Male Testosterone Therapy Consent

Purpose of Treatment

Testosterone therapy is prescribed to help improve symptoms of low testosterone or andropause, including fatigue, decreased muscle mass, reduced libido, poor concentration, depressed mood, weight gain, or reduced physical performance. 

 

Expected Benefits:

Testosterone therapy may provide improved energy, mood, and motivation, enhanced libido and sexual function, increased muscle mass and strength, improved cognition and memory, and support for metabolic health and fat loss.

Testosterone may be prescribed in various forms, including injections, transdermal creams, pellets, or compounded lozenges.

 

Risks and Side Effects:

As with any hormone therapy, testosterone therapy carries potential risks and side effects, which may include: acne or oily skin, mood swings or aggression, fluid retention or edema, elevated red blood cells (erythrocytosis), breast tenderness or enlargement (gynecomastia), worsening of sleep apnea, prostate enlargement, or theoretical increase in prostate cancer risk, and cardiovascular risks (heart attack, stroke, blood clots).

 

Alternatives to Testosterone Therapy:

You may choose not to undergo testosterone therapy.

No Treatment: Choosing not to treat hormone deficiency may result in continued or worsening symptoms and increased risk for conditions associated with testosterone loss.

Lifestyle Modifications: Incorporating diet, weight management, exercise, or sleep aids to alleviate symptoms.

Other Hormonal Options: Use of DHEA or other supplements.

 

Off-Label Use and Informed Consent:

Some testosterone therapies or dosing approaches may be considered off-label by the FDA. This means they are legally prescribed but not FDA-approved for certain specific uses or formulations. This treatment is based on clinical judgment, current literature, and a functional medicine approach.

 

Treatment and Monitoring:

Treatment is customized and dosing may change depending on symptoms and labs. Goal serum free testosterone level is between 30–40 ng/dL. Labs will be monitored regularly, including CBC, CMP, SHBG, testosterone, and estradiol. Dose adjustments are based on symptom improvement or occurrence of side effects.

 

Infertility and Fertility Considerations:

Testosterone therapy can suppress natural sperm production, leading to temporary or permanent infertility. This treatment is not appropriate for men actively trying to conceive unless fertility preservation measures (e.g., HCG, Clomid) are initiated.

 

Topical Testosterone (Cream) and Transference Risk:

If using topical testosterone cream, there is a risk of transference to others (women, children, pets) through skin contact.

Patients are instructed to:

• Wash hands thoroughly after application
• Cover the application area with clothing
• Avoid skin-to-skin contact with others for at least 4 hours
• Wash any contaminated clothing or bedding separately

Please initial below to acknowledge the following:

I confirm that I have reviewed and understand the potential risks, benefits, alternatives, and the off-label nature of testosterone therapy.

AUTHORIZATION

I voluntarily request and give my informed consent for Alexander Medical, LLC and its healthcare providers to initiate progesterone hormone therapy as recommended.

I authorize the providers to perform any additional tests, evaluations, or procedures reasonably necessary to support my care. I understand that this treatment is elective and that I may stop at any time by informing my provider.

 

ACKNOWLEDGMENT

I have read (or had read to me) this entire consent form. I have had the opportunity to ask questions and all questions have been answered to my satisfaction. I understand the risks, benefits, and alternatives, and I consent to the use of progesterone hormone therapy.