Question:

What monitoring is required in a man receiving testosterone replacement therapy for hypogonadism?

29 January 2008 note: This question is over 2 years old and may differ to any new research.

We found no UK guidelines on the monitoring of testosterone replacement therapy.   However, the SPC for a testosterone implant [1] reports:

“Physicians should consider monitoring patients receiving Testosterone Implants, before implantation and at regular intervals thereafter, for the following parameters:

- testosterone, to confirm hypogonadism

- digital rectal examination (DRE) of the prostate and PSA to exclude benign prostate hyperplasia or a sub-clinical prostate cancer. Androgens may accelerate the progression of subclinical prostatic cancer and benign prostatic hyperplasia.

Testosterone implants should be used with caution in cancer patients at risk of hypercalcaemia (and associated hypercalcuria), due to bone metastases. Regular monitoring of serum calcium concentrations is recommended in these patients.”

The American Family Physician reported on testosterone monitoring in 2006 [2] and this included the following table:

Finally, the American Endocrine Society have published guidelines (2006) on testosterone therapy [3] and this includes a section on monitoring.  However, it is too large to reproduce here, so it can be viewed via the URL below.

References

1) http://emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=8834
2) http://www.aafp.org/afp/20060501/1591.html
3) http://www.guideline.gov/summary/summary.aspx?doc_id=9420&nbr=5041&ss=6&xl=999

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