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Testosterone cypionate lasting effects tracking sheet
Use this sheet to track possible lasting effects of testosterone cypionate, such as breast tissue change, fertility concerns, hair change, and blood or blood pressure results. Bring it to your prescriber or pharmacist.
Treatment and history
Copy these details from your prescription label and records.
Medicine name on labelFor example Depo-Testosterone or another cypionate product
Dose and schedule as prescribedCopy exactly from the label
Date treatment started
Prescriber name and clinic
Pharmacy name and phone
Plans to have children soonWrite yes, no or not sure
Other steroids or hormones usedInclude any not prescribed
Before the visit
Gather these items so the visit covers each lasting effect.
- Bring the current prescription label or pharmacy printout
- Note the names of all medicines and supplements you take
- Check with your pharmacist which testosterone product you receive
- List any breast tenderness or swelling and when it started
- Note any change in hair on the head, face or body
- Bring your most recent blood test results for hematocrit
- Write down any home blood pressure readings you have taken
- Confirm the date and time of your next blood test
- Ask the clinic whether a fertility or sperm test is planned
Changes noticed over time
Record any change, even if it seems minor. Note whether you told the clinic.
| Date | Change or symptom | Where or how it showed | Told clinic |
|---|---|---|---|
Questions for your prescriber or pharmacist
- Does the label say whether breast swelling can stay after stopping?
- What should I do if breast swelling does not go away?
- Could this treatment affect my sperm count or fertility?
- Would a sperm test be useful before or during treatment?
- Is hair loss from this medicine expected to reverse?
- How often should my hematocrit be checked?
- What blood pressure readings should I report to you?
- What symptoms of a blood clot should prompt an urgent call?
- Are there other testosterone products that would change these risks?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.