Bhasin S, Cunningham GR, Hayes FJ, et al; Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95:2536-2559. Abstract
Dandona P, Rosenberg MT. A practical guide to male hypogonadism in the primary care setting. Int J Clin Pract. 2010;64:682-696. Abstract
Rosenberg MT, Staskin DR, Kaplan SA, MacDiarmid SA, Newman DK, Ohl DA. A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care setting. Int J Clin Pract. 2007;61:1535-1546. Abstract
Roehrborn CG, Boyle P, Gould AL, Waldstreicher J. Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology. 1999;53:581-589. Abstract
Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60:762-769. Abstract
Khaw KT, Dowsett M, Folkerd E, et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation. 2007;116:2694-2701. Abstract
Jones ME, Boon WC, McInnes K, Maffei L, Carani C, Simpson ER. Recognizing rare disorders: aromatase deficiency. Nat Clin Pract Endocrinol Metab. 2007;3:414-421. Abstract
Haddad RM, Kennedy CC, Caples SM, et al. Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007;82:29-39. Abstract
Basaria S, Coviello AD, Travison TG, et al. Adverse events associated with testosterone administration. N Engl J Med. 2010;363:109-122. Abstract
Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004;350:482-492. Abstract
Wang C, Nieschlag E, Swerdloff R, et al; International Society of Andrology (ISA); International Society for the Study of Aging Male (ISSAM); European Association of Urology (EAU); European Academy of Andrology (EAA); American Society of Andrology (ASA). Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. J Androl. 2009;30:1-9. Abstract
Miner MM, Sadovsky R. Evolving issues in male hypogonadism: evaluation, management, and related comorbidities. Cleve Clin J Med. 2007;74:S38-S46.
Rosenberg MT, Froehner M, Albala D, Miner MM. Biology and natural history of prostate cancer and the role of chemoprevention. Int J Clin Pract. 2010;64:1746-1753. Abstract
McGill JJ, Shoskes DA, Sabanegh ES. Androgen deficiency in older men: indications, advantages, and pitfalls of testosterone replacement therapy. Cleve Clin J Med. 2012;79:797-806. Abstract

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

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.

Author(s)

Matt T. Rosenberg, MD

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

Disclosures

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.

Editor(s)

Emilie McCardell

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Emilie McCardell has disclosed no relevant financial relationships.

Devon Schuyler

Clinical Editor, Medscape, LLC

Disclosures

Disclosure: Devon Schuyler has disclosed no relevant financial relationships.

Writer(s)

Ian List

Freelance writer, Cambridge, Massachusetts

Disclosures

Disclosure: Ian List has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

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.

CME

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

Authors: Matt T. Rosenberg, MD
CME Released: 1/29/2013
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 1/29/2014, 11:59 PM EST

Start Activity

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:

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

Disclosures

Author(s)

Matt T. Rosenberg, MD

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

Disclosures

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.

Editor(s)

Emilie McCardell

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Emilie McCardell has disclosed no relevant financial relationships.

Devon Schuyler

Clinical Editor, Medscape, LLC

Disclosures

Disclosure: Devon Schuyler has disclosed no relevant financial relationships.

Writer(s)

Ian List

Freelance writer, Cambridge, Massachusetts

Disclosures

Disclosure: Ian List has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

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.

Accreditation Statements

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.

Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

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.

Follow these steps to earn CME/CE credit*:

Read the target audience, learning objectives, and author disclosures.
Study the educational content online or printed out.
Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

From Medscape Education Family Medicine

CME

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

Authors: Matt T. Rosenberg, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 1/29/2013

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

processing....

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.

Page 1 of 6

CME Information Download Slides

Print
Like Tweet

Disclaimer

The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Author(s)

Matt T. Rosenberg, MD

Editor(s)

Emilie McCardell

Devon Schuyler

Writer(s)

Ian List

CME Reviewer(s)

Nafeez Zawahir, MD

Peer Reviewer

CME

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

Target Audience and Goal Statement

Disclosures

Author(s)

Matt T. Rosenberg, MD

Editor(s)

Emilie McCardell

Devon Schuyler

Writer(s)

Ian List

CME Reviewer(s)

Nafeez Zawahir, MD

Peer Reviewer

Accreditation Statements

For Physicians

Instructions for Participation and Credit

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

Case Study, Part 1