From the Research
In Alberta, treatment for low testosterone is generally recommended when a patient has both clinical symptoms of hypogonadism and confirmed low serum testosterone levels, specifically when morning total testosterone levels are below 8 nmol/L (230 ng/dL) on at least two separate occasions, along with symptoms such as decreased libido, erectile dysfunction, fatigue, decreased muscle mass, or depressed mood, as supported by the most recent study 1.
Key Considerations
- The primary treatment is testosterone replacement therapy (TRT), which comes in several forms: intramuscular injections (testosterone cypionate 50-100mg weekly or testosterone enanthate 100-200mg every 2 weeks), transdermal gels (AndroGel or Testim 50-100mg daily), or testosterone patches (2-6mg daily) 2.
- Before initiating treatment, patients should undergo baseline assessments including PSA, hematocrit, and liver function tests, and be monitored at 3,6, and 12 months, then annually, checking testosterone levels, hematocrit, PSA, and liver function 3.
- TRT is contraindicated in men with prostate cancer, severe lower urinary tract symptoms, hematocrit >54%, unstable heart disease, or those desiring fertility, as highlighted in 4 and 5.
Treatment Goals
- The goal of treatment is to restore testosterone levels to the mid-normal range (14-17 nmol/L) while alleviating symptoms, as testosterone plays a crucial role in maintaining male secondary sexual characteristics, bone density, muscle mass, and overall well-being.
- Alternative approaches, such as clomiphene citrate and human chorionic gonadotropin, may be considered for young hypogonadal patients who desire future fertility, as discussed in 5.