Replacement Therapy In Hypogonadal

The absolute contraindications to androgen replacement therapy are carcinoma of the prostate and breast. These are androgen-dependent tumors. Another contraindication includes an elevated hematocrit or hemoglobulin level (e.g., hematocrit >53%). Androgen treatment may cause fluid retention and, in unusual circumstances, may precipitate or aggravate heart failure. In older patients with symptoms or signs of moderate or severe of congestive heart failure, androgens should not be used until the heart failure has been treated. Although there is minimal evidence to implicate testosterone in the development or aggravation of benign prostate hyperplasia (BPH), if a patient has lower urinary tract obstructive symptoms of BPH, then the symptoms should be controlled before institution of testosterone replacement. Obese and older subjects who may be at risk of sleep apnea should be carefully questioned about their ventilatory disturbances during sleep. Such symptoms should be appropriately treated before the start of testosterone-replacement therapy.

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