From the Guidelines
You should repeat testing for low testosterone within 12 months after starting treatment and periodically thereafter, as suggested by the American College of Physicians 1. This recommendation is based on the current evidence of the benefits and harms of testosterone treatment in adult men with age-related low testosterone. The American College of Physicians (ACP) developed this guideline to provide clinical recommendations based on a systematic review on the efficacy and safety of testosterone treatment in adult men with age-related low testosterone. Some key points to consider when repeating testing for low testosterone include:
- Reevaluating symptoms within 12 months and periodically thereafter 1
- Discontinuing testosterone treatment in men with age-related low testosterone with sexual dysfunction in whom there is no improvement in sexual function 1
- Considering intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function in men with age-related low testosterone, as costs are considerably lower for the intramuscular formulation and clinical effectiveness and harms are similar 1 It's essential to discuss the potential benefits, harms, costs, and patient's preferences when initiating testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual function 1. The timing of repeat testing is crucial because testosterone replacement therapy requires careful monitoring to ensure you're receiving the appropriate dose - too little won't resolve symptoms, while too much can increase risks of side effects like elevated red blood cell counts, acne, or potential cardiovascular issues. More frequent testing may be necessary if you experience side effects or if your symptoms return. Overall, the ACP suggests that clinicians should reevaluate symptoms within 12 months and periodically thereafter, and discontinue testosterone treatment in men with age-related low testosterone with sexual dysfunction in whom there is no improvement in sexual function 1.
From the Research
Testosterone Replacement Therapy
- The decision to repeat testosterone replacement therapy (TRT) depends on various factors, including the individual's symptoms, testosterone levels, and response to treatment 2.
- According to the Endocrine Society's clinical practice guideline, TRT should be considered for men with symptomatic testosterone deficiency to induce and maintain secondary sex characteristics and correct symptoms of hypogonadism 2.
- The guideline recommends measuring fasting morning total testosterone concentrations using an accurate and reliable assay as the initial diagnostic test, and confirming the diagnosis by repeating the measurement of morning fasting total testosterone concentrations 2.
Monitoring and Adjusting TRT
- Clinicians should monitor men receiving TRT using a standardized plan that includes evaluating symptoms, adverse effects, and compliance, measuring serum testosterone and hematocrit concentrations, and evaluating prostate cancer risk during the first year after initiating TRT 2, 3.
- The aim of TRT is to achieve testosterone concentrations in the mid-normal range during treatment, taking into consideration patient preference, pharmacokinetics, formulation-specific adverse effects, treatment burden, and cost 2, 3.
- Different formulations of TRT have varying pharmacokinetics and adverse effects, and clinicians should consider the unique characteristics of each patient when selecting a treatment regimen 3.
Repeating TRT
- There is no specific guideline on how soon to repeat TRT, as it depends on individual factors such as the patient's response to treatment and testosterone levels 2, 3.
- However, studies suggest that TRT can be effective in improving symptoms of hypogonadism, including sexual function, libido, and mood, and can be repeated as needed to maintain therapeutic benefits 4, 5, 6.