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 recommend the following:

• Confirm the diagnosis of hypogonadism with consistent low serum testosterone levels measured on at least two separate occasions, ideally in the morning.
• Assess clinical symptoms consistent with testosterone deficiency, such as reduced libido, erectile dysfunction, fatigue, and loss of muscle mass.
• Before initiating TRT, exclude reversible causes of low testosterone and consider potential contraindications, including prostate cancer and severe cardiovascular disease.
• Discuss the benefits and risks of TRT with the patient, including the potential effects on sexual function, mood, bone density, and cardiovascular health.
• Start TRT at the lowest effective dose and titrate based on clinical response and serum testosterone levels.
• Monitor patients regularly for symptom improvement, testosterone levels, hematocrit, prostate-specific antigen (PSA), and adverse effects.
• Seek specialist advice if there is uncertainty about diagnosis, contraindications, or management.

These recommendations align with expert consensus and clinical practice guidelines emphasizing individualized treatment and careful monitoring to optimize outcomes and minimize risks in men with hypogonadism ⁴.