Medication Policy Manual
|
|
- Spencer Greer
- 6 years ago
- Views:
Transcription
1 Independent licensees of the Blue Cross and Blue Shield Association Medication Policy Manual Topic: Non-preferred, non-transdermal testosterone replacement therapy products (Android, Aveed, Androxy, Methitest, Natesto, Striant, Testopel, Testred, compounded testosterone products, nonpreferred generic products) Policy No: dru297 Date of Origin: March 15, 2013 Committee Approval Date: February 17, 2017 Next Review Date: February 2018 Effective Date: March 1, 2017 IMPORTANT REMINDER This Medication Policy has been developed through consideration of medical necessity, generally accepted standards of medical practice, and review of medical literature and government approval status. Benefit determinations should be based in all cases on the applicable contract language. To the extent there are any conflicts between these guidelines and the contract language, the contract language will control. The purpose of medication policy is to provide a guide to coverage. Medication Policy is not intended to dictate to providers how to practice medicine. Providers are expected to exercise their medical judgment in providing the most appropriate care. Description Testosterone replacement therapy (TRT) products are used in the treatment of hypogonadism (testosterone deficiency). The effectiveness of TRT is monitored by assessing serum testosterone levels, as well as improvement in sexual function, mood, fatigue, bone mineral density, and wellbeing. dru297.8 Page 1 of 12
2 Policy/Criteria I. Most contracts require prior authorization approval of non-preferred testosterone replacement therapy (TRT) products, as listed in Appendix 1, prior to coverage. For nonpreferred TRT products, except for Aveed (Android, Methitest, Natesto, Striant, Testopel, Testred, non-preferred generic products), products listed in Appendix 1 may be considered medically necessary when criteria A and B below are met. A. Injectable testosterone cypionate or testosterone enanthate has been ineffective, contraindicated, or not tolerated. B. One of the following four conditions (criteria 1 through 4) is met: 1. A diagnosis of primary (Testicular) hypogonadism or secondary (Pituitary-Hypothalamic) hypogonadism caused by a specific medical condition associated with a deficiency or absence of endogenous testosterone including, but not limited to, those listed in Appendix 3, when documentation of at least two low testosterone levels (less than 300 ng/dl for total testosterone, or less than 9 ng/dl for free testosterone) drawn prior to 10 AM on two separate days is provided. This criterion is not met by primary (Testicular) hypogonadism not caused by a specific medical condition. OR 2. Gender dysphoria when all of the following criteria are met: a. Clinical records document that the patient has the capacity to make fully informed decisions and consent for treatment. AND b. A licensed behavioral health practitioner has diagnosed gender dysphoria as defined by the DSM-5 criteria. AND c. At least one of the following criteria must be met for a period of 3 or more months prior to the initiation of hormone therapy i. Documentation of living as the desired gender; and/or OR ii. Psychotherapy with a licensed behavioral practitioner. 3. To induce puberty in males with delayed puberty (Testopel, Android, Methitest, and Testred only). OR 4. Used secondarily in women with inoperable, metastatic breast cancer who are 1 to 5 years postmenopausal (Android, Methitest, and Testred only). dru297.8 Page 2 of 12
3 II. Administration, Quantity Limitations, and Authorization Period A. Regence Pharmacy Services considers oral, nasal, topical, and transdermal testosterone replacement therapy (TRT) products to be self-administered medications. B. Regence Pharmacy Services does not consider Aveed or Testopel to be selfadministered medications. C. When prior authorization is approved, TRT products may be authorized as follows: TRT Products Transdermal testosterone topical solution (Axiron ); 30 mg per actuation testosterone topical gel 2% (Fortesta ); 10 mg per actuation testosterone topical gel 1% (Testim Gel 50 mg/5 gm tubes) testosterone topical gel 1% (Vogelxo 50 mg /5 gm tube or packet) testosterone topical gel 1% (Vogelxo pump bottle); 12.5 mg per actuation testosterone transdermal patch 2-4 mg/24 hours (Androderm ) Subcutaneous pellet testosterone 75 mg pellet (Testopel ) Quantity Level Limitation (per Month, unless noted) 2 pump bottles (60 actuations/bottle) 2 pump bottles (120 actuations/bottle) 60 tubes 60 tubes or packets pump bottles (60 actuations per bottle) 2-mg/24 hour: 60 patches 4-mg/24 hour: 30 patches 900 mg (12 pellets) every 3 months Oral/Buccal fluoxymesterone 10 mg tablets (Androxy) methyltestosterone 10 mg capsules (Android, Testred) methyltestosterone 10 mg tablets capsules (Methitest) testosterone 30 mg extended-release buccal tablets (Striant ) Nasal gel testosterone nasal gel 4.5% (Natesto metereddose pump bottle); 5.5 mg per actuation 60 tablets 150 capsules 150 tablets 60 tablets 3 pump bottles (60 actuations per bottle) D. Quantities above the listed quantity limits are considered not medically necessary. dru297.8 Page 3 of 12
4 E. Authorization shall be reviewed in the timeframes defined below: 1. Primary (Testicular) hypogonadism/secondary (Pituitary- Hypothalamic) hypogonadism: Authorization shall be reviewed after 6 months, and then at least annually to assure that both of the following are met: a. The member has a specific medical condition associated with a deficiency or absence of endogenous testosterone. AND b. The testosterone level does not exceed 700 ng/dl. (See Appendix 2, Lab Monitoring Guidelines for TRT Products). For patients with a testosterone level exceeding 700 ng/dl, ongoing coverage of testosterone replacement therapy will be authorized only when there is clinical documentation that the TRT dose will be adjusted for a goal level of less than 700 ng/dl. 2. Gender reassignment therapy, delayed puberty, and metastatic breast cancer: authorization may be reviewed at least annually to confirm that current medical necessity criteria are met and that the medication is effective. III. Non-preferred TRT products, as listed in Appendix 1, are considered not medically necessary for the following non-specific conditions: A. Primary (testicular) hypogonadism, not otherwise specified, including age-related hypogonadism B. Testicular hypofunction, not otherwise specified C. Low libido in men without hypogonadism or women D. Use in women for infertility; sexual dysfunction, cognitive dysfunction, cardiovascular dysfunction, metabolic dysfunction, bone health, or well-being. IV. The use of testosterone undecanoate injection (Aveed) is considered not medically necessary for any indication. V. Non-preferred TRT products, as listed in Appendix 1, are considered investigational for the following conditions: A. Weight gain in HIV-infected men Position Statement - Testosterone replacement therapy (TRT) is commonly used for treatment of hypogonadism in men and as part of gender reassignment therapy. All products are considered effective for increasing serum testosterone levels. - There is no evidence demonstrating that any one TRT product is safer or more effective than less costly generic injectable options. There are no studies that directly compare the clinical effects of different TRT products. dru297.8 Page 4 of 12
