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INFORMED CONSENT FOR HORMONE THERAPY

The following information is provided to assist you with making an informed decision regarding the use of testosterone or other hormone therapies (which include but are not limited to testosterone cypionate, human chorionic gonadotropin (hCG), and anastrozole) which may be prescribed to you by an Amazing Meds practitioner during the course of your treatments.

Please review the information below and ask any questions you have about it.

  1. Testosterone is a controlled medication with risks and benefits. Some potential benefits of testosterone and other hormone therapies include:
    • Improvement in energy
    • Improvement in sexual desire
    • Decrease in fatigue
    • Improvement in depressive symptoms
    • Increase in muscle mass
    • Increase in bone density
  2. Some known or potential risks of hormone therapy and other hormone therapies, include (but are not limited to):
    • Worsening of cholesterol (in particular, “good” HDL)
    • Increases in hematocrit (blood thickness)
    • Breast tissue growth, swelling, or tenderness (gynecomastia)
    • Elevated blood pressure
    • Water retention or swelling of arms or legs (edema)
    • Blood clots in the legs, lungs, or brain
    • Increased risk of cardiovascular or cerebrovascular events
    • Lowering of sperm counts, possibly to the point of infertility
    • Acne and male pattern baldness
    • Reduced testicular size
    • Skin-to-skin transference to a partner or child (topical therapy)
    • Skin irritation (topical therapy)
    • Breast cancer progression
    • Liver dysfunction (oral therapy)
    • Potential for abuse and dependence

I understand that during the course of treatment I may or may not feel or develop any of these benefits and/or risks and that I will have the opportunity to further discuss these potential benefits and risks with my provider.

Hormone therapy requires close monitoring and regular examinations during the course of my treatment. I therefore agree to have the appropriate laboratory testing and examinations as recommended.

Hormone therapy may increase one’s hemoglobin and hematocrit or thicken one’s blood. This problem can be diagnosed with a blood test. Thus, a complete blood count (Hemoglobin and Hematocrit) should be done at least annually.

Hormone therapy may require having a therapeutic phlebotomy performed if hematocrit levels become too high, and I agree to follow these requirements if needed. I also understand that I will only be eligible to continue receiving the medication(s) if I am up to date with my examinations, laboratory work, and any necessary therapeutic phlebotomies.

I certify that I have received and understand this information and had my questions answered. I also understand that I have the option to not take hormone therapy at any time.