increasing firmness, and duration of erections.

I realize there are potential concerns with testosterone therapy and they include the possibility of enhancing a current prostate cancer to grow more rapidly. For this reason, a prostate specific antigen blood test will be done before starting testosterone, along with other wellness labs and will be conducted each year thereafter. If there is any question about possible prostate cancer, I consent to I follow-up with an ultrasound of the prostate gland.

The second concern we have with testosterone therapy is that it may occasionally increase one's hemoglobin and hematocrit, or thicken one's blood. This is felt to be a physiologic (normal) response to testosterone and is not of any medical consequence. This problem can be diagnosed with a blood test. Thus, a complete blood count should be done least every six months.

The final concern we would have, especially in younger men, is the testosterone administration can suppress the development of sperm and therefore lower the sperm count. However this is rare and appears to be a reversible process. Once the testosterone is discontinued the sperm count is restored. We have encouraged any men who are concerned about their fertility in the future to have a semen analysis prior to initiation of testosterone therapy.

I realize that male athletes have abused testosterone. They took huge quantities of oral synthetic testosterone, they may have incurred heart and liver problems and elevated cholesterol. However, low-dose, non-oral, natural testosterone injections have NOT been associated with these problems.

My signature certifies I have read the above and I understand the risks, benefits and alternatives (including taking no hormones) and choose to proceed with hormone replacement therapy. I also understand that I can change my mind and do some other method (including no hormones) at a later date. I have had the opportunity to ask questions about this procedure and alternatives including no treatment and my questions have been answered to my satisfaction.