What is the duration of therapy for hypogonadism (low testosterone)?

From the Guidelines

Therapy for low testosterone should be reevaluated within 12 months and periodically thereafter, with consideration for discontinuation if there is no improvement in symptoms, particularly sexual function. This approach is based on the American College of Physicians' clinical guideline for testosterone treatment in adult men with age-related low testosterone, which suggests a conditional recommendation with low-certainty evidence 1.

Key Considerations for Therapy Duration

• The underlying cause of low testosterone influences the duration of therapy, with primary hypogonadism typically requiring lifelong treatment and secondary causes potentially allowing for temporary treatment until the underlying issue is resolved.
• Regular monitoring of symptoms and testosterone levels is crucial, with reevaluation recommended within 12 months and periodically thereafter to assess the effectiveness of treatment and potential side effects.
• Treatment options include injections, transdermal gels or patches, subcutaneous pellets, and buccal tablets, with the choice of formulation considering factors such as cost, clinical effectiveness, and patient preference.

Monitoring and Adjusting Therapy

• Regular blood tests are necessary to check testosterone levels, complete blood counts, and PSA levels, initially every 3-6 months and then annually once stable.
• The goal of therapy is to maintain testosterone levels within the normal range (typically 300-1000 ng/dL) while managing potential side effects and alleviating symptoms such as fatigue, decreased libido, and mood changes.
• Clinicians should consider intramuscular formulations over transdermal ones when initiating treatment to improve sexual function, due to lower costs and similar clinical effectiveness and harms 1.

Quality of Life and Symptom Management

• The primary aim of therapy is to improve quality of life by addressing symptoms associated with low testosterone, such as sexual dysfunction, decreases in energy and muscle mass, mood disturbances, and changes in bone mineral density.
• Regular follow-up with a healthcare provider is essential to adjust dosing, monitor for complications, and ensure that the benefits of treatment outweigh the risks for each individual patient.

From the Research

Duration of Therapy for Low Testosterone

• The duration of therapy for low testosterone, also known as testosterone replacement therapy (TRT), is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
• However, it is mentioned that TRT is a long-term treatment, and patients require close monitoring 2, 3.
• The studies suggest that TRT can be continued for an extended period, but the exact duration is not specified 3, 5.
• One study mentions that patients can be on TRT for more than a year without significant changes in semen parameters 4.
• Another study notes that TRT can be used to restore normal serum testosterone concentrations and relieve symptoms in most hypogonadal men, but the duration of treatment is not specified 5.

Factors Affecting Duration of Therapy

• The duration of TRT may depend on various factors, including the patient's response to treatment, the presence of contraindications, and the development of adverse effects 2, 3.
• The choice of testosterone formulation and the patient's preference may also influence the duration of therapy 2, 5.
• Additionally, the patient's goals and expectations, such as fertility preservation, may impact the duration of TRT 4, 5.