TESTOSTERONE REPLACEMENT THERAPY FOR THE AGING MALE: COUNSELING INSIGHTS FOR THE PHARMACIST TIM DRAKE, PHARM.D.

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1 TESTOSTERONE REPLACEMENT THERAPY FOR THE AGING MALE: COUNSELING INSIGHTS FOR THE PHARMACIST TIM DRAKE, PHARM.D.

2 TESTOSTERONE REPLACEMENT THERAPY FOR THE AGING MALE: COUNSELING INSIGHTS FOR THE PHARMACIST ACTIVITY DESCRIPTION Testosterone deficiency afflicts approximately 30% of men aged years, with an increase in prevalence strongly associated with aging and common medical conditions including obesity, diabetes, and hypertension. Recent estimates show that approximately 13 million men in the United States experience testosterone deficiency and less than 10 percent receive treatment for the condition. Restoring testosterone levels to within the normal range by using testosterone replacement therapy (TRT) can greatly improve quality of life. However, potential risks for TRT exist. Pharmacists should play a proactive role in identifying, treating, educating and monitoring patients with low testosterone levels. Pharmacists are in a unique and influential position to help recognize low testosterone patients and initiate patient and health care provider treatment and education. With increasing focus on quality of life and increasing prevalence of age-related conditions, pharmacists will find themselves dispensing more hormone replacement products, in addition to information about the actual condition and the expected effects of treatment. TARGET AUDIENCE The target audience for this activity is pharmacists in hospital, community, and retail pharmacy settings. LEARNING OBJECTIVES After completing this activity, the pharmacist will be able to: Review the prevalence, epidemiology and pathophysiology of testosterone deficiency Outline the risks, benefits, efficacy, and routes of administration for available testosterone replacement therapy (TRT) Identify emerging TRT, including their potential risks and benefits Counsel patients on the proper administration/application of TRT ACCREDITATION PHARMACY PharmCon, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. NURSING PharmCon, Inc. is approved by the California Board of Registered Nursing (Provider Number CEP 13649) and the Florida Board of Nursing (Provider Number ). Activities approved by the CA BRN and the FL BN are accepted by most State Boards of Nursing. CE hours provided by PharmCon, Inc. meet the ANCC criteria for formally approved continuing education hours. The ACPE is listed by the AANP as an acceptable, accredited continuing education organization for applicants seeking renewal through continuing education credit. For additional information, please visit Universal Activity No.: H01-P Credits: 1 contact hour (0.1 CEU) Release Date: September 30, 2013 Expiration Date: September 30, 2014 ACTIVITY TYPE Knowledge-Based Home Study Webcast FINANCIAL SUPPORT BY AbbVie 1

3 ABOUT THE AUTHOR Dr. Drake is a graduate from the University of Utah and is currently a clinical pharmacist/manager at McKay- Dee Hospital in Ogden, Utah. He also is an associate professor of Pharmacy Practice with the Roseman University of Health Sciences College of Pharmacy. He currently serves as preceptor for students and residents in an ambulatory care practice at a family medicine clinic. His interests include cardiology, endocrinology, pharmacy practice and management. Outside of work, he enjoys spending time with his family, boating, golfing, cooking and watching college football. Tim Drake, Pharm.D. Clinical Pharmacist/Manager McKay-Dee Hospital FACULTY DISCLOSURE It is the policy of PharmCon, Inc. to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer of any commercial product(s) and/or service(s) discussed in an educational activity. Tim Drake reports no actual or potential conflict of interest in relation to this activity. Peer review of the material in this CE activity was conducted to assess and resolve potential conflict of interest. Reviewers unanimously found that the activity is fair balanced and lacks commercial bias. Please Note: PharmCon, Inc. does not view the existence of relationships as an implication of bias or that the value of the material is decreased. The content of the activity was planned to be balanced and objective. Occasionally, authors may express opinions that represent their own viewpoint. Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient or pharmacy management. Conclusions drawn by participants should be derived from objective analysis of scientific data presented from this monograph and other unrelated sources. 2

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13 ACTIVITY TEST 1. What is the main cause of the free testosterone decreasing faster than total testosterone in an aging male? A. Age related increase in the sex hormone binding globulin B. Age related decrease in the sex hormone binding globulin. C. Age related decrease in the follicle stimulating hormone D. Age related increase in the follicle stimulating hormone 2. Which symptom below is strongly correlated with low testosterone? A. Depression B. Decreased energy C. Low libido D. Alopecia (balding) 3. Which medication below is no longer recommended due to the side effect of increased liver dysfunction? A. Striant (testosterone buccal tablet) B. Androgel (topical testosterone gel) C. Depo-Testosterone (testosterone Cypionate for injection) D. Android (methyltestosterone capsule) 4. Which medication below does not carry the risk of person to person transfer? A. Testim (topical testosterone gel) B. Androderm (topical testosterone patch) C. Fortesta (topical testosterone gel) D. Axiron (topical testosterone solution) 5. Which of the following areas is not an appropriate application site for the testosterone patches? A. Chest B. Thigh C. Ventrogluteal D. Upper arm 12

14 6. Which of the following formulations is associated with the most variability in daily testosterone levels? A. Topical testosterone gel B. Testosterone cypionate for injection C. Topical testosterone solution D. Testosterone buccal tablet 7. Where should the testosterone cypionate or the testosterone enanthate be injected? A. Deltoid B. Thigh C. Ventrogluteal D. Upper arm 8. Which of the following is an appropriate laboratory monitoring parameter to monitor for side effects of testosterone therapy? A. Electrolytes B. Complete blood count C. Thyroid stimulating hormone D. Fasting lipid profiled. 9. Which of the following is a correct counseling point to be communicated to the patient when starting a topical testosterone gel? A. Do not swim or bathe for 12 hours after application B. Apply the product anywhere that will be covered by clothing C. Allow the product to dry before covering with clothing D. Do not smoke cigarettes while using the topical products because they are flammable 10. Which of the following is a benefit of testosterone undecanoate compared to testosterone cypionate? A. Decreased volume of the injection B. No cough reported C. Decreased plasma testosterone variability D. Less injection site pain Please submit your final responses on freece.com. Thank you. 13

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