By Dr. A. Carbonell
Testosterone replacement therapy can be initiated or continued from the private sector if you deem appropriate, however the patient will need a “Testosterone Replacement Therapy Note” for ordering. This is how this is done:
1. Go to Notes (bottom tab) => New Note (bottom left side of screen) => Testosterone Replacement Therapy Note
2. One of 3 options will apply:
a. Initial VA Prescription: This will go through a questionnaire of exclusions in which testosterone should NOT be initiated
i. Exclusions include but are not limited to CHF, A1c >9.5, Elevated PSA, h/o Prostate Cancer, CAD
ii. Reasons for TRT: Testosterone level between 150 to 200. The note will say testosterone < 350 with symptoms however if their testosterone level is above 200 it is highly likely that their “symptom” is due to another medical condition and the risk of adverse events from testosterone likely outweigh the risks. Anyone with Testosterone < 150 should be evaluated by urology or endocrinology to evaluate for secondary causes of severe hypogonadism
iii. What needs to be done:
1. PSA every 6 months (baseline before starting)
2. DRE at initiation and at least once per year
3. Serum testosterone levels collected before 10 AM on 2 different occasions to confirm testosterone deficiency
4. LH, FSH and prolactin to r/o secondary causes of hypogonadism and a baseline CBC for hematocrit monitoring
b. Initial VA renewal (to be done 6 months after the Rx was initiated)
i. Repeat Testosterone panel, PSA and CBC 6 months after starting therapy to ensure response and to monitor for prostate cancer
c. Routine Renewal (to be used at the one-year mark and for every Rx thereafter
i. Repeat Testosterone panel, PSA and CBC 6 months after starting therapy to ensure response and to monitor for prostate cancer
1. Hematocrit < 54%
ii. DRE at least once per year, documented
NOTES
-Testosterone is a controlled substance, and therefore a PDMP must be done with every new prescription (can order in 6-month intervals i.e. 90-day supply with 1 renewal or 30-day supply with 5 renewals)
-Face to Face visit must be completed every 6 months