Monitoring testosterone therapy

Monitoring

After starting testosterone (T) therapy, patients should be evaluated at 3, 6 and 12 months, then annually thereafter, to monitor:

• serum testosterone - aim for a therapeutic target in the mid to upper range (15-30nmol/L), for an optimal response
• haematocrit - levels should remain <54%. Dose reductions or preparation changes may be required to keep haematocrit levels within range. If they remain high, consider stopping T therapy and reintroducing it at a lower dose
• PSA - prostate health should have been assessed via DRE and PSA prior to starting treatment. After initiating T therapy, a PSA increase >1.4ng/mL over a 1-year period, or a PSA velocity >0.4ng/mL/year during sequential measurements over >2 years warrants urological evaluation and more intensive surveillance for prostate cancer thereafter1
• cardiovascular risk factors - these should also have been assessed prior to staring treatment
• symptomatic improvement - failure to benefit within a reasonable time frame (defined as 6 months for libido, sexual function, muscle function & improved body fat) should prompt treatment discontinuation and investigation for other causes of the symptoms1

Reference

• 1. British Society of Sexual Medicine. Guidelines on the management of sexual problems in men: the role of androgens 2010. Available at: http://bssmorguk.ipage.com/wpcontent/ uploads/2017/05/UK_Guidelines_Androgens_Male_2010.pdf (Accessed May 2018).