5 - Hypogonadism may be caused either by failure of the testicles to produce testosterone (primary), or by central defects in the hypothalamus or pituitary gland which lead to secondary testicular failure. [1] - A diagnosis of hypogonadism is confirmed by measuring serum testosterone levels. [1] - Testosterone levels vary throughout the day and are highest in the morning. Normal ranges for serum testosterone levels are usually established using morning blood samples. [1] - Threshold testosterone levels below which adverse health symptoms occur are not known. Likewise, optimal levels of testosterone at which TRT improves outcomes are not known. For most symptoms in younger men, the average testosterone threshold corresponds to the lower limit of the normal range. [1] - Because testosterone levels vary significantly due to body rhythms, episodic secretion, and measurement variations, at least two levels should be obtained to confirm a diagnosis of hypogonadism. [1] - Normal ranges for testosterone vary among laboratories and assays. The Endocrine Society recommends that a lower limit for normal testosterone levels is 300 ng/dl for total testosterone and 9.0 ng/dl for free testosterone. [1] - The Endocrine Society Clinical Guideline recommends evaluating patients 3 to 6 months after initiating treatment to evaluate patients for side effects and to make sure total testosterone levels are between 400 ng/dl and 700 ng/dl. [1] - Overall, TRT products are well tolerated. - In March 2015, the FDA released a drug safety communication clarifying that the benefits and safety of TRT have not been established for the treatment of low testosterone levels due to aging, even if a man s symptoms seem related to low testosterone. The communication also stated that there is a possible increased cardiovascular risk associated with testosterone use. [2] - Since the initial drug safety communication, a limitation of use has been added to the prescribing information for multiple testosterone replacement products. The updated labeling states that safety and efficacy has not been established for age-related hypogonadism (also referred to as late-onset hypogonadism). - Primary or Secondary hypogonadism not otherwise specified (NOS), including agerelated hypogonadism, is not a covered indication. For hypogonadism, testosterone replacement may be considered medically necessary when low testosterone levels are due to a documented medical cause as listed in Appendix 3. - Age-related hypogonadism does not have a unique ICD-10 code, and therefore may be billed under a more general code, such as testicular hypofunction or testicular hypogonadism, not otherwise specified (NOS). - Low-dose testosterone therapy is a standard treatment option for the management of delayed puberty in boys. Goals of therapy include the induction of secondary sexual characteristics or growth and the mitigation of psychosocial difficulties. [3] dru297.8 Page 5 of 12
6 - Testosterone enanthate may be used secondarily in women with advancing inoperable metastatic breast cancer who are one to five years postmenopausal. Although several testosterone products are FDA-approved for this indication, newer, targeted therapies have largely replaced its use in this setting. [4] - While there is limited evidence that testosterone may have some benefit in for sexual dysfunction in post-menopausal women there is insufficient evidence to establish the safety and efficacy of testosterone in this indication. Additionally, the Endocrine Society recommends against the general use of testosterone for the indications of infertility, sexual dysfunction (other than hypoactive sexual desire disorder), cognitive health, cardiovascular health, bone health, or general well-being in women due to limited evidence of efficacy and safety. [5] - Small increases in lean body mass and body weight have been reported in HIV-infected men with weight loss; however, it is uncertain whether the change was clinically meaningful or whether it correlated with clinically relevant endpoints (increased muscle strength and physical functioning, overall quality of life, or improved survival). - While branded TRT products are comparable in price, testosterone cypionate and testosterone enanthate offer members the best value and they are available at preferred copayments. - Due to serious adverse events, such as pulmonary oil microembolism (POME) reactions and anaphylaxis, that are not present with other products, the use of testosterone undecanoate (Aveed) is considered not medically necessary. [6] - TRT should not be started in men who are at high risk for, or who have, prostate cancer. - Due to the availability of injectable formulations, quantities above the quantity limits listed criterion II.B. are considered not medically necessary. The quantity limits listed correspond with the manufacturer s prescribing information for each medication. There is a lack of literature showing improved health outcomes and safety when the maximum dosing is exceeded. Clinical Efficacy No single testosterone replacement therapy (TRT) product has been proven in reliable clinical studies to be more effective than another TRT product. - All TRT products appear to be similarly effective based on pharmacokinetic data. There is pharmacokinetic evidence that all topical testosterone products replete testosterone levels in men with hypogonadism. [7] - The FDA accepts open-label, non-comparative trials of new TRT formulations as sufficient to provide evidence of safety and efficacy. More clinically relevant endpoints would be trials with validated disease outcome measures, showing meaningful improvements in symptoms, such as low mood, sexual function, lean muscle mass, and energy levels. - There are no trials comparing any branded TRT formulation, therefore there is no evidence that one branded TRT product is superior to another. - Long-term health outcomes of TRT, such as decreased incidence of fracture or cardiovascular risk, are uncertain. [2,8] dru297.8 Page 6 of 12
