[doctor] next patient is paul edwards , date of birth is january 15th 1962 . so he's a 59 year old hiv positive gentleman here for hypogonadism . patient was last seen on november 24th 2020 . his notable things are number one , he is on 1 milliliter every 10 days , uh , his levels were less than 300 to begin with . he's on finasteride currently . he also takes cialis daily so he takes all his pills just from me . um , patient's other area of concern is gynecomastia which is ... which we will discuss with him today . his last psa was 0.66 and his last testosterone was greater than 1,500 .
[doctor] hey , how are you today ?
[patient] all right , how have you been ?
[doctor] i'm good .
[patient] good , good .
[doctor] have you lost some weight or are you at least putting on some muscle ? you look trim .
[patient] no , i think i'm pretty much the same as i've always been .
[doctor] really ? okay , maybe it's just your black shirt . makes you look thin .
[patient] yeah , i guess that's it .
[doctor] so health wise , how is everything going ?
[patient] good , the testosterone's going well .
[doctor] that's great .
[patient] uh , it helped me out . i feel good , more vigorous , sleeping well and i think it's having some positive effects . not so much physically because like i said i've- i've been this way my whole life , but i'm seeing some good improvements in my bloodwork .
[doctor] okay , well that's good .
[patient] so the finasteride i'm only taking half a pill , it's the 5 milligram one .
[doctor] yeah , i remember you telling me that .
[patient] and cialis , on the days i work out i take 5 milligrams otherwise i take two and a half milligram pills , but , uh , i have been out of it .
[doctor] okay .
[patient] but overall i'm doing well , i'm actually taking the correct steps to get my life together .
[doctor] good . it's always great to hear . well let's take a look . uhm , i'm gon na listen to your heart and lungs .
[patient] okay .
[doctor] please use my general exam template , all right . just take a few breaths .
[patient] okay .
[doctor] in and out .
[patient] okay .
[doctor] all right , everything sounds good , no concerns there .
[patient] great . so i wanted to show you something .
[doctor] sure .
[patient] look at this .
[doctor] okay , this is your cholesterol ?
[patient] yeah , my cholesterol and triglycerides . uh , i used to have high triglycerides , you see they were 265 milligrams per deciliter , and i took my first dose of the testosterone on the 28th .
[doctor] right .
[patient] now 5 months later look at my numbers .
[doctor] wow , that's remarkable .
[patient] is it the test ? it's the only change .
[doctor] i do n't know , i have n't honestly seen many guys over the years that have cholesterol problems and this . i mean there's a big correlation between diabetic control and testosterone replacement , meaning those who get good levels of their test see their diabetic control improve .
[patient] yeah .
[doctor] but i have n't seen a lot of data on the impact on cholesterol . regardless , we will take it .
[patient] i agree . i was very impressed with my triglycerides and was just wondering if the test may be what's helping .
[doctor] yeah , that's an unbelievable difference .
[patient] 145 milligrams per deciliter from 265 milligrams per deciliter is awesome . i also read that it- it's cardioprotective .
[doctor] absolutely .
[patient] my red blood cell count has increased .
[doctor] yeah , i saw that . it's fine though .
[patient] stable .
[doctor] your psa today is also , uh , is good also . it's , uh , .6 i think .
[patient] yeah . , is it ?
[doctor] yeah , it was .5 last year and anything under 4 is good .
[patient] nice , that's good news .
[doctor] so it just needs to be checked every year or so .
[patient] so in terms of , uh , estrogen control i've been hearing that indole-3-carbinol , or broccoli extract , supposedly can improve my estrogen levels . have you ever heard of it ?
[doctor] yeah , i've heard of it but i have n't had anybody consistently use it . i mean , your levels are fine and we checked your estra- estradiol and it was not elevated , so .
[patient] okay .
[doctor] i would argue that we could test that in the fall if you want , but we do n't need to do , uh , do any more tests ... any more than test once a year , excuse me .
[patient] okay , what about increasing my testosterone to 175 milligrams ? i'm at 140 now .
[doctor] well , your levels are high .
[patient] are they right now ?
[doctor] well , i mean they were last time .
[patient] yeah but i just- just injected though , or i had right before that was taken .
[doctor] i know . i know you had then , uh , when did you inject this time ?
[patient] i figure i'm on my eighth day today .
[doctor] okay .
[patient] so i'm due to dose on thursday or friday .
[doctor] all right .
[patient] i have a little med calendar and i put checks and ts on it . that helps me .
[doctor] that's a great idea . so look , the biggest issue i've seen , even if your levels today are around 700 , is that your peaks are getting greater than 1,500 , putting you at a higher chance of needing to come off due to blood thickness . and your risk will only astronomically go up the higher the dose that we go on .
[patient] okay .
[doctor] you look well , your levels are good and you're feeling well .
[patient] yeah , i'm feeling good .
[doctor] i'm going to be blunt . unfortunately this happens often where you're feeling good but you want to feel really good . i mean , i get it and this is why people get into problems with this stuff , right ? it's like , back in the day when it was n't prescribed by doctors and people would get it at gyms and stuff and they would take huge doses . and then they would have a heart attack at 50 .
[patient] yeah , they have to be taking a lot .
[doctor] likely they are taking more than testosterone , but still .
[patient] and they are taking stuff for a long time .
[doctor] true . but right now i would not change your dose .
[patient] okay .
[doctor] make sense ?
[patient] it does , i appreciate the discussion .
[doctor] no problem . what pharmacy are you using ? have you changed it or anything ?
[patient] no changes , i use walmart pharmacy . i do need more cialis and finasteride .
[doctor] okay .
[patient] i would prefer the paper prescription .
[doctor] for all of them ?
[patient] sure .
[doctor] all right , will do . i'm gon na get your prescriptions .
[patient] okay , thank you .

Medical orders:
description: blood psa needs to be checked every year or so
order_type: lab
description: finasteride half pill 5 milligram
order_type: medication
description: 140 testosterone
order_type: medication
reason: hypogonadism . gynecomastia
description: cialis daily 5 milligrams
order_type: medication
description: cialis daily two and a half milligram pills
order_type: medication