A 70-Year-Old Man Seeks Advice Regarding Testosterone Replacement Therapy

question 259

Multiple Choice

A 70-year-old man seeks advice regarding testosterone replacement therapy.  The patient recently married a younger woman and has been reading reports in the news media regarding the therapy's potential benefits.  He has diminished sexual desire and moderate erectile dysfunction that responds to sildenafil.  The patient rarely has a morning erection.  His ability to perform endurance exercise at a high level is significantly lower than it was 10 years ago.  Other medical problems include hypertension, type 2 diabetes mellitus, benign prostatic hyperplasia (American Urological Association score of 10) , and hyperlipidemia.  There is no family history of prostate cancer.
Blood pressure is 134/88 mm Hg and pulse is 84/min.  BMI is 30 kg/m².  Neck circumference is 20 in (51 cm) .  Cardiovascular, pulmonary, abdominal, and extremity examinations are normal.  The testes appear normal for age.  Digital rectal examination shows a symmetrical prostate that is mildly enlarged.
Laboratory results are as follows:
Which of the following is the best advice regarding testosterone replacement for this patient?

• A)FSH and LH levels should be obtained
• B)Further evaluation for prostate cancer is necessary before initiating testosterone therapy
• C)Testosterone replacement therapy is appropriate with a slow dose up-titration
• D)Testosterone replacement therapy would likely improve his erectile dysfunction
• E)The potential risks of testosterone replacement likely outweigh the benefits