7 - Clinical guidelines recognize TRT as standard of care and effective for treatment of hypogonadism in men. All products are considered effective in raising testosterone levels. Choice of TRT product is based on pharmacokinetics, patient preference, and cost. However, oral TRT is not recommended due to poor absorption and liver toxicity. [9,10] - The efficacy of TRT has not been established in men with age-related hypogonadism. - There are no valid, reliable, clinically relevant endpoints for studies assessing the effect of testosterone on desire, frequency of sexual activity, erectile function, mood, energy, overall quality of life, body composition (lean and fat body mass), and bone mineral density in men with age-related hypogonadism. Safety [6,7] - Overall, testosterone topical replacement (TRT) is well tolerated. Common adverse effects ( 3%) include acne, gynecomastia, oral irritation (buccal formulation), headache, and enlarged prostate. The most commonly reported adverse event with topical TRT is application site reactions. However, testosterone transdermal patch (Androderm ) is associated with a significantly higher rate of skin reactions, including blistering of the skin. - TRT may be associated with increased risk of adverse cardiovascular outcomes (increased mortality, myocardial infarction, and stroke). Although findings in several large observational studies and meta-analyses are inconsistent, the FDA s Bone, Reproductive and Urologic Drugs Advisory Committee concluded that there is a small signal of risk. Based on conclusions reached in the advisory committee, the FDA subsequently released a drug safety communication related to the CV risk and will require labeling changes for all prescription testosterone products. [2,8-11] - TRT is contraindicated in men with known or suspected prostate cancer. - Testosterone undecanoate (Aveed) has boxed warnings for pulmonary oil microembolism (POME) reactions and anaphylaxis. POME reactions may be life threatening; symptoms include cough, dyspnea, throat tightening, chest pain, dizziness, and syncope. Patients who received testosterone undecanoate (Aveed) must be monitored in a healthcare setting for 30 minute post-dose in case of serious POME reactions or anaphylaxis. - Testosterone has been subject to abuse, typically at doses higher than recommended for the approved indication and in combination with other anabolic androgenic steroids. [12] - In 2009, the FDA issued a MedWatch safety alert of inadvertent (secondary) testosterone exposure with topical testosterone gel (Testim and AndroGel), based on eight case reports of exposure in children, age nine months to five years old. Signs of virilization (development of male secondary sexual characteristics) and bone aging were observed. Black box warnings are now required on all topical gel and solution formulations of testosterone, as well as educational REMS programs to reduce secondary exposure. [13] dru297.8 Page 7 of 12
8 Appendix 1: Non-Preferred Testosterone Replacement Therapy (TRT) Products Topical testosterone topical solution 2% (Axiron ) testosterone topical gel 2% (Fortesta ) testosterone topical gel 1% (Testim Gel ) testosterone topical gel 1% (Vogelxo ) testosterone transdermal patch 2-4 mg/24 hours (Androderm ) Oral/Buccal methyltestosterone 10 mg capsule (Android, Testred ) methyltestosterone 10 mg capsule (Methitest ) testosterone 30 mg extended-release buccal tablets (Striant ) Nasal gel testosterone nasal gel 4.5% (Natesto ) Subcutaneous Pellet testosterone pellets 75 mg (Testopel ) dru297.8 Page 8 of 12
9 Appendix 2: Lab Monitoring Guidelines for TRT Products Transdermal patches Androderm Measure morning testosterone (following application of the patch the previous evening) Transdermal gels and solutions AndroGel, AndroGel Pump, Testim Fortesta Axiron Vogelxo Measure pre-dose morning testosterone level Measure testosterone 2 hours after application Measure testosterone 2 to 8 hours after application Measure testosterone 4 to 8 hours after application Subcutaneous pellet Testopel Measure pre-dose level and periodically during therapy Buccal tablet Striant Measure pre-dose morning testosterone level Nasal gel Natesto Measure pre-dose level Injectable testosterone cypionate (generics) testosterone enanthate (generics) Measure pre-dose level and periodically during therapy Measure pre-dose level and periodically during therapy dru297.8 Page 9 of 12
10 Appendix 3: Causes of Primary (Testicular) and Secondary (Pituitary-Hypothalamic) hypogonadism [14,15] Primary (Testicular) Hypogonadism due to testicular dysfunction, including but not limited to the following conditions: a Bilateral Torsion Cryptorchidism Disorders of androgen biosynthesis Klinefelter s syndrome or other chromosomal abnormalities Myotonic dystrophy Orchitis Toxic damage from chemotherapy, alcohol, or heavy metals Trauma to the testicles Vanishing testis syndrome Varicocele Secondary (Pituitary-Hypothalamic) hypogonadism due to pituitary-hypothalamic dysfunction, including but not limited to the following conditions: Congenital GnRH deficiency Hyperprolactinemia Idiopathic gonadotropic or luteinizing hormone-releasing hormone deficiency Kallman Syndrome Pituitary-hypothalamic dysfunction (not otherwise specified) Pituitary-hypothalamic injury from tumors, trauma, or radiation a Primary (Testicular) or Secondary (Pituitary-Hypothalamic) Hypogonadism (not otherwise specified, including age-related) is not a covered indication. dru297.8 Page 10 of 12
