Editing Testosterone Deficiency (2018) (section)

== Follow-up of Men on Testosterone Therapy ==

* '''<span style="color:#ff0000">Initial follow-up total testosterone level after an appropriate interval (depends on the method of administration) to ensure that target testosterone levels have been achieved'''
** Patients on topical gels, patches, and intranasal formulations should have their testosterone checked between 2-4 weeks after commencement of therapy.
** Patients on short-acting IM or short-acting SQ pellets (testosterone cypionate or enanthate) should have their testosterone measured after several cycles such that testosterone level equilibration has been achieved.
***Endocrine Society Clinical Practice Guidelines recommend measuring serum T levels midway between injections for IM testosterone enanthate or testosterone cypionate and at the end of the dosing interval prior to the subsequent injection for IM testosterone undecanoate, adjusting dose or frequency to target the low‐mid physiological range (12.1–20.8 nmol/L, or 350–600 ng/dl).[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9293229/#andr13108-bib-0002 §]
** Given the mechanisms of action of anastrozole, clomiphene citrate, and hCG, patients using these medications should wait a longer period before follow-up blood work is performed.
* '''<span style="color:#ff0000">Symptoms/signs should be re-evaluated within 3 months after the commencement of treatment to determine if dosing adjustments are necessary'''
** While some patients may continue to experience symptom/sign relief after this time point, '''the majority of men have meaningful improvements within the first 3 months of therapy'''
** '''For men who remain testosterone deficient in the setting of symptom/sign improvement, testosterone therapy should be stopped'''
** '''For men with on-treatment testosterone levels that fall below the suggested target range but who:'''
*** '''Have some on-treatment amelioration of symptoms, up-titration may be considered in an effort to achieve symptom abolition.'''
*** '''Experience complete resolution of symptoms, there is no need to titrate dosing.'''
** '''For men who experience normalization of total testosterone levels but fail to achieve symptom or sign improvement, cessation of testosterone therapy 3-6 months after commencement of treatment should be discussed'''
*** '''An exception can be made if patients do not have symptoms but have documented BMD loss'''
*** '''Similarly, in the event patients have unexplained anemia that improves on testosterone therapy, continuation can be considered even in the absence of other symptom improvement.'''
* '''<span style="color:#ff0000">Total testosterone levels should be measured every 6-12 months while on testosterone therapy'''
* '''<span style="color:#ff0000">Hematocrit/hemoglobin should be measured every 6-12 months or sooner depending on prior values to maintain hematocrit levels < 54%'''
* '''<span style="color:#ff0000">PSA'''
** '''In men without a history of prostate cancer, testing should be conducted utilizing a shared decision-making approach, in accordance with the AUA Early Detection of Prostate Cancer Guideline'''
** '''Prostate cancer patients on testosterone therapy should have their PSA levels monitored on the same schedule as men without AD; however, clinicians may choose to increase the frequency of testing'''
* '''If baseline DEXA demonstrate bone density loss, imaging should be repeated 1-2 years after testosterone initiation.''' DEXA should be repeated sooner should any LTBF occur. If normalized, subsequent serial imaging can be performed in 2-5 years.