Testosterone Therapy in Men with Testosterone Deficiency

Primary Clinical Scenarios

The American Urological Association recommends that for men in their mid-40s with testosterone deficiency, combining injectable testosterone with hCG is primarily indicated when fertility preservation is a priority, as this combination maintains spermatogenesis while restoring testosterone levels—otherwise, testosterone monotherapy alone is appropriate for those not concerned with fertility 1, 2, 3
The Endocrine Society suggests that testosterone monotherapy should never be prescribed to men interested in current or future fertility, as it suppresses spermatogenesis and can lead to azoospermia in 40% of patients 1, 2

The American College of Physicians found that men in their mid-40s can expect small to moderate improvements in erectile function and global sexual function from testosterone treatment 4, 5, 6
The American Heart Association notes that testosterone treatment can lead to modest improvements in fatigue and energy levels, as well as improvements in lean body mass and anemia 4, 5, 6

The American Urological Association recommends that before initiating therapy, baseline testing is required, including PSA measurement to exclude occult prostate cancer, hemoglobin/hematocrit, and cardiovascular risk factor assessment 4, 7
The Endocrine Society suggests that fertility assessment is necessary if relevant, including testicular examination, serum FSH measurement, and consideration of semen analysis if FSH is elevated 1, 4

The American College of Cardiology notes that during treatment, hematocrit >54% warrants intervention such as dose reduction or temporary discontinuation, as injectable testosterone causes the greatest increases in hemoglobin/hematocrit among all formulations 4
The American Heart Association found that low-certainty evidence shows a small increase to no difference in adverse cardiovascular events with testosterone therapy 5, 6