11 Cross References Testosterone Replacement Therapies, BlueCross BlueShield Association Medical Policy, , Issue 12:2014 Transgender Services, Medical Policy. Medicine, Policy No Testosterone cypionate, testosterone enanthate, Medication Policy Manual, Policy No. dru395 Preferred transdermal testosterone replacement therapy products (AndroGel, AndroGel Pump ), Medication Policy Manual, Policy No. dru411 Non-preferred, transdermal testosterone replacement therapy products, Medication Policy Manual, Policy No. dru415 Codes Number Description HCPCS J3145 Testosterone undecanoate, 1 mg HCPCS S1089 Testosterone pellet, 75 mg References 1. Bhasin, S, Cunningham, GR, Hayes, FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology and metabolism. 2010;95: PMID: U.S. Food and Drug Administration. Summary Minutes of the Joint Meeting of the Bone, Reproductive and Urologic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee. [cited 11/7/2014]; Available from: s/reproductivehealthdrugsadvisorycommittee/ucm pdf. 3. Palmert, MR, Dunkel, L. Clinical practice. Delayed puberty. The New England journal of medicine Feb 2;366(5): PMID: Ellis, M, Naughton, MJ, Ma, CX. Treatment approach to metastatic hormone receptorpositive breast cancer: Endocrine therapy. In: UpToDate, Basow, DS (Ed). UpToDate, Waltham, MA, Wierman, ME, Arlt, W, Basson, R, et al. Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology and metabolism Oct;99(10): PMID: Aveed [package insert]. Malvern, PA: Endo Pharmaceuticals; September Micromedex Healthcare Series [internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically. dru297.8 Page 11 of 12
12 8. U.S. Food and Drug Administration. FDA Briefing Information for the September 17, 2014 Joint Meeting of the Bone, Reproductive and Urologic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee Meeting. [cited 11/7/2014]; Available from: s/reproductivehealthdrugsadvisorycommittee/ucm pdf. 9. Vigen, R, O'Donnell, CI, Baron, AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA : the journal of the American Medical Association. 2013;310: PMID: Xu, L, Freeman, G, Cowling, BJ, Schooling, CM. Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebocontrolled randomized trials. BMC Med. 2013;11:108. PMID: Finkle, WD, Greenland, S, Ridgeway, GK, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One. 2014;9:e PMID: FDA approves new changes to testosterone labeling regarding the risks associated with abuse and dependence of testosterone and other anabolic androgenic steroids (AAS). [cited 1/4/2017]; Available from: MedWatch. FDA news release: Testosterone Gel Safety Concerns Prompt FDA to Require Label Changes, Medication Guide. 7May2009. [cited 2/16/2011]; Available from: Snyder, PJ. Causes of secondary hypogonadism in males. In: UpToDate, Martin, K.A. (Ed). UpToDate, Waltham, MA, Snyder, PJ. Causes of primary hypogonadism in males. In: UpToDate, Martin, K.A. (Ed). UpToDate, Waltham, MA, Revision Date Revision Summary 2/17/2017 Increased Testopel QL, clarified Androxy QL 2/12/2016 Clarified that primary (testicular) hypogonadism and testicular hypofunction not otherwise specified (NOS), including age-related are considered not medically necessary Clarified that Appendix 3 is not an exhaustive list of potential causes of primary (testicular) and secondary (pituitaryhypothalamic) hypogonadism. Updated not medically necessary uses 12/11/2015 Rearranged policy criteria Clarified that the cause of hypogonadism must be caused by a condition listed in appendix 3 Updated appendix 3 with additional causes of hypogonadism Allowed for reauthorization if testosterone levels exceed 700 ng/ml. Reauthorization requires a documented plan to address the high level or adjust the dose. dru297.8 Page 12 of 12
Androgens and Anabolic Steroids Prior Authorization with Quantity Limit - Through Preferred Topical Androgen Agent
Androgens and Anabolic Steroids Prior Authorization with Quantity Limit - Through Preferred Topical Androgen Agent Androgens/Anabolic Steroids Prior Authorization with Quantity Limit Through Preferred
More informationSUMMACARE COMMERCIAL MEDICATION REQUEST GUIDELINES TESTOSTERON. Generic Brand HICL GCN Exception/Other ROUTE MISCELL.
Generic Brand HICL GCN Exception/Other ANDRODERM 01403 ROUTE MISCELL. ANDROGEL AXIRON FORTESTA NATESTO STRIANT TESTIM VOGELXO DEPO- 01400 ROUTE MISCELL. CYPIONATE TESTOSTERON E GCN 38586 DELATESTRYL 01401
More informationTestosterone Topical/Buccal/Nasal
BENEFIT APPLICATION Testosterone Topical/Buccal/Nasal DRUG POLICY Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2017 P 2018-9 Program Prior Authorization/Medical Necessity Topical Androgens Medication Axiron*, Androderm, Androgel*, Fortesta*, Natesto*,
More informationTestosterone Hormone Replacement Drug Class Prior Authorization Protocol
Testosterone Hormone Replacement Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective date: April 1, 2018 This policy has been developed through
More informationTestosterone Hormone Replacement Drug Class Prior Authorization Protocol
Line of business: Medi-Cal Effective Date: August 16, 2017 Revision Date: August 16, 2017 Testosterone Hormone Replacement Drug Class Prior Authorization Protocol This policy has been developed through
More informationHARVARD PILGRIM HEALTH CARE RECOMMENDED MEDICATION REQUEST GUIDELINES
Generic Brand HICL GCN Exception/Other METHYL ANDROID METHITEST METHYL TESTRED 01404 ROUTE MISCELL. CYPIONATE ENANTHATE GUIDELINES FOR USE ANDRODERM ANDROGEL AXIRON FORTESTA NATESTO STRIANT TESTIM VOGELXO
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Reference Number: CP.CPA.291 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy for important regulatory
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Androgens and Anabolic Steroids Page 1 of 57 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Androgens and Anabolic Steroids Prime Therapeutics will review Prior
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Androgens and Anabolic Steroids Page 1 of 53 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Androgens and Anabolic Steroids Prime Therapeutics will review Prior
More informationDrug Class Monograph
Drug Class Monograph Class: Testosterone Hormone Replacement Drug: Androderm (testosterone transdermal system), Androgel (testosterone topical gel), Axiron (testosterone topical solution), Aveed (testosterone
More informationIssues. What is a low testosterone? Who needs testosterone therapy? Benefits/adverse effects of testosterone replacement Treatment options
Male Hypogonadism Jauch Symposium Waterloo, IA May 17, 2013 Janet A. Schlechte, M.D. Disclosure of Financial Relationships Janet A. Schlechte, M.D. has no relationships with any proprietary entity producing
More informationClinical Policy: Testosterone Reference Number: AZ.CP.PHAR.02 Effective Date: Last Review Date: Line of Business: Arizona Medicaid
Clinical Policy: Reference Number: AZ.CP.PHAR.02 Effective Date: 11.16.16 Last Review Date: 09.12.18 Line of Business: Arizona Medicaid Revision Log See Important Reminder at the end of this policy for
More informationPolicy. covered: bilateral. alcohol or. Approve. 3. Palliative enanthate injection in. women for. 6 months if. can also sponsive tumor.
