VS: BP 148/90 mm Hg, p 85 bpm, RR 18/min, T 37°C (98.6°F)

CV: Normal exam

Genital/Rectal: Normal scrotum and testicles w/o masses; penis without discharge or curvature

Labs: Complete metabolic panel, CBC, and thyroid panel within normal limits; lipid panel: total cholesterol, LDL, HDL, triglycerides within normal limits; hemoglobin A1c 8% (0.08), testosterone 700 ng/dL (24 nmol/L)

Given this additional information, what are his risk factors for ED?

Identify treatment goals for this patient.

What pharmacologic and nonpharmacologic alternatives are available for this patient?

An alternative to the oral route is the buccal mucoadhesive system. The Striantbuc-cal system adheres to the inside of the mouth and the testosterone is absorbed through the oral mucosa and delivered to the systemic circulation. There is no first-pass effect, as the liver is bypassed by this route of administration. Patients apply a 30-mg tablet to the upper gum twice daily. The cost is similar to that of the patch or gel. Side effects unique to this dosage form include oral irritation, bitter taste, and gum edema.

General side effects of testosterone include gynecomastia, dyslipidemia, polycythemia, and acne. Weight gain, hypertension, edema, and exacerbations of congestive heart failure also occur due to sodium retention. Before initiating testosterone, the patient should undergo evaluation for benign prostatic hypertrophy and prostate cancer. Routine follow-up includes yearly prostate-specific antigen, digital rectal exam, hemoglobin and liver function, in addition to assessment of response.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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