Hypogonadism in men

Patients receiving testosterone therapy require regular follow-up to ensure compliance, assess effectiveness, adjust dosing (according to symptoms, serum levels, and hematocrit), and monitor for adverse effects.

Review patients at regular intervals (every 3-4 months) during the first year of treatment, and annually thereafter.[29]Wang C, Nieschlag E, Swerdloff R, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol. 2008 Nov;159(5):507-14. https://academic.oup.com/ejendo/article/159/5/507/6676079 http://www.ncbi.nlm.nih.gov/pubmed/18955511?tool=bestpractice.com [37]Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-44. https://academic.oup.com/jcem/article/103/5/1715/4939465 http://www.ncbi.nlm.nih.gov/pubmed/29562364?tool=bestpractice.com

An evaluation of benefits and adverse effects is advised, and cessation of treatment should be considered in men without therapeutic benefit (although this would be unusual in men with a verified diagnosis of hypogonadism at baseline). Men whose sexual function or other presenting symptoms fail to improve to the desired extent should be encouraged to persevere with testosterone therapy to benefit other aspects of their long-term health.

Topical and transdermal testosterone formulations

Testosterone level should be checked 6-12 hours after testosterone gel application as this gives the mid-point value. Testosterone levels can be checked to see if they have reached therapeutic levels as early as 1 week after initiation of transdermal products, to ensure adequate treatment has been given. Hematocrit will, however, take approximately 2 months to reach a steady state, at which time final dose-adjustment can be made.

Short-acting intramuscular preparations

It is seldom useful to measure peak levels of testosterone after an injection. Rather, trough levels (prior to the next injection) are more helpful. Levels should be checked periodically. Lower testosterone levels may need to be accepted in order to prevent or mitigate erythrocytosis.

Long-acting testosterone undecanoate

Testosterone levels should be measured either immediately prior to an injection (i.e., trough level) to ensure concentration is in the low-normal range, or at the mid-point between injections, aiming for a mid-range testosterone concentration. Lower testosterone levels may need to be accepted in order to prevent or mitigate erythrocytosis.