What questions should a provider ask when following up on a patient taking Testosterone Replacement Therapy (TRT)?

From the Guidelines

When following up on a patient taking Testosterone Replacement Therapy (TRT), providers should ask about symptom improvement, side effects, medication adherence, and any new health concerns, prioritizing questions about changes in energy levels, libido, mood, and physical symptoms, as well as monitoring for erythrocytosis, sleep apnea, and prostate issues, as recommended by the American College of Physicians in 2020 1.

Key Questions to Ask

• Changes in energy levels, libido, mood, and physical symptoms that initially prompted treatment
• Side effects such as erythrocytosis (headaches, visual changes, or flushing), sleep apnea symptoms, acne, breast tenderness or enlargement, testicular atrophy, and fertility concerns
• Medication adherence and administration technique for injections, gels, patches, or pellets
• Recent blood test results, including total testosterone levels (aiming for 400-700 ng/dL), hematocrit (watching for levels above 54%), PSA (for prostate cancer risk), and lipid profiles
• Changes in urinary symptoms that might indicate prostate issues, cardiovascular symptoms, and any new medications or supplements that could interact with TRT

Importance of Monitoring

Monitoring is crucial to balance the benefits of TRT against potential adverse effects, as testosterone affects multiple body systems, and evidence from 20 observational studies with a mean follow-up ranging from 0.73 to 10.3 years showed no increased risk for mortality, cardiovascular events, prostate cancer, or pulmonary embolism or deep venous thrombosis, but evidence for long-term safety is lacking 1.

Patient Preferences

Patient preferences should also be considered, as studies have shown that patients prefer topical gels over injections or patches due to convenience, ease of use, and nonstaining of clothes, and that lack of energy, decreased strength and endurance, and deterioration in work performance are the most bothersome symptoms for men with hypogonadism 1.

From the FDA Drug Label

5 WARNINGS AND PRECAUTIONS 5.1 Worsening of Benign Prostatic Hyperplasia (BPH) and Potential Risk of Prostate Cancer 5.3 Polycythemia 5.4 Venous Thromboembolism 5.5 Cardiovascular Risk 5.6 Abuse of Testosterone and Monitoring of Serum Testosterone Concentrations 17.3 Potential Adverse Reactions with Androgens

When following up on a patient taking Testosterone Replacement Therapy (TRT), a provider should ask questions related to:

• Prostate health: symptoms of benign prostatic hyperplasia (BPH) or prostate cancer
• Polycythemia: signs of increased red blood cell mass
• Venous thromboembolism: symptoms of blood clots
• Cardiovascular risk: signs of increased cardiovascular risk
• Abuse of testosterone: signs of abuse or misuse
• Adverse reactions: any potential adverse reactions to androgens, such as gynecomastia, sleep apnea, or edema 2

From the Research

Follow-up Questions for Patients on TRT

When following up on a patient taking Testosterone Replacement Therapy (TRT), providers should ask questions to monitor the patient's response to treatment, potential side effects, and overall satisfaction with the therapy. Some key questions to ask include:

• How have your symptoms of testosterone deficiency changed since starting TRT, such as libido, erectile function, energy, and mood? 3, 4
• Have you experienced any improvements in concentration or mood since starting TRT? 4
• Are you satisfied with your current TRT regimen, and are there any reasons you prefer your current treatment method (e.g., injections, gels, pellets)? 4
• Have you noticed any changes in your physical health, such as increased muscle mass or decreased fat deposition? 5
• Are you experiencing any side effects from TRT, such as acne, hair loss, or increased red blood cell count? 5

Monitoring and Adjustments

Providers should also ask questions to monitor potential risks associated with TRT, such as:

• Do you have a history of heart failure, and have you experienced any changes in your cardiovascular health since starting TRT? 5
• Have you noticed any changes in your urinary or prostate health, such as increased urinary frequency or prostate-specific antigen (PSA) levels? 6
• Are you aware of the potential risks associated with TRT, such as heart attack, stroke, or blood clots? 6

Mental Health and Quality of Life

Additionally, providers should ask questions to assess the patient's mental health and quality of life, such as:

• Have you experienced any changes in your depressive symptoms or anxiety since starting TRT? 7
• How has TRT affected your overall quality of life, including your relationships and daily activities? 3, 4