Treatment guidelines

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 The main points to consider are listed below.

Evaluation of the patient

Assess response of signs and symptoms of hypogonadism to treatment and to evaluate any adverse effects.

  • 3 months after commencing treatment
  • annually

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

Monitoring of serum testosterone levels

Monitor serum testosterone levels 2–3 months after commencing treatment to ensure levels in the mid-normal physiological range have been attained.

Hematocrit Check

  • At Baseline
  • At 3 months
  • 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.

Measurement of bone mineral density

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

Digital rectal examination and prostate-specific-antigen check

Performance of digital rectal examination and determination of prostate-specific antigen (PSA) levels in men over the age of 45

  • At Baseline
  • 3-6 months
  • At 12 months
  • Annually (or according to standard prostate cancer screening protocols)

Digital rectal examination and prostate-specific-antigen check

Evaluate formulation-specific adverse events at each visit

  • Read about the different treatment options read more


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.

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.

Last updated: 2019