What is the typical starting dose of testosterone for a male?

Starting Dose of Testosterone for Males

The typical starting dose of testosterone for adult males with hypogonadism is 200 mg of testosterone undecanoate orally (100 mg twice daily) or 50-100 mg of testosterone cypionate/enanthate intramuscularly every 1-2 weeks. 1, 2

Dosing by Administration Route

Oral Testosterone Undecanoate

• Starting dose: 200 mg daily (100 mg twice daily, morning and evening) 1
• Must be taken with food for proper absorption 1
• Dose adjustments:
  • Minimum: 100 mg once daily
  • Maximum: 400 mg twice daily
  • Adjust based on serum testosterone levels measured 3-5 hours after morning dose 1

Injectable Testosterone

• Starting dose: 50-100 mg weekly or 100-200 mg every 2 weeks (intramuscular) 2
• Maintenance range: 50-400 mg every 2-4 weeks 2
• Subcutaneous administration is an effective alternative to intramuscular injections:
  • Typically starting at 50 mg weekly 3
  • Dose range: 50-150 mg weekly (median 75-80 mg) 3
  • Associated with less pain and better patient preference compared to IM 3

Topical Testosterone Gel

• Applied daily to clean, dry, intact skin
• Formulations vary in concentration (1-2%) and recommended starting doses 4
• Hands must be washed thoroughly after application
• Risk of transfer to others through skin contact 4

Monitoring and Dose Adjustment

1. Check testosterone levels 4-6 weeks after treatment initiation 5
2. Target testosterone levels: 450-600 ng/dL 5
3. Dose adjustments:
   • Increase by 50 mg if testosterone <300 ng/dL
   • Decrease by 50 mg if testosterone >600 ng/dL 5
4. Continue monitoring every 3-6 months 5

Safety Considerations and Contraindications

Key Contraindications

• Prostate cancer or male breast cancer
• Desire for fertility in near future
• Severe obstructive sleep apnea
• Uncontrolled congestive heart failure
• Hematocrit >54% 5
• Hypogonadal conditions not associated with structural or genetic etiologies 1

Important Monitoring Parameters

• Blood pressure: Monitor regularly as testosterone can increase BP 1
• Hematocrit/hemoglobin: Check every 3-6 months 5
  • Discontinue if hematocrit exceeds 54%
  • Injectable forms have higher risk of erythrocytosis (43.8%) than transdermal preparations (5.5-15.4%) 5
• Prostate-specific antigen (PSA): Monitor before and during treatment 1
• Lipid profile: Periodically monitor as testosterone may affect serum lipids 1

Common Pitfalls to Avoid

1. Diagnosing hypogonadism based on a single testosterone measurement

   • Confirm with morning measurements on at least two separate days 5, 1

2. Not measuring free testosterone in obese patients

   • Total testosterone may be misleadingly low due to reduced SHBG

3. Overlooking secondary causes of hypogonadism

   • Complete appropriate diagnostic workup before initiating therapy

4. Initiating therapy without proper baseline evaluation

   • Measure baseline testosterone, hematocrit, PSA, and blood pressure

5. Using testosterone for "age-related hypogonadism" without structural or genetic etiology

   • FDA approval is specifically for conditions associated with deficiency or absence of endogenous testosterone 5, 1

6. Not warning patients about potential fertility impact

   • Testosterone therapy can suppress spermatogenesis 5

By following these guidelines for testosterone replacement therapy, clinicians can optimize treatment outcomes while minimizing potential risks for male patients with hypogonadism.