PCCA博客 保持目前的PCCA新闻和活动,市场趋势,以及所有复杂的东西!//www.browskids.com/blog. 如何建立自己作为男性的健康顾问 //www.browskids.com/blog/how-to-tablish-yourself-as-a-mens-health-consultant?postid=110 男士健康,药房营销/业务,睾酮替代疗法 星期三,1月22日2020年18:52:35 GMT

by Bruce Biundo,RPH,FACA,PCCA临床复合药剂士


您的男性患者在哪里获取有关睾酮的信息?关于前列腺健康吗?关于可以帮助他们的补充剂?从我自己的观察结果来看,许多人正在听到这些东西,从跑步上跑上运动谈话节目,互联网或其他非医疗来源。听取并阅读一些这些广告,我看看有多少人可以形成关于它们的“天然睾酮助推器”可以为它们做些什么的不切实际的概念,甚至是睾酮本身的适当和预期的益处。你的医生怎么样?虽然他们中的许多人都有兴趣帮助这些男性患者,但他们可能会发现很难跟上你的药剂师,可以在治疗方面提供它们,例如谁是睾酮的良好候选人,谁没有您可以提供哪些配料选择。

非常重要,您可能对如何启动或增加这些服务来帮助您的药房提高这些挑战时期的盈利能力。作为前独立的药房所有者,我自己和长期社区药剂师,我非常兴趣帮助您通过作为男性健康顾问的更熟悉来帮助您帮助您的底线。 So let’s take a look at what is involved.

Have Men’s Health Information Readily Available
There are numerous sources of useful information that can help your male patients become more knowledgeable about men’s health issues. A couple books that can be very helpful are Testosterone for Life, by Abraham Morgentaler, MD, and Saving Your Sex Life, by John P. Mulhall, MD. These can be great references for you and your patients. I also find the monthly magazine Men’s Health often provides useful, up-to-date news that both you and your patients can find beneficial. With either the books or the magazine, your male patients will likely become better informed and more interested in what your pharmacy provides.

Offer Private Patient Consultation
Well-established by many pharmacists over the past 20+ years, a private consultation can be a key component in your practice. You should have an appropriate setting for this, preferably a private room, which enhances the patient’s comfort level. You should also charge appropriate professional fees for this service — for example, $60–$100 for a 20–30 minute session, more for consults lasting up to an hour. It is not uncommon for consultation fees of $175–$200 for those of sufficient skills. If you do this on a regular basis and become proficient at it, private consultations can become a lucrative part of your practice.

A typical session could include a brief discussion on testosterone, a review of the patient’s laboratory values and then a walk-through of the patient’s screening form, which he would have previously filled out. During this time, the patient will be free to ask questions on the topic, and in this environment, you, the pharmacist, can satisfy the concerns expressed. The consultation concludes with you making a therapeutic recommendation to the patient’s physician and, often, a specific recommendation to the patient for nutritional supplements. These supplements, of course, are items that your pharmacy could offer, so the patient would be able to get exactly what you recommend.

Offer Nutritional Supplements
There are many excellent products out there that are very helpful, but I want to mention three specific nutrients that appear to be particularly useful relative to male hypogonadism, or low testosterone: magnesium, vitamin D and zinc. A study showed that magnesium supplementation increased free and total testosterone, with even higher increases in men who supplemented magnesium and exercised regularly.1 Another study showed an association between vitamin D levels and testosterone levels (i.e., men who had low vitamin D levels frequently also had low levels of testosterone).2 Other articles have shown the same association. And lastly, researchers have correlated zinc status with testosterone levels; specifically, low zinc levels correlated with low testosterone levels, and restoration of the zinc deficiencies restored testosterone levels.3

Wellness Works offers professional-quality nutritional supplements for pharmacies to offer their customers, including magnesium chelate tablets, magnesium glycinate powder, vitamin D softgels, zinc monomethionine tablets and zinc lozenges.

Keep up with Testosterone Supplementation Updates
The use of testosterone by injection has been long studied; what is newer is the interest in subcutaneous injections of testosterone. An article by Kaminetsky, Jaffe and Swerdloff revealed that patients obtained consistently high levels of testosterone with 100 mg subcutaneously, as contrasted with the bi-weekly intramuscular (IM) dose of 200 mg. They cited patient comfort and convenience as advantages over the more conventional IM dosing.4 Subcutaneous dosing has become much more common in recent years, and may be an excellent alternative to IM injections.

At PCCA, we get many calls on sublingual dosing of testosterone as well, and it seems to be increasing in preference compared with the past use. Sublingual dosing has unique characteristics. Because of the rapid absorption and relatively short half-life of testosterone, it is best done several times a day at doses of 15–25 mg, as opposed to high doses once a day. The difference can be readily seen in measured hormone levels: high doses produce very high testosterone levels, but for relatively short periods of time. Better to do a lower dose several times a day, as that will be more like the body’s usual production than the high, once-a-day dose. PCCA members can see our recommended dosing-range chart for various dosage forms.

