Testosterone replacement therapy (TRT) is indicated for men with hypogonadism defined by low serum total testosterone (<300-350 ng/dL on two separate morning samples) plus signs or symptoms, with management individualized through shared decision-making regarding risks, benefits, formulation choice, and close monitoring.
Key Findings
Background
Testosterone levels decrease as men age, and when testes fail to produce adequate endogenous testosterone, men develop hypogonadism.
Hypogonadism is defined as a combination of low testosterone level and signs or symptoms of hypogonadism.
The definition of a low testosterone level varies among guidelines.
A serum total testosterone level of less than 300 to 350 ng/dL is the commonly used threshold.
Diagnosis requires two separate morning blood samples both showing low levels.
Background
Multiple testosterone formulations are available for TRT, with formulation choice depending on cost and patient preference.
Available formulations range from topical gels to intramuscular injections.
Numerous testosterone formulations are described as available.
Patient preference and cost are cited as the primary determinants of formulation selection.
Background
TRT use is limited by contraindications, adverse effects, and a lack of long-term safety data.
Patients receiving TRT require close monitoring.
The paper identifies contraindications as a limiting factor for TRT use.
Lack of long-term safety data is explicitly cited as a limitation of current TRT use.
Background
Nonhormonal pharmacotherapies are available as alternatives for patients who cannot or do not wish to use exogenous testosterone.
Nonhormonal options are indicated for patients who wish to avoid exogenous hormones.
These alternatives are also applicable for patients who are not candidates for TRT.
Nonhormonal pharmacotherapies are also available for patients unable to tolerate TRT adverse effects.
Several such nonhormonal pharmacotherapies are described as available.
Background
Management of hypogonadism should be individualized with shared decision-making prior to initiating TRT.
Management discussions should be individualized to address patient needs and goals.
Counseling before therapy should include shared decision-making regarding risks, benefits, and expectations.
Patient criteria for TRT include both a documented low testosterone level and clinical signs or symptoms of hypogonadism.