11 responses to “Appropriate testosterone testing for male hypogonadism”

  1. Excellent summary
    When in cycle ideally should TT be measured in men already taking replacement to determine biochemical response?
    Mid-cycle or at trough pre next dose ?

  2. This is a succinct article that will help Physicians educate men with minor complaints. Often a total testosterone is really not necessary.

  3. Clear & comprehensive article. Thank you.

  4. Good outline to follow.

  5. Succinct,rational. Is there a particular pattern that would indicate the recovery phase or the withdrawal phase of someone who had used illicit androgens?

  6. Great article

  7. Excellent! Thank you!

  8. Nice article! Perhaps a dumb question…but is there a patient age above which you would suggest to a man that it is not pathological age-related hypogonadism that would benefit from treatment, but rather is normal aging?

  9. Thanks for your questions. I’ll address each one briefly below:

    1. For men who are taking testosterone by injection, I usually recommend a peak and trough level after 2-3 months. This allows for adjustment of the dose (based on the peak level) and frequency (based on the trough level). Once the dose and frequency have been determined, I usually monitor a mid-cycle testosterone annually to ensure no change in the dosing. For testosterone patch or gel, a single testosterone measurement while on therapy is adequate.

    2. Recovery of endogenous testosterone after use of androgens can be highly variable depending upon the dose and duration of therapy and the age and underlying health status of the patient. I usually quote a recovery time of 3-6 months in men under the age of 50 years with no other reasons for hypogonadism. Of course, this assumes that the patient abstains from all supplements that may contain androgenic properties. If there is no significant recovery in that time, it’s unlikely that full recovery will take place.

    3. There is no age limit for testosterone therapy. Even men in their 70s and 80s may benefit, if they have unequivocally low testosterone levels and symptoms associated with hypogonadism. However, I recommend having a detailed discussion with the patient about the goals of therapy and possible adverse effects and if these goals are not being met within 3-6 months, consider stopping treatment.

    I plan to discuss testosterone therapy in a future article.

  10. The reminder about hemochromatosis was useful.
    I have been to two lectures where suppression of testosterone in diabetic men was discussed. Narcotic use has also been mentioned- where would you advise UDS?
    I am interested in the cost of this iterative method for establishing a diagnosis. We never see the costs of the laboratory testing, and the patients never see the cost of the repeat visits.

  11. Not sure why you wouldn’t perform testing for someone with “non-specific symptoms” esp. when alternative possibilities have been ruled out. I would agree that testing testosterone has a low yield in these circumstances, but the risks of testosterone treatments for cardiovascular issues and prostate cancer are lower than conventional wisdom has suggested, and may have benefit for management of diabetes and fatty liver.

    Use of testosterone supplements in hypogonadism associated with opiate pain medication may actually improve survival and reduce morbidity with major adverse cardiovascular events, anemia, and femoral or hip fractures.

    If you are overly conservative with treatment you will deny treatment to those who could benefit, and the risks may have been overblown.

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