Testosterone Replacement Therapy

Abstract

The aim of testosterone replacement therapy (TRT) is to provide the development of and maintain the secondary sex characteristics and to improve the symptoms and signs due to testosterone deficiency in patients with androgen deficiency. Testosterone replacement should be applied in patients with hypogonadism who have symptoms and signs of androgen deficiency associated with low testosterone levels. TRT has positive effects on secondary sex characteristics, sexual functions, muscle strength, physical functions, mood and bone density. Several testosterone preparations such as oral preparations, parenteral testosterone esters, transdermal testosterone patch, testosterone gels and transdermal testosterone tablets are available for the treatment of male hypogonadism. The adequacy of testosterone therapy is assessed according to the clinical response and serum testosterone levels. The biochemical goal in treatment is to keep testosterone levels at mid-normal range. After starting TRT, serum testosterone, hematocrit and PSA levels should be measured periodically, and digital rectal examination should be performed in the follow-up. TRT is contraindicated in patients with metastatic prostate and breast cancers. Before starting TRT, men with a history of prostate cancer or are at high risk for developing prostate cancer should be identified. Testosterone therapy is also not recommended in patients with increased hematocrit values, patients with obstructive sleep apnea, uncontrolled heart failure and lower urinary tract symptoms.KeywordsTestosterone replacement therapyAndrogen deficiencyMale hypogonadismTestosterone formulations