Injectablee Testosterone Products Prior Authorization Policy Number: 5.01.597 Origination: 07/2014 Last Review: 07/2014 Next Review: 07/2015 Policy BCBSKC will provide coverage for injectable testosterone
More informationSeptember 17, FDA background documents for the discussion of two major issues in testosterone replacement therapy (TRT):
JOINT MEETING FOR BONE, REPRODUCTIVE AND UROLOGIC DRUGS ADVISORY COMMITTEE (BRUDAC) AND THE DRUG SAFETY AND RISK MANAGEMENT ADVISORY COMMITTEE (DSARM AC) September 17, 2014 FDA background documents for
More informationAndrogens and Anabolic Steroids Prior Authorization with Quantity Limit Through Preferred Topical Androgen Criteria Program Summary
OBJECTIVE The intent of the Androgens and Anabolic Steroids Prior Authorization with Quantity Limit (PA) program is to appropriately select patients for therapy according to product labeling and/or clinical
More informationMALE HORMONE THERAPY OPTIONS
MALE HORMONE THERAPY OPTIONS The following tables have been compiled by Women s staff pharmacists to represent some of the more frequently prescribed regimens for men. The Women s logo is placed throughout
More informationMonth/Year of Review: September 2013 Date of Last Review: December 2009
Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119 Copyright 2013 Oregon State University. All Rights
More informationMI Androgen Deficiency Hypogonadism
MI Androgen Deficiency Hypogonadism WADA TUE Expert Group John A Lombardo, MD October 2014, Columbus, Ohio USA Hypothalamic-Pituitary-Gonadal Axis / 2 Hypogonadism/Androgen Deficiency Clinical syndrome:
More informationJeremiah Murphy, MD Mercy Urology Clinic. October 21, 2017
Jeremiah Murphy, MD Mercy Urology Clinic October 21, 2017 Describe an appropriate strategy for the evaluation and diagnosis of male hypogonadism Endocrine Society Clinical Practice Guideline-2010 Review
More informationAndrogens and Anabolic Steroids Prior Authorization and Quantity Limit Program Summary
Androgens and Anabolic Steroids Prior Authorization and Quantity Limit Program Summary FDA APPROVED INDICATIONS DOSAGE 1-11,27,28,32,33,37-39,41,42,46,50 Topical Androgen Agents Agent Indication Dosage
More informationMedical Policy Testosterone Therapy
Medical Policy Testosterone Therapy Subject: Testosterone Therapy Effective Date: April 2015 Overview: Testosterone cypionate, testosterone enanthate, testosterone undecanoate, and testosterone pellet
More informationInsight into male menopause'
Insight into male menopause' Dr Mark Vanderpump MD FRCP Consultant Endocrinologist Clinics: Tuesday PM Mark Vanderpump Consultant Physician and Endocrinologist Introduction Serum total and free testosterone
More informationThe Testosterone Quandary. Beth Crowder, PhD, APRN
The Testosterone Quandary Beth Crowder, PhD, APRN Objectives Define testosterone, the hypothalamic-pituitary-gonadotrophic axis, and normal blood levels List functions of testosterone and symptoms of low
More informationMALE HORMONE THERAPY OPTIONS
MALE HORMONE THERAPY OPTIONS The following tables have been compiled by Women s International Pharmacy staff pharmacists to represent some of the more frequently prescribed regimens for men. The Women
More informationCigna Drug and Biologic Coverage Policy
Cigna Drug and Biologic Coverage Policy Subject Implantable Hormone Pellets Table of Contents Coverage Policy... 1 General Background... 3 Coding/Billing Information... 5 References... 6 Effective Date...
More informationNatural Hair Transplant Medical Center, Inc Dove Street, Suite #250, Newport Beach, CA Phone
Natural Hair Transplant Medical Center, Inc. 1000 Dove Street, Suite #250, Newport Beach, CA 92660 Phone-949-622-6969 Finasteride (PROPECIA ) Acknowledgement Finasteride is an oral medication, manufactured
More informationInappropriate Testosterone Billings
Inappropriate Testosterone Billings Carla Patrick-Fagan March 30, 2015 Truven Health Analytics Inc. All Rights Reserved. 1 Agenda Proposed in the 2015 analytic plan Steroid prescriptions Code of Federal
More informationAll About T Testosterone for FTMs. Presented by John Otto, MLIS
All About T Testosterone for FTMs Presented by John Otto, MLIS Who? Anyone thinking about transitioning Those who have transitioned, but want to know more Empowerment from self-managing transition Allies
More informationComparison of Testosterone Replacement Therapy Medications in the Treatment of Hypogonadism
Brigham Young University BYU ScholarsArchive All Student Publications 2016-07-27 Comparison of Testosterone Replacement Therapy Medications in the Treatment of Hypogonadism Christopher M. Williams Brigham
More informationSecrets of Abang Sado : Effects of testosterone therapy. Azraai Nasruddin
+ Secrets of Abang Sado : Effects of testosterone therapy Azraai Nasruddin + Testosterone Testosterone : Steroid hormone - Made primarily by the testicles in males - Small amounts produced by the adrenal
More informationM0BCore Safety Profile. Pharmaceutical form(s)/strength: 5 mg SE/H/PSUR/0002/006 Date of FAR:
M0BCore Safety Profile Active substance: Finasteride Pharmaceutical form(s)/strength: 5 mg P-RMS: SE/H/PSUR/0002/006 Date of FAR: 16.05.2014 4.3 Contraindications Finasteride is not indicated for use in
More informationAffirming Care of the Transgender Patient
Mountain West AIDS Education and Training Center Affirming Care of the Transgender Patient Jessica Rongitsch, MD, FACP This presentation is intended for educational use only, and does not in any way constitute
More informationSUMMARY and OBJECTIVES. LOW T- I m half the man I used to be. Prevalence of Low-T. Definition of Hypogonadism 9/19/ Million men in the US
SUMMARY and OBJECTIVES LOW T- I m half the man I used to be A discussion of male hypogonadism David Doriguzzi, PA-C Valley Endocrine & Diabetes Consultants Definition Prevalence Causes Signs & Symptoms
More informationDonald W. Morrish, MD, PhD, FRCPC Presented at Mountain Man: Men's Health Conference, May Terry s Testosterone
Focus on CME at University of Alberta ADAM: Dealing with the Decline Donald W. Morrish, MD, PhD, FRCPC Presented at Mountain Man: Men's Health Conference, May 2005 We now know there is a decline in total
More information1001 West Broadway, Vancouver, BC V6H 4B1. Topical Finasteride
1001 West Broadway, Vancouver, BC V6H 4B1 Topical Finasteride 1 Topical finasteride is a solution containing the drug finasteride typically sold under the brand names Propecia and Proscar. The Finasteride
More informationAndrogenes and Antiandrogenes
Androgenes and Antiandrogenes Androgens The androgens are a group of steroids that have anabolic and/or masculinizing effects in both males and females. Testosterone [tess-toss-terone], the most important
More informationTestosterone Use and Effects
Parkland College Natural Sciences Poster Sessions Student Works 2013 Testosterone Use and Effects Brandon Mills Parkland College Recommended Citation Mills, Brandon, "Testosterone Use and Effects" (2013).
