|
HRT Initial Visit and symptoms
• • •
|
Follow up visit
• • •
|
|
Physical Exam
• • •
|
Improvement
• • •
|
|
General [-]
|
|
|
Cardiovascular [-]
|
|
|
Respiratory [-]
|
|
|
Genital (Male) [-]
|
|
|
Neurological [-]
|
|
|
General WNL
|
|
|
Cardiovascular WNL
|
|
|
Lungs WNL
|
|
|
MSK WNL
|
|
|
Neuro WNL
|
|
|
Lab Results obtained during Therapy?
|
|
|
Testosterone (total)
|
Free Testosterone
|
|
PSA
|
IGF-1
|
|
Estradiol
|
Progesterone
|
|
LDL
|
HDL
|
|
Free T3
|
Vitamin D3
|
|
TSH
|
Hemoglobin
|
|
AST
|
ALT
|
|
HbA1c
|
Plan - Meds
• • •
|
|
Assessment
• • •
|
Follow up Time
• • •
|
|
Plan - Supplements
• • •
|
Other Recommendations
• • •
|
|
Follow-up labs
• • •
|
|
