Monitoring Table 8. Monitoring of men receiving testosterone therapy
1. Evaluate the patient 3 months after treatment starts and then annually to assess whether symptoms have responded to treatment and whether the patient is suffering from any adverse effects, and to check compliance. (1⎟ ⊕)
2. Monitor testosterone levels 2 or 3 months after initiation of testosterone therapy:
> Therapy should aim to raise serum testosterone levels into the mid-normal range. > Injectable testosterone enanthate or cypionate: Measure serum testosterone levels midway between injections. Aim for testosterone levels between 400 and 700 ng/dL. (2⎟ ⊕⊕)
> Transdermal patch: Assess testosterone levels 3–12 h after application of the patch; adjust dose to achieve testosterone levels in the mid-normal range.
> Buccal testosterone bioadhesive tablet: Assess levels immediately before or after application of fresh system.
> Transdermal gel: Assess testosterone level any time after patient has been on treatment for at least 1 wk; adjust dose to achieve serum testosterone levels in the mid-normal range.
> Oral testosterone undecanoate:* Monitor serum testosterone levels 3–5 h after ingestion.
> Injectable testosterone undecanoate:* Measure serum testosterone level just prior to each subsequent injection and adjust the dosing interval to maintain serum testosterone in mid-normal range.
3. Check hematocrit at baseline, at 3 months, and then annually. If hematocrit is > 54%, stop therapy until hematocrit decreases to a safe level; evaluate the patient for hypoxia and sleep apnea; reinitiate therapy with a reduced dose. (1⎟ ⊕)
4. Measure bone mineral density of lumbar spine and/or femoral neck after 1–2 yr of testosterone therapy in hypogonadal men with osteoporosis or low trauma fracture. (2⎟ ⊕)
5. In men 40 years of age or older who have a baseline PSA > 0.6 ng/mL, perform a digital examination of the prostate and PSA measurement before initiating treatment at 3 to 6 months, and then in accordance with guidelines for prostate cancer screening depending on the age and race of the patient. (1⎟ ⊕)
6. Obtain urological consultation (1⎟ ⊕) if there is:
> An increase in serum PSA concentration > 1.4 ng/mL within any 12-month period of testosterone treatment.
> A PSA velocity of > 0.4 ng/mL/yr using the PSA level after 6 months of testosterone administration as the reference (only applicable if PSA data are available for a period exceeding 2 yr).
> Detection of a prostatic abnormality on digital rectal examination. > An AUA or IPSS prostate symptom score of > 19.
7
