Activity objectives

Learning Objectives

Upon completion of this activity, participants should be able to perform the following. Objectives marked pharmacology map to the 4.75 pharmacology hours of the 6.00 estimated total contact hours.

Course objectives

Pharmacology objectives

Parts

Estimated hours

6.00

Course-level objectives

Differentiate the clinical presentations of testosterone deficiency from the many conditions that mimic it, including obstructive sleep apnea, depression, thyroid disease, anemia, and medication effect.
Apply correct testosterone testing methodology — early-morning fasting sampling, confirmatory repeat testing, and appropriate use of SHBG and calculated free testosterone.
Distinguish primary from secondary hypogonadism using LH and FSH, and determine when prolactin, iron studies, or pituitary imaging are indicated.
Identify and address reversible contributors to low testosterone before initiating therapy, including obesity, opioids, glucocorticoids, and untreated sleep apnea. (pharmacology)
Select an appropriate testosterone formulation and starting dose based on the patient's fertility goals, hematocrit, adherence profile, and preference. (pharmacology)
Construct a guideline-based monitoring plan including testosterone level timing by formulation, hematocrit, PSA, and symptom reassessment. (pharmacology)
Manage erythrocytosis, elevated estradiol, gynecomastia, acne, and other adverse effects of testosterone therapy without reflexively discontinuing treatment. (pharmacology)
Counsel men on the fertility consequences of exogenous testosterone and describe evidence-supported fertility-preserving strategies. (pharmacology)
Interpret the current cardiovascular and prostate safety evidence, including the TRAVERSE trial, and counsel patients accurately about risk. (pharmacology)
Determine when to discontinue therapy, when to refer to urology or endocrinology, and how to document shared decision-making for an off-label or long-term therapy. (pharmacology)

Part-level objectives

Part I45 minutes

The HPG Axis, Androgen Physiology, and What 'Low T' Actually Means

Describe the regulation of testosterone production by the HPG axis, including GnRH pulsatility, LH and FSH signaling, and negative feedback.
Explain why testosterone is measured in the early morning and why a single value is insufficient for diagnosis.
Explain how SHBG and albumin binding determine free and bioavailable testosterone, and identify the conditions that shift SHBG.
Distinguish age-related decline in testosterone from organic hypogonadism requiring treatment.

Part II55 minutes

Symptoms, Differential Diagnosis, and Correct Testing Methodology

Differentiate specific from nonspecific symptoms of testosterone deficiency.
Construct a differential diagnosis for the man presenting with fatigue, low libido, and low mood.
Apply correct preanalytic testing methodology, including timing, fasting state, and confirmatory repeat testing.
Use LH and FSH to classify primary versus secondary hypogonadism and determine when prolactin, ferritin, and pituitary imaging are indicated.

Part III40 minutesPharmacology

Reversible Causes, Contraindications, and the Fertility Branch Point

Identify reversible contributors to low testosterone and describe the expected effect of correcting them.
Apply absolute and relative contraindications to testosterone therapy.
Counsel men of reproductive age on the fertility consequences of exogenous testosterone before initiation.
Document a defensible shared decision-making conversation for initiation of testosterone therapy.

Part IV65 minutesPharmacology

Formulation Selection, Starting Doses, and Titration

Compare available testosterone formulations on pharmacokinetics, adverse effect profile, and practical considerations.
Select a starting formulation and dose matched to a specific patient's risk profile and preferences.
Determine the correct timing of the follow-up testosterone level for each formulation.
Titrate therapy to a mid-normal target and recognize when a formulation change is preferable to a dose increase.

Part V45 minutesPharmacology

Monitoring: Hematocrit, PSA, Estradiol, and the Follow-Up Rhythm

Construct a formulation-specific monitoring schedule for a man initiating testosterone therapy.
Apply hematocrit thresholds to decide between dose reduction, formulation change, therapeutic phlebotomy, and discontinuation.
Interpret PSA changes on testosterone therapy and determine when urology referral is indicated.
Determine when estradiol measurement changes management and when it does not.

Part VI55 minutesPharmacology

Troubleshooting: Non-Response, Adverse Effects, and Difficult Conversations

Evaluate the man whose symptoms have not responded to therapy despite a therapeutic testosterone level.
Manage common adverse effects of testosterone therapy without unnecessary discontinuation.
Counsel patients on testicular atrophy, hair loss, and acne using accurate expectations.
Address non-prescribed testosterone and anabolic steroid use in a clinically productive way.

Part VII40 minutesPharmacology

Cardiovascular Safety, Prostate Safety, and Counseling Accurately

Summarize the design, findings, and limitations of the TRAVERSE cardiovascular safety trial.
Counsel patients accurately on cardiovascular risk using current labeling and trial evidence.
Describe the evidence on venous thromboembolism, atrial fibrillation, and fracture risk with testosterone therapy.
Describe the expected effects of testosterone therapy on bone density, body composition, sexual function, mood, and glycemia.

Part VIII40 minutesPharmacology

Fertility, Discontinuation, Referral, and Long-Term Planning

Counsel men on fertility preservation options before and during testosterone therapy.
Describe evidence-supported approaches to restoring spermatogenesis after exogenous androgen exposure.
Discontinue testosterone therapy safely and set accurate expectations for recovery.
Apply clear referral criteria to urology, endocrinology, and reproductive medicine.

Begin with the pre-test Post-test