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Assessment and Management of the Patient With Hypogonadism and Mild Enlargement of the Prostate

  • Authors: Matt T. Rosenberg, MD
  • CME Released: 1/29/2013
  • Valid for credit through: 1/29/2014, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for primary care physicians, urologists, and oncologists.

The goal of this activity is to allow clinicians to recognize and treat hypogonadism.

Upon completion of this activity, participants will be able to:

  1. Describe the common comorbid conditions associated with hypogonadism
  2. Cite the signs and symptoms of hypogonadism and the criteria for diagnosis
  3. Assess appropriateness of testosterone therapy and customize therapy given patient preference for drug delivery and dosing


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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Matt T. Rosenberg, MD

    Mid-Michigan Health Centers, Department of Family Practice, Allegiance Health, Jackson, Michigan


    Disclosure: Matt T. Rosenberg, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Astellas Pharma, Inc; Ferring Pharmaceuticals; Horizon Pharma; Lilly USA, LLC; Pfizer Inc
    Served as a speaker or a member of a speakers bureau for: Astellas Pharma, Inc; Forest Laboratories; Horizon Pharma; Ortho-McNeil-Janssen Pharmaceuticals, Inc.; Pfizer Inc

    Dr Rosenberg does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

    Dr Rosenberg does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.


  • Emilie McCardell

    Scientific Director, Medscape, LLC


    Disclosure: Emilie McCardell has disclosed no relevant financial relationships.

  • Devon Schuyler

    Clinical Editor, Medscape, LLC


    Disclosure: Devon Schuyler has disclosed no relevant financial relationships.


  • Ian List

    Freelance writer, Cambridge, Massachusetts


    Disclosure: Ian List has disclosed no relevant financial relationships.

CME Reviewer(s)

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC


    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

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    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

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Assessment and Management of the Patient With Hypogonadism and Mild Enlargement of the Prostate

Authors: Matt T. Rosenberg, MDFaculty and Disclosures

CME Released: 1/29/2013

Valid for credit through: 1/29/2014, 11:59 PM EST


Wayne Strom, aged 54 years, is seeing his primary care physician to get help for feelings of unusually strong fatigue. He fills out the International Prostate Symptom Score form in the waiting room and also reports urinary symptoms, including urgency and nocturia. Mr Strom has also recently gained weight. His family history is positive for prostate cancer.

Case Study, Part 1

Doctor: Good morning, Mr Strom. Nice to see you again.

Mr Strom: Hello, doctor. I know; it's been a while.

Doctor: It's OK; I'm glad you came in. So, I understand you've been feeling fatigued?

Mr Strom: Yeah; it's like I just don't have any energy.

Doctor: When did you first notice this?

Mr Strom: Maybe about 6 months ago or so. It's gotten worse over the past few months.

Doctor: Are you getting enough sleep?

Mr Strom: I think so, but I do seem be nodding off a lot. .

Doctor: Any other symptoms -- headache, dizziness, fever?

Mr Strom: No. It's just that my mind doesn't seem to be as -- I don't know -- sharp as it once was.

Doctor: Are you having difficulty concentrating?

Mr Strom: Yes. It's like I'm in a fog half the time. And I forget things a lot. I'm telling you, this is not like me! I'm usually totally on top of everything.

Doctor: Have you been under any particular stress during this time -- at work or at home?

Mr Strom: Nothing out of the ordinary. I mean, I manage about 30 employees, so there's always some stress. But, I don't know -- the stress used to kind of energize me. Now I've lost my edge, my oomph. It's been really hard.

Doctor: Would you say you've been feeling depressed?

Mr Strom: Well, I'm used to having a lot of energy, always doing things, starting new projects. So, yeah, I've been depressed about it. What do you think is going on?

Doctor: It's hard to say for sure without doing further tests. You have gained a significant amount of weight since your last appointment -- that could be contributing to your fatigue.

Doctor: I also see that you've been experiencing some urinary symptoms -- increased urgency and getting up a lot in the middle of the night.

Mr Strom: Yeah. I notice these things because my father and uncle both had prostate cancer. But I also notice that my stream isn't as -- I don't know -- robust as it used to be.

Doctor: OK, we'll get another PSA reading and I'll do rectal exam today just to check -- it's been a couple of years since your last one.

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