Hormone replacement may be started for a variety of reasons. Once started, it is usually maintained for life. Since patients must be monitored for the duration of time that they are on testosterone replacement, essentially, the monitoring is a lifetime commitment.
There is not yet a general consensus on how men with testosterone replacement should be monitored. It is clear that those patients who have begun testosterone replacement for a particular symptom should have that symptom carefully observed. For example, a patient using testosterone because of problems with osteoporosis should have regular serial bone density screens. Patients with mood or libido changes must also be carefully evaluated.
In general, dosage should begin low. Hormone levels and subjective impressions should then be checked 2 to3 months afterward. If adequate blood hormone levels have not been reached, the dosage should be increased, and, again, the patient should return in another 2 to 3 months for blood work.
The goal is to get the patient in the mid-range of the testosterone values. Once this has occurred, the patient must then be monitored at regular intervals both in terms of symptoms and blood work.
Our practice monitors blood fairly frequently. Once the patient has achieved the right dosage of hormone, we follow the patient's progress and draw blood every 3 months for at least a year. The following year, we evaluate the patient and draw bloodevery 4 months. Thereafter, appointments and blood work are required every 6 months.
During the initial follow-up appointments, we evaluate the patient psychologically and physically. Blood work includes hormone levels, a complete chemistry profile including chemistries, lipids (fat profiles), and liver function tests. We also perform a complete blood cell count to check the patient's hematocrit (an increased hematocrit is a common side effect of testosterone replacement therapy). It is important that the patient receive serial prostate exams at all of these visits as well as a PSA test. It is also important to discuss any sleep disorders with the patient and to assess his mood, libido, and emotional state.