Is this patient a good candidate for testosterone therapy?

A
43-year-old African American male has a history of hypertension,
hypertriglyceridemia, and avitaminosis D. Current medications include ezetimibe
10 mg daily, niacin SR 1,000 mg at bedtime, HCTZ/lisinopril 25/20 mg daily, and
vitamin D3 over the counter 5,000 units twice a day. He had a previous
testosterone level drawn at another facility that he reports as being low. He
endorses a feeling of fogginess, lack of energy, core weight gain, decrease in
erections, and decrease in semen consistency. Labs reveal testosterone 180
ng/dL (193–836 ng/dL), and thyroid-stimulating hormone/thyroxine, vitamin D,
follicle-stimulating hormone/luteinizing hormone, and prostate-specific antigen
within normal levels.

Questions:

1. Is this
patient a good candidate for testosterone therapy? Why or why not?

2. What
are his risk factors for having erectile dysfunction?

3. What if
any of these medications are contributing to his symptoms?

A
29-year-old Caucasian female with significant bipolar disorder is treated with
lamotrigine. She has a history of endometriosis. She presents with a history of
heavy, irregular menses for the past 7 weeks. Patient reports that symptoms
started insidiously 7 weeks ago with excessive clotting/bleeding that would
last for 5 days. The pattern repeats itself every 2 weeks. Previously, she was
on a combined estrogen/progesterone oral contraceptive pill. This was stopped
due to concerns of interaction with lamotrigine. She was started on a
progesterone-only pill. The patient was concerned that she might be pregnant
due to fatigue, nausea, and weight gain. There is no family history of ovarian,
uterine, or breast cancer. Her mother has a history of thyroid cancer and type
2 diabetes mellitus. Her father has a history of hypertension. Her blood pressure
is 118/75 mm Hg and her body mass index is 27.63.

1. What
are the considerations of using contraceptives with individuals on mental
health medication?

2. Are
certain contraceptives better in this population?

3. Are
there fetal implications for her medications?

4. Are the
patient’s symptoms consistent with contraceptives, her endometriosis, and/or
her mental health medications?

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