More informationFINASTERIDE (PROPECIA, PROSCAR) SIDE EFFECT & CONSENT FORM
750 West Broadway Street Suite 905 Vancouver, BC M5Z 1K1 FAX: (604) 648-9003 vancouveroffice@donovanmedical.com FINASTERIDE (PROPECIA, PROSCAR) SIDE EFFECT & CONSENT FORM What is finasteride? Finasteride
More informationPRODUCT INFORMATION TESTOVIRON DEPOT. (testosterone enanthate)
PRODUCT INFORMATION TESTOVIRON DEPOT (testosterone enanthate) NAME OF THE MEDICINE Testosterone enanthate is designated chemically as 17 beta-heptanoyloxy-4-androstene-3- one. The empirical formula of
More informationHGH for Sale Natural Anti-Aging Human Growth Hormone
HGH for Sale Natural Anti-Aging Human Growth Hormone Human growth hormone is one of the hottest supplement trends on the market, and now you can purchase top-quality HGH to be delivered right to your home!
More informationRobert Perlstein, M.D. Medical Officer. Center for Drug Evaluation and Research. U.S. Food & Drug Administration
-------------------- Robert Perlstein, M.D. Medical Officer Center for Drug Evaluation and Research U.S. Food & Drug Administration -------------------- Sentencing of Food and Drug Offenses Before the
More informationOriginal Research Declining testicular function in aging men
(2003) 15, Suppl 4, S3 S8 & 2003 Nature Publishing Group All rights reserved 0955-9930/03 $25.00 www.nature.com/ijir Original Research 1 * 1 Wesley Woods Health Center, Atlanta, Georgia, USA Age-related
More informationIcd-10 low levels of testosterone
Icd-10 low levels of testosterone The Borg System is 100 % Icd-10 low levels of testosterone 1-10-2017 if your hormone levels are too high or too low, you may have a hormone disorder. Hormone diseases
More informationTestosterone Replacement Therapy
30 Bond Street, Toronto ON, M5B 1W8 www.odprn.ca info@odprn.ca Testosterone Replacement Therapy Environmental Scan and Local/Historical Context December 1, 2014 2 Executive Summary Part A: Pharmacy Benefit
More informationTestosterone Effects in Transmen
Transmen Testosterone Effects in Transmen EFFECT Skin oiliness/acne Facial/body hair growth Scalp hair loss Increased muscle mass/strength Fat redistribution Cessation of menses Clitoral enlargement Vaginal
More informationTREATMENT OPTIONS FOR MALE HYPOGONADISM
TREATMENT OPTIONS FOR MALE HYPOGONADISM Bruce Biundo, RPh, FACA PCCA Pharmacy Consulting Department Updated July 2012 Hypogonadism in men is primarily a state involving lower than expected levels of testosterone,
More informationGynaecomastia. Benign breast conditions information provided by Breast Cancer Care
Gynaecomastia This booklet tells you about gynaecomastia. It explains what gynaecomastia is, what causes it, how it s diagnosed and what will happen if it needs to be treated or followed up. Benign breast
More informationCurrent Data and Considerations Novel Testosterone Formulations
Current Data and Considerations Novel Testosterone Formulations 1 Current and Novel Therapeutic Options Module 4 2 Objectives Identify desirable characteristics of ideal testosterone formulations Review
More informationCpt code for testosterone cypionate injection
Cpt code for testosterone cypionate injection As the number of people taking injections. Number: 0007. Policy. Aetna considers the diagnosis and treatment of erectile dysfunction (impotence) medically
More informationAdverse effects of anabolic androgenic steroids abuse on gonadal function, glucose homeostasis and cardiovascular function
Adverse effects of anabolic androgenic steroids abuse on gonadal function, glucose homeostasis and cardiovascular function Associate Professor Caroline Kistorp, Ph.D Department of Internal Medicine, Herlev
More informationTESTOFEN HUMAN CLINICAL TRIAL GENCOR PACIFIC, INC. Copyright 2006 by Gencor Pacific, Inc.
