From the Guidelines
Testosterone replacement therapy should generally be continued perioperatively. Patients on chronic testosterone therapy should maintain their regular dosing schedule through the surgical period to avoid hormonal fluctuations that could lead to symptoms of testosterone withdrawal, including fatigue, depression, and reduced sense of well-being. For patients using injectable testosterone cypionate or enanthate, timing the injection within 1-2 weeks before surgery is advisable. Those using daily transdermal preparations (gels, patches) or shorter-acting formulations should continue their regular application.
Key Considerations
- The decision to continue or modify testosterone therapy perioperatively should be individualized, taking into account the patient's specific health status, the type of surgery, and the risk of thrombosis 1.
- The benefits of continuing testosterone therapy, including maintaining physical and mental health, may outweigh the risks, especially when thromboprophylaxis strategies are in place 1.
- Recent guidelines suggest that initiation or continuation of testosterone replacement therapy is reasonable in men with confirmed hypogonadism and does not increase the risk of stroke 1.
Perioperative Management
- Patients should discuss their specific testosterone regimen with both their surgeon and the provider who manages their hormone therapy well before surgery to develop an appropriate perioperative plan.
- For major surgeries, especially those with high thrombotic risk, some clinicians may consider temporarily reducing the dose or briefly interrupting therapy, particularly in patients with other risk factors for thrombosis.
- However, the rationale for continuing therapy is that abrupt discontinuation can cause significant hormonal fluctuations, potentially affecting recovery, while testosterone's effects on erythropoiesis and hemostasis develop over weeks to months rather than days.
From the Research
Perioperative Testosterone Replacement Therapy
The decision to continue testosterone replacement therapy (TRT) perioperatively depends on various factors, including the patient's overall health, the type of surgery, and the potential risks and benefits of continuing or discontinuing TRT.
- There is no direct evidence from the provided studies that specifically addresses the continuation of TRT perioperatively 2, 3, 4, 5, 6.
- However, the studies suggest that TRT can be beneficial for hypogonadal men, improving symptoms and signs of testosterone deficiency, such as decreased libido, erectile dysfunction, and loss of muscle and bone mass 2, 3, 4, 6.
- The choice of formulation and management of TRT should be individualized, taking into account patient preferences, cost, and potential risks and benefits 3, 4, 6.
- Close monitoring of patients receiving TRT is necessary to minimize risks and adjust treatment as needed 3, 6.
- The Society for Endocrinology guidelines for TRT in male hypogonadism provide a multidisciplinary approach to treating patients with hypogonadism, but do not specifically address perioperative management 5.
Considerations for Perioperative Management
- Patients with hypogonadism who are undergoing surgery may require careful consideration of their TRT regimen to minimize potential risks and ensure optimal outcomes.
- The potential benefits of continuing TRT perioperatively, such as maintaining normal serum testosterone concentrations and relieving symptoms, should be weighed against potential risks, such as bleeding or thrombotic complications.
- Further research is needed to provide evidence-based guidance on the management of TRT in the perioperative period.