Overview of monitoring testosterone replacement therapy

Monitoring testosterone replacement therapy for male androgen deficiency involves reviewing response to therapy (by assessing clinical response and measuring testosterone concentration) and being alert to evidence of adverse events. See Monitoring for clinical response and serious adverse effects of testosterone replacement therapy for a summary of monitoring undertaken by a specialist or under specialist guidance.

Table 1. Monitoring for clinical response and serious adverse effects of testosterone replacement therapy
Reason for monitoring	Action
assessing adequacy of testosterone replacement	review improvement in symptoms of male androgen deficiency 3 months after starting testosterone, then at least annually measure serum testosterone concentration 3 to 6 months after starting testosterone, then as determined by response measure bone mineral density 12 months or more after starting testosterone
risk of polycythaemia	review FBE at baseline, 3 months after starting testosterone, then at least annually
risk of promoting growth in a pre-existing prostate cancer [NB1]	assess baseline risk of prostate cancer exclude symptoms of prostate cancer discuss limitations of PSA screening with asymptomatic men; if PSA screening is chosen, see here for advice on frequency of monitoring
cardiovascular risk in frail older men [NB2]	assess baseline cardiovascular risk factors; review for symptoms of fluid overload
Note: FBE = full blood examination; PSA = prostate specific antigen NB1: For discussion of testosterone replacement therapy and prostate cancer risk, see Monitoring for adverse effects of testosterone replacement therapy. NB2: Data on cardiovascular risks of testosterone replacement therapy are conflicting; see Monitoring for adverse effects of testosterone replacement therapy.