GENCOR PACIFIC, INC. 920 E. Orangethorpe Avenue, Suite B, Anaheim, CA 92801 Ph: 714.870.8723 714.870.8724 efax: 732.875.0306 drjit@gencorpacific.com gita@gencorpacific.com www.gencorpacific.com TESTOFEN
More informationTransgender 201: Case Discussion Group
Transgender 201: Case Discussion Group Melissa Davis, MD Maria Barnett, DO October 19, 2017 Maria Barnett, DO, Date Welcome! Disclosures Introductions Discussion The total time of this workshop will depend
More informationClinical Study Synopsis
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
More informationFemale testosterone level chart
Female testosterone level chart The Borg System is 100 % Female testosterone level chart Mar 23, 2015. Male, Female. Age: T Level (ng/dl):, Age: T Level (ng/dl):. 0-5 mo. 75-400, 0-5 mo. 20-80. 6 mos.-9
More informationTESTIM (testosterone gel) for topical use, CIII Initial U.S. Approval: 1953
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use TESTIM safely and effectively. See full prescribing information for TESTIM. TESTIM (testosterone
More informationPHYSICIANS CIRCULAR FINASTERIDE PROSCAR. Tablet 5-Alpha Reductase Inhibitor
PHYSICIANS CIRCULAR FINASTERIDE PROSCAR Tablet 5-Alpha Reductase Inhibitor FINASTERIDE (PROSCAR) a synthetic 4-azasteroid compound, is a specific inhibitor of Type II 5α-reductase, an intracellular enzyme
More informationXYOSTED (testosterone enanthate) injection, for subcutaneous use CIII Initial US approval: 1953 IMPORTANT SAFETY INFORMATION
ANTARES PHARMA ANNOUNCES THE COMMERCIAL AVAILABILITY OF XYOSTED (TESTOSTERONE ENANTHATE) INJECTION A NEW TREATMENT FOR ADULT MEN DIAGNOSED WITH TESTOSTERONE DEFICIENCY XYOSTED - A Novel Subcutaneous Testosterone
More informationThe ICL Insider. Lab Testing: Testosterone. In This Issue. The Debate
The ICL Insider February 2017 Volume 2, Issue 2 Lab Testing: Testosterone In This Issue Testosterone shashtilak@iclabs.ca Next Issue: Expected Release April 2017 The Debate Aging is accompanied by various
More informationDr Tarza Jamal Pharmacology Lecture 2
Contraceptives and androgen hormone Contraceptives: Currently, interference with ovulation is the most common pharmacologic intervention for preventing pregnancy. Major classes of contraceptives 1. Combination
More informationscr.zacks.com 10 S. Riverside Plaza, Suite 1600, Chicago, IL (LPCN - NASDAQ) INITIATION ZACKS ESTIMATES
Small-Cap Research August 18, 2014 Jason Napodano, CFA David Bautz, PhD 312-265-9421 / jnapodano@zacks.com scr.zacks.com 10 S. Riverside Plaza, Suite 1600, Chicago, IL 60606 Lipocine, Inc. (LPCN - NASDAQ)
More informationIcd 10 hormone replacement therapy male
Icd 10 hormone replacement therapy male 2018 ICD - 10 code for Hormone replacement therapy is Z79.890. Lookup the complete ICD 10 Code details for Z79.890. The ICD - 10 system requires that. TEENren who
More informationElements for a Public Summary. Overview of disease epidemiology
VI.2 VI.2.1 Elements for a Public Summary Overview of disease epidemiology Benign prostatic hyperplasia (BPH) (an increase in size of the prostate that is not cancerous) is the most prevalent of all diseases
More informationHIGHLIGHTS OF PRESCRIBING INFORMATION
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use testosterone gel safely and effectively. See full prescribing information for testosterone gel. Testosterone
More informationTESTOSTERONE gel, for topical use, CIII Initial U.S. Approval: 1953
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use TESTOSTERONE gel safely and effectively. See full prescribing information for TESTOSTERONE gel. TESTOSTERONE
More informationUse of Performance Enhancing Substances Good Chemistry Gone Bad. Evan M. Klass, M.D., F.A.C.P.
Use of Performance Enhancing Substances 2017 Good Chemistry Gone Bad Evan M. Klass, M.D., F.A.C.P. Doping the use of banned athletic performance-enhancing drugs by competitors Performance enhancing substances
More informationGSK Medicine: Study Number: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Human, Recombinant) Reference Number: CP.CPA.76 Effective Date: 11.16.16 Last Review Date: 08.17 Line of Business: Medicaid Medi-Cal Revision Log See Important Reminder at the end of
More informationCreatine Versus Anabolic Steroids. Over the past few years, many athletes have been using performance-enhancing
Hester 1 Kyle Hester Instructor s Name ENGL 1013 Date Creatine Versus Anabolic Steroids Over the past few years, many athletes have been using performance-enhancing supplements on a regular basis. Two
More informationPRODUCT INFORMATION PRIMOTESTON DEPOT. (testosterone enantate)
PRODUCT INFORMATION PRIMOTESTON DEPOT (testosterone enantate) NAME OF THE MEDICINE Testosterone enantate is designated chemically as 17 beta-heptanoyloxy-4-androstene-3- one. The empirical formula of testosterone
More informationArthi Thirumalai 1, Kathryn E. Berkseth 1, John K. Amory 2
REVIEW Treatment of Hypogonadism: Current and Future Therapies [version 1; referees: 2 approved] Arthi Thirumalai 1, Kathryn E. Berkseth 1, John K. Amory 2 1Division of Metabolism, Endocrinology, and Nutrition,
More informationMale Hormone Replacement Therapy. Punita Dhindsa D.O PGY 2
Male Hormone Replacement Therapy Punita Dhindsa D.O PGY 2 Physiology of Testosterone & Causes of Hypogonadism in Males The use of testosterone therapy is very common in the US, with an estimated 2.3 million
More informationUpdates on Anti-doping and TUE Management in Paralympic Sport
International Paralympic Committee Updates on Anti-doping and TUE Management in Paralympic Sport Matthew Fedoruk, Ph.D. March 15, 2018 PyeongChang 2018 IPC Medical / Sports Science Committee Workshops
More informationChapter 5. General discussion
Chapter 5. General discussion 127 Chapter 5 In 2003, two review papers concluded that endogenous androgens do not show any consistent association with cardiovascular disease (CVD) risk 1,2. Apparently,
More informationFormally known as anabolic steroids or anabolic-androgenic steroids, but they are sometimes called 'roids', 'gear' or 'juice'.
Steroids What are steroids? Steroids are drugs that help the growth and repair of muscle tissue. They are synthetic hormones that imitate male sex hormones, specifically testosterone. Steroids can increase
More informationAnadrol For Sale Oxymetholone
Anadrol For Sale Anadrol 50, a brand name for the chemical oxymetholone (C 12 H 32 O 3 ), is a powerful anabolic steroid that most people still refer to as simply Anadrol. Anadrol reviews are usually positive,
More informationThe study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationEssential Standards. 8.ATOD.2 Understand the health risks associated with alcohol, tobacco, and other drug use.
Essential Standards 8.ATOD.2 Understand the health risks associated with alcohol, tobacco, and other drug use. Clarifying Objective 8.ATOD.2.2 Evaluate the magnitude and likelihood of the risks associated
More informationWhat do these athletes have in common?
