How often can I prescribe testosterone (testosterone) for hypogonadism?

Testosterone Prescription Frequency for Hypogonadism

For hypogonadism treatment, testosterone should be prescribed at 50-400 mg every 2-4 weeks for intramuscular injections, or daily for transdermal preparations, with monitoring of testosterone levels 2-3 months after initiation and every 6-12 months thereafter. 1, 2, 3

Diagnosis Requirements Before Prescribing

Before prescribing testosterone, ensure proper diagnosis:

• Diagnosis requires at least two morning testosterone measurements confirming low levels (total testosterone <300 ng/dL) 2, 3
• Measurements must be taken on separate occasions, both in early morning 2
• Clinical symptoms must be present alongside low testosterone levels 2, 3

Prescription Options and Frequency

Injectable Testosterone:

• Testosterone Cypionate/Enanthate:
  • Dosage: 50-400 mg every 2-4 weeks 1
  • For hypogonadal men, 100-200 mg every 2 weeks or 50 mg weekly is typical 2
  • Advantages: Relatively inexpensive, flexible dosing, no risk of transfer 2
  • Disadvantages: Requires injection, fluctuating testosterone levels 2

Transdermal Preparations:

• Testosterone Gel/Patches:
  • Applied daily to skin 3
  • Advantages: Stable serum levels, convenient application 3
  • Disadvantages: Potential transfer to others (gels), skin irritation (patches), higher cost 2, 3

Long-Acting Options:

• Implantable Testosterone Pellets:
  • Longer-term alternative requiring implantation procedure 2, 3

Monitoring Protocol

• Check testosterone levels 2-3 months after starting therapy or dose adjustment 3
• Target mid-normal testosterone range (500-600 ng/dL) 2, 3
• Once stable levels are confirmed, monitor every 6-12 months 2
• Timing of measurements varies by preparation:
  • For injections: Measure midway between injections 2
  • For transdermal preparations: Can measure at any time (peak values 6-8 hours after patch application) 2

Safety Considerations

• Monitor hematocrit, PSA, liver function, and lipid profile every 6-12 months 3
• Evaluate symptom improvement and blood pressure regularly 3
• Be aware of potential cardiovascular risks, especially with injectable forms 2

Common Pitfalls to Avoid

1. Prescribing based on a single testosterone measurement 3
2. Failing to confirm low testosterone with morning measurements 2
3. Not monitoring testosterone levels after therapy commences (nearly half of treated men) 2
4. Prescribing to men who don't meet diagnostic criteria (up to 25% of prescriptions) 2
5. Not considering contraindications: prostate cancer, male breast cancer, desire for fertility 3
6. Using inappropriate dosing schedules that lead to excessive fluctuations in testosterone levels 2, 3

The American Urological Association and Endocrine Society guidelines emphasize that proper diagnosis, appropriate dosing, and regular monitoring are essential for safe and effective testosterone replacement therapy in hypogonadal men.