Testosterone Therapy Evaluation and Management

Initial Evaluation and Assessment

The American Urological Association recommends measuring morning total testosterone levels between 8-10 AM on at least two separate occasions to confirm testosterone deficiency 4
The Endocrine Society suggests measuring free testosterone by equilibrium dialysis and sex hormone-binding globulin, particularly in obese patients 4
Measure luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to distinguish between primary and secondary hypogonadism, as recommended by the American Association of Clinical Endocrinologists 4
Obtain baseline hemoglobin/hematocrit, and withhold therapy if hematocrit exceeds 50%, according to the American College of Physicians 1, 2, 3
Measure PSA in men over 40 years of age to exclude occult prostate cancer, as recommended by the American Cancer Society 1, 2, 5
Assess for cardiovascular disease risk factors, as suggested by the American Heart Association 1, 2, 6

Perform testicular examination to evaluate size, consistency, and descent, as recommended by the American Society for Reproductive Medicine 3, 7
Measure serum FSH to assess underlying reproductive health status, according to the American College of Obstetricians and Gynecologists 3, 7
Consider semen analysis for patients interested in preserving fertility, as suggested by the Society for Assisted Reproductive Technology 3, 7
Offer reproductive genetic testing for patients with severe oligospermia or non-obstructive azoospermia, as recommended by the American Society of Human Genetics 1, 3

Discuss potential benefits of testosterone therapy, including improvements in erectile function, libido, anemia, bone mineral density, lean body mass, and depressive symptoms, as recommended by the American Psychiatric Association 1, 3, 5
Inform patients about potential risks, including polycythemia, sleep apnea exacerbation, and effects on fertility, according to the National Sleep Foundation 8
Counsel patients that current evidence cannot definitively state whether testosterone therapy increases or decreases cardiovascular risk, as suggested by the American College of Cardiology 6
Advise patients on lifestyle modifications, such as weight loss and physical activity, as adjunctive treatment, as recommended by the American Heart Association 6