Claude Skills by dromlakhani

Measure early morning serum DHEAS to screen for adrenal hyperandrogenism in women with hirsutism and normal total/free testosterone but clinical signs of androgen excess. Consider testing when there is suspicion of nonclassic congenital adrenal hyperplasia or adrenal tumor, especially in patients with high-risk ethnicity, family history, or progressive hirsutism despite normal ovarian androgen levels.

The clinician orders early morning serum total and free testosterone when total testosterone is normal but the patient presents with moderate to severe hirsutism or mild hirsutism accompanied by signs of hyperandrogenism such as menstrual irregularity or lack of response to therapy. This is indicated when a clinician questions whether to check free testosterone in a patient with normal total testosterone but worsening hirsutism and irregular periods.

For women with patient-important hirsutism despite cosmetic measures who have suboptimal response after ≥6 months of oral contraceptive monotherapy, consider adding an antiandrogen; no preference among antiandrogens but avoid flutamide due to its hepatotoxicity risk.

This skill guides clinicians to initiate oral combined estrogen–progestin contraceptives as initial therapy for premenopausal women with patient-important hirsutism despite cosmetic measures who are not seeking fertility. It emphasizes that no specific OC formulation is preferred, as all appear equally effective for hirsutism with low side‑effect risk.

Suggest oral combined estrogen–progestin contraceptives as initial therapy for most premenopausal women with patient‑important hirsutism who are not seeking fertility. Consider this approach when hirsutism persists despite cosmetic measures (shaving, plucking, waxing) and the patient desires pharmacological treatment.

Perform pelvic ultrasonography to detect ovarian neoplasm in patients with severe or progressive hyperandrogenism, triggered by moderate/severe hirsutism, virilization, or rapid hair growth despite therapy. Third-person guidance for clinicians to gather data, rule in/out indication, classify findings, and decide next steps.

In patients with known hyperandrogenemia undergoing hair removal (laser, photoepilation, or electrolysis), add pharmacologic therapy to minimize hair regrowth. Trigger phrases include "known hyperandrogenemia," "post-laser hair regrowth," and "persistent hirsutism after hair removal."

This skill guides clinicians to select photoepilation for patients with dark (auburn/brown/black) terminal hair and electrolysis for those with light (blonde/white) hair when considering direct hair removal for hirsutism. Trigger phrases include "patient-important hirsutism despite cosmetic measures," "dark facial hair," "light facial hair," and desire for permanent hair reduction.

Performs a urine or serum pregnancy test in premenopausal women presenting with amenorrhea and hirsutism to exclude pregnancy before initiating androgen evaluation or teratogenic therapies. Trigger phrases include "amenorrhea", "hirsutism", "rule out pregnancy", and "sexually active".

Orders early morning 17‑hydroxyprogesterone to screen for nonclassic congenital adrenal hyperplasia due to 21‑hydroxylase deficiency in hyperandrogenemic women with amenorrhea or infrequent menses. Triggered by menstrual irregularity with hirsutism and a clinical request to rule out adrenal hyperplasia.

This skill screens high‑risk patients for nonclassic congenital adrenal hyperplasia (NCCAH) by measuring 17‑OHP even when total and free testosterone are normal. Use when a clinician says, "She has a family history of CAH; should we still screen despite normal androgens?" or notes positive family history or high‑risk ethnic group.

For premenopausal women with patient-important hirsutism despite cosmetic measures, clinicians should initiate pharmacologic therapy and maintain the same regimen for at least six months before considering any dose change, medication switch, or addition of another agent. Trigger phrases that prompt evaluation include "patient-important hirsutism despite cosmetic measures," "suboptimal response after six months of monotherapy," and "need to alter dose or agent."

Initiates oral contraceptives or other pharmacologic agents as first‑line treatment for women with hirsutism that causes sufficient distress to seek additional treatment despite shaving, plucking, or waxing. Trigger phrase: "She’s tried shaving and waxing but still wants treatment; should we start medicine?"

Measures serum total and/or free testosterone in women with an abnormal Ferriman–Gallwey hirsutism score to evaluate for hyperandrogenemia. Triggered when a clinician wonders whether to check androgen levels because the patient's hirsutism score exceeds the population cutoff.

For women of color with facial hirsutism seeking photoepilation, suggest long‑wavelength laser (Nd:YAG or diode) with skin cooling and warn about paradoxical hypertrichosis, especially in Mediterranean or Middle Eastern backgrounds. Consider electrolysis or topical eflornithine when PH risk is high.

Suggests a 3- to 6‑month trial of testosterone dosing to achieve a mid‑normal premenopausal value in a reference assay for postmenopausal women with properly diagnosed HSDD and no contraindications. Triggered when a postmenopausal woman requests therapy for low sexual desire after appropriate HSDD workup and exclusion of contraindications.

