Treatment guidelines

The international medical societies European Association of Urology (EAU), International Society for the Study of the Aging Male (ISSAM), International Society of Andrology (ISA), American Society of Andrology (ASA), and European Academy of Andrology (EAA) have issued recommendations on the definition, investigation, treatment and follow-up of men with late-onset hypogonadism.1,2 They recommend:
Evaluate the patient 3 months after commencing treatment then annually to assess response of signs and symptoms of hypogonadism to treatment and to evaluate any adverse effects. Failure to benefit clinical manifestations should result in discontinuation of treatment. As testosterone normally results in improvements in mood and well-being, the development of negative behavioral patterns during treatment calls for dose modifications or discontinuation of therapy
Monitor serum testosterone levels 2–3 months after commencing treatment to ensure levels in the mid-normal physiological range have been attained
Check hematocrit at baseline, at 3 months, and then annually. Therapy should be stopped if hematocrit is >54%, indicating erythrocytosis. Patient should be evaluated for hypoxia and sleep apnea. When hematocrit decreases to a safe level therapy may be reintroduced at a decreased dose
Measure bone mineral density of lumbar spine and/or femoral neck after 1–2 years of testosterone therapy in men with osteoporosis or low trauma fracture
Perform digital rectal examination and determination of prostate-specific antigen (PSA) levels at baseline in men over the age of 45 years, then at 3 to 6 months after commencing testosterone treatment, at 12 months, and then yearly thereafter (or according to standard prostate cancer screening protocols)
Evaluate formulation-specific adverse events at each visit


1 Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM; Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010 Jun;95(6):2536-59.
doi: 10.1210/jc.2009-2354. Review.

2 ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Wang C, Nieschlag E, Swerdloff RS, Behre H, Hellstrom WJ, Gooren LJ, Kaufman JM, Legros JJ, Lunenfeld B, Morales A, Morley JE, Schulman C, Thompson IM, Weidner W, Wu FC. Aging Male. 2009 Mar;12(1):5-12. doi: 10.1080/13685530802389628
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Last updated: 2016