Patient Note — 135661

4/21/26, 1:30 AM Print Preview [PATIENT_NAME] DOB: [DOB] (36 yo M) Acc No. [ACCOUNT_ID] DOS: 04/20/2026 [PATIENT_NAME] 36 Y old Male, DOB: [DOB] Account: [ACCOUNT_ID]: [PHONE] [ADDRESS] Home: [PHONE] Guarantor: [GUARANTOR_NAME] Insurance: Aetna PCP: ADVANCED UROLOGY Referring: ADVANCED UROLOGY Appointment Facility: TELE-POTOMAC UROLOGY CENTER-Alex 04/20/2026 TV-F/U : [PROVIDER_NAME], MD Reason for Appointment 1. TESTO LAB REV History of Present Illness ARTERA: 36 yo Male is here with hx of vasectomy and low T. He had vasectomy with Dr. Marhamati but reported having a lot of pain during the procedure. Otherwise he is doing fine. He presents for Televisit to review repeat F/T testosterone. Latest testosterone was 198. His first T was 245. Repeat was 307. He has numerous coworkers on short activing testosterone. He has less rigid erections. Less spontaneous erections. No medical issues. NKDA. Labs from 04/2026 showed Total testosterone 198, Sex Horm Binding Glob 13.7, Free testo 51.9. Screening Vital Signs Assessments 1.Low testosterone - R79.89 (Primary) 2.Vasectomy evaluation - Z30.09 3.Erectile dysfunction associated with vasculopathy - N52.9 Treatment 1.Low testosterone Notes: Labs from 04/2026 showed Total testosterone 198, Sex Horm Binding Glob 13.7, Free testo 51.9. Albumin 4.8, Total testosterone 307.3, Sex horm binding glob, serum 15.0, Free testost 81.4. He now has two low Testosterones. We discussed Aveed and T pellets. Risks inclcude increase in h/H, increase in PSA, mood changes, testicular atrophy, affect on liver enzymes. We also discussed conservative ways of increasing testosterone naturally. He will discuss with his wife and let me know if he wants to proceed. Will proceed with Aveed bnefits. Progress Note: [PROVIDER_NAME], MD 04/20/2026 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com) Generated for Printing/Faxing/eTransmitting on: 04/21/2026 04:30 AM EDT 1/2 4/21/26, 1:30 AM Print Preview [PATIENT_NAME] DOB: [DOB] (36 yo M) Acc No. [ACCOUNT_ID] DOS: 04/20/2026 2.Vasectomy evaluation Notes: s/p Vasectomy. 3.Erectile dysfunction associated with vasculopathy Notes: We discussed ED treatment. He will hold off until he treats low T. Visit Codes [ZIP] Office Visit, Est Pt., Level 4. Modifiers: 95 Electronically signed by [PROVIDER_NAME], M.D on 04/20/2026 at 11:41 PM EDT Sign off status: Completed [FACILITY] [ADDRESS] STE 300 ALEXANDRIA, VA [ZIP] Tel: [PHONE] Fax: Progress Note: [PROVIDER_NAME], MD 04/20/2026 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com) Generated for Printing/Faxing/eTransmitting on: 04/21/2026 04:30 AM EDT 2/2