What are the current guidelines for initiating testosterone replacement therapy in men with confirmed hypogonadism?

Current guidelines for initiating testosterone replacement therapy (TRT) in men with confirmed hypogonadism:

• Testosterone replacement therapy should be considered only after a confirmed diagnosis of hypogonadism, which requires consistent low serum testosterone levels measured on at least two separate occasions alongside clinical symptoms.
• Before initiating TRT, underlying causes of hypogonadism should be identified and addressed where possible.
• TRT is indicated to alleviate symptoms related to testosterone deficiency such as reduced libido, fatigue, and loss of muscle mass, and to improve quality of life.
• Prescribing testosterone should be done cautiously, using the lowest effective dose, and treatment should be regularly reviewed for efficacy and adverse effects.
• Specialist advice is recommended before starting TRT, especially in men with comorbidities or risk factors such as prostate cancer or cardiovascular disease.
• Men on TRT require monitoring of testosterone levels, haematocrit, prostate-specific antigen (PSA), and clinical response at regular intervals.
• TRT is contraindicated in men with prostate or breast cancer and should be used with caution in men at high risk of cardiovascular events.

These recommendations align with expert consensus and clinical practice guidelines emphasizing careful diagnosis, individualized treatment, and ongoing monitoring to ensure safety and effectiveness of testosterone replacement therapy in men with confirmed hypogonadism ⁴,².