What do these athletes have in common? Drugs in Sport Why do athletes cheat? 1988 Olympics 100m Final Why is this photo so iconic? 1988 Olympics 100m Final First time ever 4 of the 8 finalists run under
More informationIntroduction. 1 Policy
Policies for the Commissioning of Healthcare Policy for the commissioning of arthroscopic shoulder decompression surgery for the management of Pure Subacromial Shoulder Impingement Policy Number 48 (Pan
More informationMens Health Post Puberty. Nayan Patel PharmD
Mens Health Post Puberty Nayan Patel PharmD Definition of Androgen Deficiency * Consistently low testosterone * Associated signs/symptoms * Evidence based review of literature * Data is weak at best Definition
More informationIntroduction to ICD-10-CM. Improving the Financial Health of the Practices we Serve.
Improving the Financial Health of the Practices we Serve. What is ICD-10???? ICD-10 replaces the ICD-9 code sets and includes updated NEW medical terminology and updated classification of diseases. The
More informationAre Steroids Worth the Risk?
Are Steroids Worth the Risk? Dominic has baseball on the brain. Just being good isn't enough he wants to be the best. He dreams of playing in the majors someday, but worries about the intense competition
More informationAndroGel. (testosterone gel) 1% H 3 C
1 AndroGel (testosterone gel) 1% 500122/500127 Rev Dec 2004 DESCRIPTION AndroGel (testosterone gel) is a clear, colorless hydroalcoholic gel containing 1% testosterone. AndroGel provides continuous transdermal
More informationWHY IS PREVENTION IMPORTANT?
A GUIDE TO TRUST THE POWER OF PREVENTION < 2 > WHY IS PREVENTION IMPORTANT? Hereditary angioedema (HAE) symptoms can range in severity. Some attacks may be mild or temporarily disabling, but others can
More informationw w w. o p t i m a l h e a l t h m d. c o m Optimal Health & Rejuvenation Center, LLC 2007
Optimize your life. LONGEVITY GUIDE TO 2 0 0 7 w w w. o p t i m a l h e a l t h m d. c o m Optimize your life. INTRODUCTION..................................I DO YOU NEED THERAPY?.........................1
More informationpump. a metered-dose pump that delivers 30 mg of testosterone per twist. Each metered-dose pump is supplied with an applicator.
1 HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use AXIRON safely and effectively. See full prescribing information for AXIRON. AXIRON (testosterone)
More informationElements for a public summary
VI.2 VI.2.1 Elements for a public summary Overview of disease epidemiology Prostate gland enlargement is a common condition as men get older. Also called benign prostatic hyperplasia (BPH) and prostatic
More informationPackage Leaflet: Information for the patient. Sustanon 250, 250 mg/ml, solution for injection (testosterone esters)
Package Leaflet: Information for the patient Sustanon 250, 250 mg/ml, solution for injection (testosterone esters) Read all of this leaflet carefully before you start using this medicine because it contains
More informationTestosterone for Sale
Testosterone for Sale Testosterone (C 19 H 28 O 2 ) is the male hormone. The brain, the pituitary gland, and the testes must work in perfect harmony to produce adequate amounts of it. If you want to know
More informationTESTOVIRON 300 TESTOCYP 200 INJECTABLE PRODUCTS
Platinum Biotech has a commitment to all people, a commitment of improving the quality of life for each and every person worldwide, through which we constantly strive to innovate, improve and increase
More informationDrugs & Exercise. Lesson. By Carone Fitness
Lesson Drugs & Exercise By Carone Fitness Being physically fit and using drugs just don t mix. Unfortunately, there are some athletes that do use drugs for recreation or to enhance performance. There are
More informationPRODUCT INFORMATION PROVIRON
PRODUCT INFORMATION PROVIRON NAME OF TE MEDICINE Mesterolone is a white to yellowish crystalline powder and is practically insoluble in water. The chemical name for mesterolone is 17 beta-ydroxy-1 alpha-methyl-5
More informationLearning Goals. What are steroids? Who uses steroids? Why do people use steroids? What are the health risks associated with using steroids?
Learning Goals What are steroids? Who uses steroids? Why do people use steroids? What are the health risks associated with using steroids? Performance Enhancing Drugs Nutritional Aids Pharmacological Aids
More informationHypogonadism and Testosterone Replacement Therapy
Testosterone Replacement Therapy Hypogonadism and Testosterone Replacement Therapy a report by Adrian S Dobs, MD, MHS and Anjana Myneni, MD Professor of Medicine and Oncology, Department of Medicine, Johns
More informationThe Science of. NUTRICULA Longevity Journal
32 December, 2011 The Science of 33 NUTRICULA Longevity Journal As men age, there is often a decline in libido and sexual function. This decline frequently interferes in intimacy within romantic relationships,
More informationPACKAGE LEAFLET: INFORMATION FOR THE USER. FINASTERIDE 1 MG FILM-COATED TABLETS (finasteride)
PACKAGE LEAFLET: INFORMATION FOR THE USER FINASTERIDE 1 MG FILM-COATED TABLETS (finasteride) Read all of this leaflet carefully before you start taking this medicine because it contains important information
More informationAnavar For Sale Oxandrolone
Anavar For Sale Oxandrolone Anavar (oxandrolone C 19 H 30 O 3 ) is an anabolic steroid that provides outstanding results. The Anavar steroid is a synthesized version of testosterone that boosts lean muscle
More informationNatural estrogens estradiol estrone estriol
Estrogens Natural estrogens estradiol estrone estriol Nonsteroidal synthetic Diethylstilbestrol Chlorotrianisene Methallenestril Steroidal synthetic Ethinyl estradiol Mestranol Quinestrol To decrease some
More informationIf looking for a book Testosterone: Boost Testosterone Naturally - For - Weight Loss, Muscle Building, Libido & Erectile Dysfunction (Testosterone
Testosterone: Boost Testosterone Naturally - For - Weight Loss, Muscle Building, Libido & Erectile Dysfunction (Testosterone Enanthate, Testosterone Replacement... Pressure, Tongkat Ali, Increase Testo)
More information