From the Guidelines
Testosterone treatment should be managed by healthcare providers such as endocrinologists, urologists, or primary care physicians with experience in hormone therapy. These specialists will first evaluate a patient through blood tests to determine testosterone levels, assess symptoms, and rule out contraindications before initiating treatment, as suggested by the American College of Physicians guideline 1.
Key Considerations
- The guideline recommends considering intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function in men with age-related low testosterone, due to lower costs and similar clinical effectiveness and harms 1.
- The treatment options include injections, transdermal gels, patches, pellets, or buccal tablets, with dosing and formulation chosen based on patient-specific factors and symptoms.
- Regular monitoring is essential, with follow-up blood tests checking testosterone levels, complete blood count, prostate-specific antigen, and lipid profiles typically conducted at 3-6 month intervals, to adjust dosing and detect potential side effects.
Treatment Approach
- The healthcare provider will assess the patient's symptoms, medical history, and laboratory results to determine the best course of treatment, taking into account the potential benefits and risks of testosterone therapy.
- The American College of Physicians suggests that clinicians not initiate testosterone treatment in men with age-related low testosterone to improve energy, vitality, physical function, or cognition, due to low-certainty evidence 1.
- Patients should maintain regular appointments with their provider to ensure the treatment remains effective and safe, as testosterone therapy is typically a long-term commitment requiring ongoing professional oversight to balance symptom relief with minimizing potential risks.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Testosterone Treatment
- Testosterone replacement therapy is typically managed by a physician, with the selection of the method depending on the patient's preference and medical advice 2.
- The Society for Endocrinology has commissioned guidelines for testosterone replacement therapy in male hypogonadism, which provide a multidisciplinary approach to treating patients with hypogonadism, including input from endocrine, primary care, clinical biochemistry, urology, and reproductive medicine practices 3.
Healthcare Professionals Involved
- Endocrinologists are likely to be involved in the management of testosterone treatment, as they specialize in the diagnosis and treatment of hormonal disorders 3.
- Primary care physicians may also be involved in the management of testosterone treatment, particularly in the initial diagnosis and referral to a specialist 3.
- Urologists and reproductive medicine specialists may be involved in the management of testosterone treatment, particularly in cases where fertility is a concern 3, 4.
Treatment Options
- Testosterone replacement therapy is a common treatment option for hypogonadism, but it may not be suitable for all patients, particularly those who desire fertility preservation 2, 5.
- Alternative treatment options, such as human chorionic gonadotropin (hCG), selective estrogen receptor modulators (SERMs), and aromatase inhibitors, may be used in certain cases, particularly where fertility preservation is a concern 5, 4, 6.