This skill advises against routinely treating women with low androgen levels due to hypopituitarism, adrenal insufficiency, surgical menopause, pharmacological glucocorticoid administration, or other associated conditions because of insufficient efficacy and long-term safety data. It is triggered when a clinician considers androgen therapy for a woman with known hypopituitarism, adrenal insufficiency, or history of bilateral oophorectomy.

Suggests oral contraceptives over injectable contraceptives for women with BMI ≥27 kg/m2 with comorbidities or BMI ≥30 kg/m2 seeking contraception, provided they are well‑informed and oral contraceptives are not contraindicated. Triggers include clinician questions such as “Which contraceptive method is less likely to cause weight gain in this obese patient?” or “Should I recommend oral pills instead of depot injection for this patient with BMI 29 and hypertension?”.

Recommends measuring testosterone levels at baseline and after 3–6 weeks of initial treatment to assess for patient overuse or excessive dosing. Triggered when initiating testosterone therapy in women with hypoactive sexual desire disorder (HSDD) to verify levels remain within physiological range and avoid supratherapeutic dosing.

Recommends discontinuing testosterone therapy in women with hypoactive sexual desire disorder (HSDD) who show no symptomatic improvement after a 6‑month trial. Triggers include a clinician reviewing lack of response at follow‑up and considering continuation beyond six months while noting the absence of long‑term safety data.

This skill recommends discontinuing testosterone therapy in women with hypoactive sexual desire disorder (HSDD) when there is no clinical improvement in desire or sexual satisfaction after six months of treatment. Clinical triggers include a reassessment visit where the patient reports persistent lack of improvement in libido or sexual pleasure despite adherence to therapy.

The guideline recommends against generalized testosterone use for indications such as infertility, sexual dysfunction other than HSDD, cognitive, cardiovascular, metabolic, bone health, or general well-being due to insufficient evidence of benefit and lacking long-term safety data. Consider this recommendation when a clinician contemplates prescribing testosterone for any indication other than confirmed hypoactive sexual desire disorder in postmenopausal women.

Advises against using testosterone preparations formulated for men or compounded by pharmacies in women due to lack of efficacy and safety data specific to female physiology. Triggers include a clinician considering a transdermal patch, gel, or injectable testosterone product that is labeled or compounded for male use.

The guideline recommends against routinely measuring testosterone in women for diagnostic purposes due to the lack of a reliable correlation between symptoms and testosterone levels. This recommendation is triggered when a clinician orders a testosterone test to assess fatigue, low libido, or mood symptoms without evidence of underlying endocrine pathology.

This skill recommends monitoring serum testosterone levels 3–6 weeks after initiating therapy and every 6 months thereafter to detect overuse or signs of androgen excess. It is triggered when a clinician manages a woman on testosterone therapy requiring early safety assessment and ongoing surveillance for adverse effects.

Recommends reviewing serum testosterone levels every 6 months during ongoing therapy to monitor for excessive use and signs of androgen excess such as hirsutism or acne. It is indicated when a clinician manages a woman receiving long-term testosterone therapy and needs to evaluate for adverse effects or consider dose adjustment.

Recommends checking baseline testosterone level and using an approved non-oral preparation (such as transdermal patch, gel, or cream) when initiating a testosterone trial for hypoactive sexual desire disorder (HSDD) in women. Triggered when a clinician plans to start a T trial for HSDD and needs to confirm baseline levels and select an appropriate delivery method.

Suggests testosterone therapy as symptomatically indicated for low testosterone levels, and not for improving dyslipidemia or cardiovascular disease risk. Trigger phrases include "Patient with low testosterone symptomatic", "Considering testosterone for hypogonadism symptoms", and "Assessing appropriate indications for testosterone replacement".

Recommends that medical therapy for acromegaly be withheld during pregnancy and administered only for tumor control and headache relief. Consider when managing a pregnant patient with acromegaly who presents with tumor growth or worsening headache.

Advises adjusting testosterone dose based on serum levels and clinical response: reduce dose if total testosterone consistently exceeds the normal range, escalate if hypogonadal symptoms persist despite sub-mid-normal levels. Triggered when a clinician reviews a patient's testosterone result and symptoms and wonders, "Do I need to change the dose or is the current dose appropriate?"

Advises against obtaining testosterone levels during acute illness as results may be unreliable. Triggers when a patient is febrile, infected, or otherwise acutely unwell and the clinician questions whether to draw testosterone now or delay testing until recovery.

Advises against testosterone therapy in men with biochemical recurrence after prostate cancer treatment due to very limited data and potential risk of progression. Consider when a patient has a rising PSA after definitive therapy and the clinician evaluates testosterone for hypogonadism, questioning whether TTh is safe in BCR.

Testosterone monotherapy is not an effective treatment for clinical depressive disorders in hypogonadal men and should not be used for that purpose. Consider this when a patient presents with depressive mood and low testosterone, questioning whether testosterone will improve depression or if depression should be treated separately.

