Do I need to be monitored while on testosterone therapy

All hypogonadal men receiving testosterone replacement therapy require monitoring. All men should have a baseline PSA, hemoglobin level, and digital rectal examination prior to the start of testosterone replacement therapy. Those males with an elevated PSA and/or abnormal digital rectal examination should undergo further evaluation to rule out prostate cancer prior to starting testosterone replacement therapy. Once testosterone therapy has been started, patients return for an assessment of the efficacy of treatment and measurement of testosterone levels. Once an appropriate dose of testosterone has been identified, patients are followed at 3 to 6 month intervals during the first year and yearly thereafter. At each visit, an assessment of response, voiding symptoms, and sleep apnea symptoms should be determined. In addition, a digital rectal examination is performed and blood tests, including serum testosterone, PSA and hemoglobin/hematocrit levels. In patients receiving intramuscular testosterone, there is more variability in the serum testosterone levels. Typically, the testosterone levels peak 2 to 5 days after the injection and often return to baseline at 10 to 14 days after injection. This variability must be kept in mind when interpreting testosterone level results.

The PSA may also increase due to benign growth of the prostate over time. It is generally accepted that the PSA should not increase by 0.7 to 0.75 ng/ml per year and thus an increase in PSA beyond 0.35 ng/ml over a 6 month period would prompt withholding of the testosterone therapy and further evaluation with a transrectal ultrasound guided prostate biopsy. If the hemoglobin/hematocrit increases beyond the normal range, consideration should be given to withholding testosterone replacement therapy, reducing the dosage of testosterone, or if clinically significant and/or in high risk patients, performing a phlebotomy.

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