Testosterone Monitoring Schedule for Male Hypogonadism HRT
Testosterone levels should be tested 2-3 months after treatment initiation or any dose change, and once stable levels are confirmed, monitoring should continue every 6-12 months. 1, 2
Initial Monitoring Protocol
- First follow-up: Check testosterone levels at 1-2 months after starting therapy to assess efficacy 2
- Early adjustments: Test testosterone levels 2-3 months after treatment initiation and/or after any dose adjustment 1
- Target range: Aim for testosterone levels in the mid-tertile of normal range (450-600 ng/dL) 2
Long-term Monitoring Schedule
- Stable therapy: Once stable levels are confirmed on a given dose, monitor testosterone levels every 6-12 months 1, 2
- First year: Follow-up visits at 3-6 month intervals during the first year of treatment 2
- Subsequent years: Annual monitoring once stabilized 2
Timing of Testosterone Measurements
The timing of testosterone measurements varies by preparation type:
- Injectable testosterone: Measure levels midway between injections, targeting mid-normal values (500-600 ng/dL) 1
- Transdermal preparations (gels, patches): Can be measured at any time, but note that:
- Peak values occur 6-8 hours after patch application
- Testosterone concentrations can vary substantially with gel use 1
Dose Adjustment Guidelines
Adjust dosing based on pre-dose morning testosterone levels:
| Pre-Dose Morning Testosterone | Dose Adjustment |
|---|---|
| >750 ng/dL | Decrease daily dose by 20-25% |
| 350-750 ng/dL | No change |
| <350 ng/dL | Increase daily dose by 20-25% |
Additional Monitoring Parameters
Beyond testosterone levels, regular monitoring should include:
- Hematocrit/hemoglobin (to detect erythrocytosis)
- Prostate-specific antigen (PSA) and symptoms of prostate enlargement
- Symptomatic response assessment
- Voiding symptoms
- Sleep apnea symptoms
- Cardiovascular status, particularly in elderly patients 2
Common Pitfalls to Avoid
- Inconsistent timing: For injectable testosterone, measuring at inconsistent points in the injection cycle can lead to misleading results
- Inadequate follow-up: Failing to monitor at recommended intervals increases risk of adverse effects
- Ignoring other parameters: Focusing only on testosterone levels without monitoring for adverse effects (erythrocytosis, prostate issues)
- Overlooking fertility concerns: Regular testosterone therapy can suppress spermatogenesis; alternative treatments should be considered for men concerned about fertility 2
The monitoring schedule balances the need to ensure therapeutic efficacy while minimizing the risk of adverse effects, which include erythrocytosis, cardiovascular effects, and potential prostate issues.