Problem:
A 52-year-old man presents due to fatigue, decreased libido, and decreased muscle strength; the latter of which he has noticed during weightlifting exercises at his gym. He reports that his symptoms were first noticeable several months ago, but have worsened over the past couple of months. Based upon his own Google research and what he has seen on TV, he is interested in testosterone therapy to treat his self-diagnosis of 'low T'. He has a six year history of hypertension for which he takes Micardis-HCT (telmisartan-HCTZ) and atenolol; he also takes a daily multivitamin. His height is 6'-1" and weight is 255 lbs. (BMI = 33.6 kg/m2). Vitals include blood pressure, 140/65 mm Hg; pulse, 62/min; and SaO2 97%. He does not smoke and drinks 5-10 alcoholic drinks on weekends. Which of the following treatment options is indicated? Clomiphene Leuprolide Recombinant GnRH Testosterone analogue Recombinant LH and FSH Bromocriptine