Management of Low Testosterone Levels

Diagnosis and Evaluation

The American Urological Association recommends a testosterone level of 300 ng/dL as the threshold for diagnosing hypogonadism in men, and a level of 282 ng/dL is considered below this threshold 1, 2
Diagnosis of hypogonadism should be confirmed with a second morning total testosterone measurement before initiating treatment, as recommended by the American Urological Association 1
Clinical diagnosis of hypogonadism requires both low testosterone levels and symptoms/signs of testosterone deficiency, according to the American Urological Association 1
Measurement of serum luteinizing hormone (LH) levels can help establish the etiology of testosterone deficiency (primary vs. secondary hypogonadism) 1

The American Urological Association recommends initiating testosterone replacement therapy with the goal of achieving testosterone levels in the middle tertile of the normal reference range (450-600 ng/dL) 4
Intramuscular injections are an alternative option for testosterone replacement therapy, as suggested by the American College of Physicians 2
Testosterone replacement therapy should be avoided in patients with recent cardiovascular events (within past 3-6 months), as recommended by the American Heart Association 3
Alkylated oral testosterone should be avoided due to the risk of liver toxicity, as warned by the American Urological Association 4

Weight loss and increased physical activity may help increase endogenous testosterone levels and reduce symptoms, as suggested by the American Urological Association 4, 5

Testosterone levels should be monitored to ensure they reach the target range of 450-600 ng/dL, as recommended by the American Urological Association 4
Patients on testosterone replacement therapy should be monitored for potential adverse effects, including hematocrit elevation (polycythemia), as warned by the American Urological Association 6
If symptoms do not improve despite reaching target testosterone levels, consideration should be given to discontinuing therapy, as recommended by the American Urological Association 4

Testosterone therapy may improve metabolic parameters, including insulin sensitivity, glucose control, and body composition in men with hypogonadism, as suggested by the American Diabetes Association 5
Patients should be advised that current evidence does not definitively demonstrate increased cardiovascular risk with testosterone therapy, as stated by the American Heart Association 4