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 TRT to assess symptom improvement and any adverse effects, then continue with at least annual reviews unless clinical indications require earlier assessment.

At each review, evaluate the efficacy by assessing symptom relief, including sexual function and quality of life, and check for any bothersome adverse effects.

Safety monitoring should include clinical assessment and relevant blood tests such as testosterone levels to ensure appropriate dosing, and monitoring for potential side effects like erythrocytosis, liver function abnormalities, and lipid profile changes.

Consider cardiovascular risk factors and manage them appropriately, as TRT can influence these parameters.

If the patient has co-morbidities such as hypothyroidism, monitor thyroid function tests as TRT may affect thyroid hormone metabolism.

Adjust the dose, formulation, or route of administration based on clinical response and tolerability.

Refer to a specialist if there is uncertainty about safety, persistent adverse effects, or if symptoms do not improve despite dose adjustments.