How should I monitor a patient on testosterone replacement therapy for efficacy and safety?

Monitoring a patient receiving testosterone replacement therapy (TRT) involves regular assessment of both efficacy and safety.

Initially, arrange a review approximately 3 months after starting or changing the testosterone therapy to assess treatment response and tolerability, then continue with at least annual reviews unless clinical indications require earlier assessment.

At each review, assess symptom improvement related to testosterone deficiency and any adverse effects experienced by the patient.

Monitor serum testosterone levels to ensure they are within the target therapeutic range, adjusting the dose accordingly to avoid under- or overtreatment.

Evaluate for potential adverse effects such as changes in haematocrit (polycythaemia), liver function abnormalities, lipid profile changes, and prostate health, including PSA levels in men, as testosterone can influence these parameters.

Consider cardiovascular risk factors and manage them appropriately, as testosterone therapy may have implications for cardiovascular health.

If the patient has co-morbidities such as hypothyroidism, monitor relevant parameters (e.g., TSH) as testosterone therapy may interact with other endocrine conditions.

In cases of persistent symptoms despite dose adjustment, consider alternative causes or referral to a specialist with expertise in hormone therapy.

Provide lifestyle advice and reinforce information about the benefits and risks of ongoing testosterone therapy at each review.