Clinical Hypogonadism and Androgen Replacement Therapy: An Overview

Dana A. Ohl; Susanne A. Quallich

Disclosures

Urol Nurs. 2006;26(4):253-259,269. 

In This Article

Recommendations For Followup

Prior to beginning androgen replacement, the patient should have a baseline voiding history, blood pressure, rectal examination, and be specifically asked about a history of sleep apnea. Baseline laboratory work should include PSA, fasting cholesterol profile, complete blood count, and liver function tests. After a method for replacement has been agreed upon (see Table 4 ), the patient should have morning testosterone levels within 2 to 3 weeks of starting the testosterone if it is gel, patch, or buccal, and in approximately 8 weeks if an injectable form is used. When treating with injectable preparations, levels should be checked at the halfway time point between injections. This is to confirm that the proper dose has been prescribed. The managing clinician may decide to schedule an interval appointment to monitor the patient's progress. There is no upper age limit to starting testosterone therapy; it is limited only by a patient's co-morbidities and tolerance of side effects.

After 3 months, the patient should return for an efficacy assessment. This includes a voiding history, blood pressure, rectal examination, repeat blood tests, and morning total testosterone level for patch users. He should specifically be asked if he has noticed improvements in the symptoms that led to the diagnosis of hypogonadism, be it sexual function, energy level, or muscle mass. If the patient exhibits no changes in repeat blood tests, and has noticed improvements to his overall symptomatology, he can be followed every 6 months.

Every 6 months thereafter, the patient should receive an efficacy assessment, voiding history, blood pressure, rectal examination, PSA, and testosterone level. Other laboratory values can be followed yearly. It is important to keep in mind that monitoring must be tailored to the individual. There is no target level for replacement, and the patient's reports of the effectiveness of the therapy are generally a reliable indicator of success. Once testosterone re placement therapy is initiated, the treatment is likely to be lifelong.

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