Hypogonadism in men

Transdermal preparations

Testosterone level should be checked 2 to 4 hours after testosterone gel application, when peak absorption level is attained. Testosterone levels can be checked to see if they have reached therapeutic levels as early as 1 week after initiation of transdermal products, to ensure that adequate treatment has been given.

Short-acting intramuscular preparations

It is seldom useful to measure peak levels of testosterone after an injection. Rather, trough levels (prior to the next injection) are more helpful. Levels should be checked periodically. Lower testosterone levels may need to be accepted in order to prevent or mitigate erythrocytosis.

Long-acting testosterone undecanoate

Testosterone levels should be measured just prior to an injection (i.e., trough level) to ensure concentration is in the low-normal range. Lower testosterone levels may need to be accepted in order to prevent or mitigate erythrocytosis.

Haematocrit and prostate-specific antigen should be checked at regular intervals after initiation of therapy and then annually. An evaluation of benefits and side effects is advised and cessation of treatment should be considered in men without therapeutic benefit (although this would be unusual in men with a verified diagnosis of hypogonadism at baseline).

Men whose sexual function or other presenting symptoms fail to improve to the desired extent should be encouraged to persevere with testosterone therapy to promote long-term bone health.