The guideline recommends against using testosterone therapy alone to prevent or treat diabetes in men with hypogonadism. Clinicians should consider this recommendation when contemplating testosterone to improve HbA1c or insulin resistance and questioning whether testosterone can replace glucose-lowering therapy or be used for diabetes management.

This skill advises against initiating testosterone therapy in men who express a desire for future fathering, as exogenous testosterone suppresses spermatogenesis and can lead to infertility. It is triggered when a patient reports wanting children and the clinician contemplates prescribing testosterone, raising the question of whether testosterone therapy is safe for future fertility or should be avoided.

Recommends against using testosterone monotherapy solely to reduce fracture risk in hypogonadal men with high fracture risk. Triggered when a clinician considers osteoporosis management and asks whether testosterone will prevent fractures or if testosterone therapy should be used for bone health.

The skill advises against using testosterone therapy alone for weight loss or cardio-metabolic improvement. It triggers when a clinician considers prescribing testosterone for obesity or diabetes and questions whether testosterone alone will aid weight loss or improve metabolic parameters.

This skill advises against initiating testosterone therapy in eugonadal men with normal serum testosterone and no symptoms of deficiency. It is triggered when a clinician questions whether to prescribe testosterone for a patient with normal labs and no hypogonadal symptoms, such as asking 'should I give testosterone to someone with normal T?' or 'is treatment appropriate for eugonadal men?'

Contraindicates testosterone therapy in men with metastatic prostate cancer because of insufficient safety data and risk of rapid progression. Triggers when a patient has metastatic disease and low testosterone and the clinician wonders "can I use testosterone here?" or "is testosterone therapy appropriate in metastatic PCa?"

This skill advises against universal testosterone screening in asymptomatic men, recommending testing only when specific clinical indications are present. Trigger phrases include 'should I screen everyone for low T', 'is universal testing appropriate', or considering testosterone order in an asymptomatic patient.

Provides a practical algorithm to estimate free testosterone from total testosterone, SHBG, and albumin using the Vermeulen equation for clinical use when direct measurement is unavailable. Triggers when a clinician needs to assess bioavailable testosterone and asks "how do I calculate free T?" or "what free T value corresponds to this total T and SHBG?"

This skill suggests measuring albumin and SHBG to calculate free testosterone in men with clear dysmetabolic conditions to improve diagnostic accuracy. It is triggered when managing a patient with obesity, diabetes, or metabolic syndrome and questioning whether to calculate free testosterone or obtain SHBG and albumin.

Recommends mass spectrometry for research purposes and good-quality immunoassays for routine clinical diagnosis when standardized against an international reference range. Triggers when a clinician orders a testosterone test and asks "which assay should I use?" or questions "is this immunoassay reliable enough?"

Considers offering testosterone therapy to men on active surveillance for low-grade prostate cancer when both clinician and patient acknowledge the limited data on cancer progression risk. Triggered when managing a man with low-grade prostate cancer and low testosterone who questions whether testosterone can be used while monitoring the cancer.

This skill advises that testosterone therapy may be reasonable for men on active surveillance for prostate cancer who have hypogonadism when both clinician and patient acknowledge the paucity of long-term safety data. It is triggered when a clinician manages a man on cancer surveillance with hypogonadism and questions whether it is okay to use testosterone while monitoring the cancer, and both clinician and patient accept the uncertainty.

This skill guides clinicians to consider testosterone therapy after definitive radiation or brachytherapy for prostate cancer when the patient shows a good post-treatment response (e.g., stable low PSA) and remains low-risk. It is triggered when a patient with persistent hypogonadism symptoms and low testosterone levels is being followed post-radiotherapy and the clinician questions the safety of initiating testosterone therapy.

This skill suggests testosterone therapy may be considered after radical prostatectomy when postoperative PSA is undetectable and pathology reveals negative surgical margins, negative seminal vesicles, and negative lymph nodes. It is triggered when a clinician encounters a post‑prostatectomy patient with symptomatic low testosterone and questions whether it is safe to initiate testosterone therapy or if the cancer is sufficiently cleared.

Large RCTs show no increased prostate cancer risk with testosterone therapy in men without known prostate cancer and normal PSA, supporting its consideration in this population. This skill is triggered when a clinician evaluates a hypogonadal man with normal PSA and no prior cancer diagnosis and questions whether testosterone therapy is safe to initiate.

Recommends postponing testosterone initiation and pursuing MRI or biopsy when PSA is elevated or a prostate nodule is detected on digital rectal examination; if evaluation shows no cancer, testosterone therapy may be considered. Triggered by clinician findings of elevated PSA (>4 ng/mL) or a palpable prostate nodule during DRE, prompting the question of whether to hold testosterone until prostate cancer is ruled out.

Recommends a thorough conversation about options to preserve spermatogenesis and testicular volume when initiating testosterone in men with prior anabolic‑steroid use or ongoing testosterone therapy. Triggers when a clinician plans to start testosterone in a man with a history of AAS or current TTh and wonders how to protect fertility or what alternatives exist to maintain sperm production.