HealthRX.com · Printable question sheet
Saxenda and testosterone visit questions and monitoring tracker
Bring this sheet to your prescriber or pharmacist if you use Saxenda and testosterone, or are considering both. Record your medicines, lab and vital sign results, and questions about the monitoring points the two labels share.
My medicines and prescribers
Write what you take exactly as your pharmacy label shows it.
Saxenda prescriber nameDoctor or clinic that prescribed Saxenda
Saxenda start month and yearWhen you first began this medicine
Testosterone product nameFor example cypionate injection, gel, patch or pellets
Testosterone prescriber nameDoctor or clinic that prescribed testosterone
Pharmacy name and phoneThe pharmacy that fills both medicines
Insulin or sulfonylurea useWrite yes or no, and the name of any diabetes medicine
Before the visit
Gather these so the visit can cover both medicines.
- Bring both medicine containers or a printed list of all current medicines
- Bring your most recent hematocrit and hemoglobin lab report
- Note any blood pressure readings taken at home since your last visit
- Write down any heart rate readings or wearable device trends you have seen
- Check with your pharmacist whether any oral medicine you take is listed in the Saxenda label
- Note any blood sugar readings, especially any low readings and what caused them
- Write down any new symptoms such as headache, dizziness, or breathing changes
- Confirm the date and time of your next scheduled lab draw
Monitoring results over time
Write one row for each visit or home reading. Leave blank if not measured.
| Date | Hematocrit result | Blood pressure reading | Resting heart rate | Glucose reading |
|---|---|---|---|---|
Questions to ask
- Does my Saxenda label or testosterone label change how I should be monitored?
- How often should my hematocrit and hemoglobin be checked while on testosterone?
- What hematocrit result would prompt a change in my testosterone plan?
- Should my blood pressure be checked more often given both medicines?
- Will testosterone affect my blood sugar or any diabetes medicine I take?
- Should my insulin or sulfonylurea dose be reviewed if I use Saxenda?
- Is my resting heart rate change something to report between visits?
- Which of these symptoms should I call about right away?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.