Voluntary Participation
You are voluntarily choosing to receive services at Arizona Endocrinology of your own free will. You may withdraw from treatment at any time without penalty.
Other Medical Providers
Participation in this program does not require you to stop seeing other physicians or medical providers. Arizona Endocrinology does not offer primary care services. You are required to maintain an active primary care physician.
Treatment and FDA Approval
Some treatments provided or prescribed at Arizona Endocrinology may be compounded medications, off-label uses of approved medications, or treatments that are not individually FDA-approved. Ask any questions you have during a physician visit, and keep a log of questions between visits to bring to your next physician visit.
Symptom Questionnaire at Every Physician Visit
Every visit with a physician at Arizona Endocrinology requires you to complete a symptom tracking questionnaire before the visit. You can answer these questions before you arrive by requesting the symptom questionnaire at a previous visit. This is part of your ongoing clinical monitoring.
Annual Paperwork Update
You agree to update your administrative and intake paperwork annually. Arizona Endocrinology will remind you when this is due. Failure to update annual paperwork may affect your ability to receive refills.
Accommodation
If you require an accommodation to access this consent or any clinic materials — including but not limited to visual, hearing, or language needs — please notify us. We will arrange an appropriate alternative to ensure you have full access to this information.
The sections below explain why your physician may recommend a specific medication, how it is used, the possible benefits, the possible side effects and serious risks, and other choices you may have. You may choose not to take any medication — choosing no treatment is always an option.
Testosterone Cypionate — Injection
When your physician recommends testosterone, it is because your symptoms, examination, and/or laboratory results suggest that testosterone treatment may be appropriate for you. Testosterone may help improve symptoms of low testosterone, such as low sex drive, low energy, loss of muscle, or reduced sense of well-being. Testosterone treatment is not right for everyone, and your physician will review your health history and laboratory results before starting treatment and at regular intervals to monitor efficacy and safety. Sharing your medication is not only illegal but could be potentially dangerous to another person — you agree never to share your medication with anyone.
Testosterone cypionate is usually given by injection. Your dose and schedule will be based on your symptoms, testosterone levels, and treatment goals, and may change over time based on how you respond and what your labs show.
Common side effects can include acne or oily skin, changes in mood or sex drive, fluid retention or swelling, breast tenderness, and pain, redness, or irritation at the injection site. Testosterone can decrease sperm production and fertility and can cause the testicles to become smaller — important if you are trying to have children.
Testosterone can increase your red blood cell count, which can thicken your blood and increase your risk of a blood clot — your blood count will be checked during treatment. It can also affect cholesterol levels, cause fluid retention, worsen sleep apnea, and affect the prostate, including worsening urinary symptoms in men with an enlarged prostate. Your physician will monitor your PSA and prostate health when appropriate.
Serious risks: blood clots, including in the legs or lungs, have been reported with testosterone treatment, and testosterone labeling includes a warning about possible cardiovascular risk. Seek urgent medical care for chest pain, trouble breathing, sudden weakness or numbness, severe headache, one-sided leg swelling or pain, or other symptoms that could mean a blood clot, stroke, or other serious problem.
Other choices include a testosterone cypionate/propionate blend, testosterone pellets, or no testosterone treatment.
Testosterone Cypionate/Propionate Blend — Injection
This combination of two forms of testosterone may provide a different pattern of testosterone levels than testosterone cypionate alone. Side effects are similar to testosterone cypionate, and you may notice more soreness or irritation from the injection. Serious problems can include a blood clot, pulmonary embolism, cardiovascular problems, or significant fluid retention.
Other choices include standard testosterone cypionate, testosterone pellets, or no testosterone treatment.
Testosterone Pellets
Pellets are small implants placed under the skin during a minor office procedure, slowly releasing testosterone over a longer period of time. Unlike injections, the dose cannot simply be changed or removed once the pellets have been placed — if your level becomes too high or you develop a side effect, the medication cannot be quickly stopped the way an injection can.
Medication side effects are similar to other forms of testosterone. The pellet procedure itself also carries risks: pain, bruising, bleeding, infection, scarring, poor healing, the pellet coming out through the incision, or the pellet moving from where it was placed. A separate pellet procedure consent explains these risks in more detail.
Other choices include injectable testosterone or no testosterone treatment.
Anastrozole
Anastrozole may be used to lower estrogen levels in men receiving testosterone when estrogen becomes higher than desired or is associated with symptoms. Common side effects include joint or muscle pain, headache, hot flashes, mood changes, and changes in sex drive. Anastrozole can also lower estrogen too much, which may affect sexual function, mood, cholesterol, and bone health — long-term low estrogen can decrease bone strength and increase fracture risk, and can increase cholesterol levels.
Other choices include changing your testosterone dose, a different treatment, or no medication with monitoring of symptoms and labs instead.
