Testosterone Replacement Therapy in Men

Indications and Benefits

The American College of Physicians recommends testosterone replacement therapy (TRT) for men with hypogonadism, characterized by low testosterone levels (below 250-350 ng/dL) and symptoms such as decreased libido, erectile dysfunction, low energy, and depression, with a strength of evidence rated as moderate 1, 2
TRT may improve sexual function, increase bone density and muscle mass, enhance mood, and reduce depressive symptoms in men with confirmed hypogonadism, according to the Endocrine Society guidelines 1, 2
The European Association of Urology suggests that TRT can also improve overall sense of well-being and energy levels in hypogonadal men, with a high level of evidence 1, 2

The American Heart Association notes that TRT may increase the risk of cardiovascular events, such as myocardial infarction and stroke, particularly in men with pre-existing cardiovascular disease, with a strength of evidence rated as low to moderate 3
The National Institute of Diabetes and Digestive and Kidney Diseases warns that TRT can cause erythrocytosis (elevated hematocrit), which may increase the risk of thromboembolic events, with a high level of evidence 3, 4
The American Urological Association recommends regular monitoring of hematocrit, PSA, and blood pressure in men undergoing TRT, with a strength of evidence rated as high 3, 4

The FDA advises against the use of TRT in men with prostate or breast cancer, as well as in those with uncontrolled heart failure, due to the potential for worsening of these conditions, with a high level of evidence 3
The European Medicines Agency warns that TRT can cause infertility and testicular atrophy, which may be irreversible, particularly in young men, with a strength of evidence rated as high 3

The American College of Physicians recommends regular monitoring of PSA, hematocrit, and blood pressure in men undergoing TRT, as well as periodic assessment of symptoms and side effects, with a strength of evidence rated as high 3, 4
The Endocrine Society suggests that men undergoing TRT should be evaluated for sleep apnea and other potential side effects, with a moderate level of evidence 3, 4