Testosterone Therapy Guidelines

Introduction to Testosterone Therapy

• The American Urological Association (AUA) guidelines do not list increased aggression as a significant side effect requiring monitoring during testosterone therapy 1
• Testosterone therapy should target the middle tertile of the normal reference range to minimize potential side effects while achieving clinical benefits 1

Effects of Testosterone on Emotional Function

• The American College of Physicians' evidence report notes that testosterone treatment was associated with small improvements in mood and depressive symptoms (SMD, −0.19) 2
• Testosterone therapy may slightly improve mood in men with testosterone deficiency, rather than impairing emotional function 2

Monitoring and Follow-up

• When initiating testosterone therapy, focus monitoring on established risks, including erythrocytosis, fluid retention, cardiovascular events, and sleep apnea 3
• Follow-up schedule: first follow-up at 1-2 months after initiation, subsequent visits every 3-6 months for the first year, then yearly, monitoring symptomatic response, including mood changes 3
• Monitor for cardiovascular events, although evidence is of low certainty 2

Treatment Targets and Discontinuation

• Target mid-normal testosterone range rather than upper-normal to minimize potential adverse effects 3
• Discontinue therapy if no symptom improvement after 12 months 3