However, do you give testosterone to all men who are clearly symptomatic and low on measured levels? No. Consider the age of the patient, and inquire as to his desire to maintain fertility. Testosterone supplementation can definitely suppress spermatogenesis, resulting in decreased fertility. Consider clomiphene for those men who are low in testosterone but want to maintain fertility.5 Another useful agent is anastrozole, widely used as an aromatase inhibitor, which can block the production of estrogen. Given the strong influence that estradiol has in the production/suppression of the messenger hormone responsible for testosterone production, anastrozole has also shown to be somewhat useful in increasing the production of testosterone in many men.6 It may be considered as an alternative to clomiphene in that regard.

PCCA members with Clinical Services access can view related testosterone formulas in our database, including some in Atrevis Hydrogel®.

Develop Collegial Relationships with Physicians
This is probably the most important part of establishing yourself as a men’s health consultant: forming and maintaining professional, mutually beneficial relationships with physicians and other health care providers who are interested in working with you in caring for patients. Fortunately, doctors want your knowledge, your skills and your ability to offer useful solutions to their patients’ needs. And we help PCCA members by offering treatment options, treatment documents and up-to-date information, all of which they can share with practitioners. PCCA members can see our concise yet wide-ranging Male Hypogonadism Packet for discussion of what is involved in treating male patients with low testosterone.

I advise PCCA members to also look at our newly revised Men’s Health Reference Guide, which meticulously indexes and provides links to abstracts for over seven hundred clinical articles. I think they will find it a valuable resource for their toolkits.

Finally, always remember that we are just one call away for PCCA members with Clinical Services access. For questions, they can contact our team of clinical compounding pharmacists at 800.331.2498.

Bruce Biundo, RPh, FACA, PCCA Clinical Compounding Pharmacist, joined the PCCA staff in 1997 after many years as a community pharmacist. In 1998, as PCCA was beginning to develop educational seminars, he realized that there wasn't much focus on men and testosterone issues, and began research on the subject. In April 1999, Bruce presented what is likely the first educational event on low testosterone in men at the PCCA International Seminar. Over the years, he has made presentations at dozens of hormone seminars to physician groups locally and internationally, and has many articles published, mostly dealing with men’s health. In addition, he was a contributor to Remington: The Science and Practice of Pharmacy, 22nd edition, and is the co-author of the nutrition chapter in Aging Men's Health.

A version of this article originally appeared in PCCA’s members-only magazine, the Apothagram.

References

  1. Cinar, V., Polat, Y., Baltaci, A. K., & Moqulkoc, R. (2011). Effects of magnesium supplementation on testosterone levels of athletes and sedentary subjects at rest and after exhaustion. Biological Trace Elements Research, 140(1), 18–23. https://doi.org/10.1007/s12011-010-8676-3
  2. Lee, D. M., Tajar, A., Pye, S. R., Boonen, S., Vanderschueren, D., Bouillon, R., … Wu, F. C. (2012). Association of hypogonadism with vitamin D status: the European Male Ageing Study. European Journal of Endocrinology, 166(1), 77–85. https://doi.org/10.1530/EJE-11-0743
  3. Prasad, A. S., Mantzoros, C. S., Beck, F. W., Hess, J. W., & Brewer, G. J. (1996). Zinc status and serum testosterone levels of healthy adults. Nutrition, 12(5), 344–348.
  4. Kaminetsky, J., Jaffe, J. S., & Swerdloff, R. S. (2015). Pharmacokinetic profile of subcutaneous testosterone enanthate delivered via a novel, prefilled single-use autoinjector: A phase II study. Sexual Medicine, 3(4), 269–279. https://doi.org/10.1002/sm2.80
  5. Moskovic, D. J., Katz, D. J., Akhavan, A., Park, K., & Mulhall, J. P. (2012). Clomiphene citrate is safe and effective for long-term management of hypogonadism. BJU International, 110(10), 1524–1528. https://doi.org/10.1111/j.1464-410X.2012.10968.x
  6. Leder, B. Z., Rohrer, J. L., Rubin, S. D., Gallo, J., & Longcope, C. (2004). Effects of aromatase inhibition in elderly men with low or borderline-low serum testosterone levels. The Journal of Clinical Endocrinology & Metabolism, 89(3), 1174–1180. https://doi.org/10.1210/jc.2003-031467
These statements are provided for educational purposes only. They have not been evaluated by the Food and Drug Administration, and are not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information contained herein is not intended to replace or substitute for conventional medical care, or encourage its abandonment.
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在药房的塔达拉夫尔复合 //www.browskids.com/blog/tadalafil-in-pharmacy-compounding-rssid?postid=44. 复合研究,一般药房复合,男子健康,女性健康 星期三,2019年2月13日18:59:44 GMT


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