Enclomiphene
Enclomiphene may help your body make more of its own testosterone rather than supplying it directly, and may be particularly useful when maintaining fertility is a goal. It's taken by mouth, and your response can vary — it may not work well for you.
Possible side effects include headache, mood changes, changes in sex drive, breast tenderness, and changes in hormone levels. One important warning involves vision — medicines in this drug class can cause visual problems. If you develop new vision changes, stop the medication and contact your physician promptly; seek urgent care for sudden or severe vision loss.
Enclomiphene is not an FDA-approved drug for male testosterone replacement. If your prescription is compounded, the compounded product itself is not FDA-approved, and the FDA does not review compounded drugs before they're marketed the way it reviews FDA-approved drugs.
Other choices include testosterone treatment, HCG, or no treatment.
Nandrolone
When your physician recommends nandrolone, a separate informed consent is required.
Tadalafil
Tadalafil may help with erectile dysfunction by increasing blood flow when you are sexually stimulated — it does not automatically cause an erection. Side effects can include headache, flushing, a stuffy nose, indigestion, back pain, muscle aches, or dizziness.
Important interaction: do not take tadalafil with nitrate medicines such as nitroglycerin — this combination can cause a dangerous drop in blood pressure. Tell your physician about all medicines you take. A rare but serious side effect is an erection lasting more than four hours (priapism) — go to an emergency department immediately if this occurs. Rarely, sudden vision or hearing loss has been reported; seek urgent care if this happens.
Other choices include sildenafil or another ED medication, non-drug treatment, or no treatment.
Progesterone — Low-Dose Oral Use With Testosterone
Low-dose oral progesterone may be used with testosterone in some men when the goal is to support sleep. This is an individual treatment choice, not necessary for every patient on testosterone. It may make you sleepy or dizzy, so know how it affects you before driving or doing anything requiring alertness.
Possible side effects include sleepiness, dizziness, mood changes, breast tenderness, headache, and changes in sex drive. Contact your physician for severe mood changes, unusual symptoms, or significant swelling.
Other choices include non-hormonal sleep support, other approaches to improving sleep, or no progesterone treatment.
Peptides — CJC-1295/Ipamorelin
These peptides may affect growth-hormone signaling and may be used to support recovery, sleep, or body composition — expected benefit varies by person. These products are different from FDA-approved medications for specific conditions; if compounded, they are not FDA-approved, and long-term safety information is limited.
Given by injection, possible side effects include injection-site pain or irritation, headache, water retention, changes in appetite or blood sugar, fatigue, or changes in energy. Seek medical care for severe swelling, trouble breathing, severe headache, chest pain, or another serious reaction.
Other choices include exercise, nutrition, sleep improvement, other wellness strategies, or no peptide treatment.
HCG
HCG may act like a natural hormone (LH) and may help maintain testicular activity, size, and support sperm production in men on testosterone — it does not guarantee fertility will be maintained. Given by injection, possible side effects include injection-site pain, headache, mood changes, breast tenderness, bloating, or fluid retention. It can increase estrogen in some people.
Other choices include no HCG, enclomiphene, or a different treatment plan.
Levothyroxine / Liothyronine
Thyroid hormone treatment is recommended when your body isn't making enough on its own, or when otherwise clinically appropriate. Levothyroxine provides T4; liothyronine provides T3 — they may be used alone or together. Your physician will check thyroid labs and adjust your dose as needed; the medication works best taken consistently, and certain foods, vitamins, and other medicines can affect absorption.
Too much thyroid hormone can cause fast heartbeat, palpitations, anxiety, shaking, sweating, trouble sleeping, weight loss, diarrhea, or feeling unusually hot, and can stress the heart or weaken bones over time. Too little can cause fatigue, weight gain, feeling cold, constipation, dry skin, low mood, or brain fog. Seek urgent care for severe chest pain, fainting, severe shortness of breath, or a very fast or irregular heartbeat.
Other choices depend on your condition and may include monitoring without medication, levothyroxine alone, another thyroid treatment, or evaluation by another thyroid specialist.
FDA Approval and Compounded Medications
Not all medications discussed or prescribed in this practice are FDA-approved for the specific use described in this consent. Some may be used off-label (FDA-approved for another use, prescribed for a different reason), and some may be compounded — specially prepared by a pharmacy. Compounded medications are not FDA-approved, and the FDA does not review them for safety, effectiveness, or quality before they're made and dispensed the way it reviews FDA-approved medications.
You have the right to ask questions and to choose an FDA-approved treatment, another treatment option, or no treatment when appropriate. Medications prescribed by Arizona Endocrinology are obtained from pharmacies that meet applicable federal and state requirements, and when applicable, are tested by the pharmacy and/or an independent laboratory for identity, potency, purity, and quality before they are dispensed.
Consent to Diagnose and Treat
"Receiving services from the physician means I have read and understood the above, and have had the opportunity to ask questions. I understand that noncompliance with this agreement may result in termination of the doctor-patient relationship. I hereby consent to diagnosis and treatment."