Complications
POME may occur with intramuscular injections of long-acting testosterone undecanoate, and less commonly with other oil-based intramuscular testosterone injections. Symptoms may include cough, dyspnea, throat tightening, chest pain, dizziness, and syncope.[58] These episodes typically occur within 30 minutes of administration and resolve spontaneously. POME is much less frequent if the injection is given slowly. For this reason, long-acting testosterone undecanoate should be administered in a healthcare setting (rather than at home).
Occurs less frequently with gels/creams than with transdermal patches; the mechanism is unclear.
Obtain urology consultation if: PSA increases to above 4.0 nanograms/mL; PSA velocity is above 0.4 nanograms/mL/year; there is an increase in PSA above 1.4 nanograms/mL within a 12-month period of testosterone treatment.[34]
PSA elevation may occur from causes other than testosterone therapy: for example, exercise (in particular cycling), urinary tract infection (check urine), prostatitis, benign prostatic hypertrophy, urinary retention, urinary catheterization, digital rectal exam, sigmoidoscopy/colonoscopy, inflammatory bowel disease, ejaculation, anal intercourse, and recent surgery.
It is expected that patients may experience testicular shrinkage as a result of negative feedback of testosterone on gonadotropin secretion.
Reduction in sperm count may occur on testosterone therapy. This may lead to subfertility. Sperm count may be abnormal as part of hypogonadal condition. Patients should be advised that there is no evidence that testosterone therapy is detrimental to their fertility if later switched to alternatives such as human chorionic gonadotropin for fertility treatment.[62]
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