Nurse Practitioner Chronicles

  Testosterone Testing in Men: When to Check, How to Interpret, and the Prescribing Minefield of TRT A total testosterone of 280 at 8 AM in a symptomatic man means something. A total testosterone of 280 drawn at 3 PM after a night of poor sleep means almost nothing. Testosterone replacement therapy (TRT) is one of the fastest-growing prescriptions in men's health, driven by direct-to-consumer marketing, telehealth "optimization" clinics, and patient demand. For primary care NPs, this creates a two-sided problem: underdiagnosis of true hypogonadism in men who would benefit from treatment, and overprescription of testosterone in men who don't meet diagnostic criteria and face real risks. Getting the workup right is the foundation of safe prescribing. The Physiology: What Testosterone Does and How It's Regulated The hypothalamic-pituitary-gonadal (HPG) axis works as a feedback loop: GnRH from the hypothalamus stimulates LH and FSH from the anterior pituitary, LH stim...

  Tumor Markers in Primary Care: When to Order, When to Step Away, and Why Screening Causes More Harm Than Good PSA, CA-125, CEA, AFP—the tests that cause the most unnecessary panic in your practice. Tumor markers are among the most misused tests in primary care. They get ordered for vague abdominal pain, pelvic discomfort, fatigue, or "just to be thorough"—and then a mildly elevated result triggers imaging, referrals, biopsies, and patient anxiety for a condition that doesn't exist. The core principle:  tumor markers are for monitoring known cancers, not for screening asymptomatic patients  (with limited exceptions). The Markers: What They Do and Don't Tell You Marker Primary Cancer Association Non-Cancer Causes of Elevation Role in Primary Care PSA Prostate cancer BPH, prostatitis, recent ejaculation, bike riding, UTI, age Screening (shared decision-making for men 55–69); monitoring after treatment CA-125 Ovarian cancer Endometriosis, fibroids, PID, pregnancy, menst...