How should doctors monitor men receiving testosterone replacement therapy?

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Excel Male

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Very good short paper that summarizes what several medical guidelines say about monitoring men on testosterone replacement. I suggest you print it out and give your doctor a copy since it is simple and short. The summary table is great!

You will realize that not a single guideline group includes estradiol monitoring. That may change in the future. Estradiol testing via sensitive test is suggested after 6-8 weeks of starting testosterone replacement therapy. If under 50 pg/ml, no further testing is required and no anastrozole should be used.

Download PDF of article below (right after the table)
table5 - Copy.jpg


  • how should doctors monitor TRT.pdf
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Defy Medical TRT clinic doctor

Nelson Vergel

Blood Analysis Required Before Starting Testosterone and as Follow-Up

After ensuring PSA is under 4, then these tests can be performed before starting testosterone


1 ------- CAH Panel 6B (Comprehensive Screen) (10299X)
2 ------- Estradiol [4021X](13- 54 pg/mL) (ultrasensitive)
3 ------- Testosterone, Free, Bio/Total (LC/MS/MS) Code: 14966X
4 ------- DHEAs
5 ------- Comprehensive Metabolic Panel w/EGFR
6 ------- CBC w/ diff/PLT
7 ------- Lipid profile
8------- T3, Free
9------- T4, Free
10------- Ultrasensitive TSH
11------- LH & FSH

For follow up, LH and FSH can be dropped. Lipids and thyroid tests only once or twice a year depending on patient metabolic issues. CBC includes hematocrit, one of the main variables to watch for on TRT at least for the first 6 months to a year. PSA could be added to 6 month follow up specially if over 2 at baseline.

The following is what different guideline groups say (you will see no estradiol in this table since guidelines do not mention that test):

The following graph shows approximate times to expect increases and stabilization of hematocrit and prostate volume and PSA (From:How Long Does It Take for TRT to Work? )

Nelson Vergel

Why Testosterone Should Not Be Injected Every Two Weeks As Many Doctors Recommend

These graphs show what happens (average since everyone is different) in a study that used 200 mg of testosterone injections every two weeks. I have not been able to locate pk graphs of 100 mg per week, but the peak should be much less pronounced. As you can tell if these graphs, the 3 first days show increases beyond the max value in the range. You can also see the bars that show standard deviations to demonstrate how widely people respond (the age group was wide from 22-65, that may have been the main reason). You can also see DHT and estradiol levels. Or course gels do not exhibit this type of response curves. But I would say that 100 mg per week of injectable testosterone will not spike most people too much during day 1-3. Some men may use 75 mg per week instead. Testosterone response is linked to liver function, aromatase enzyme activity, fat content, genetic factors that we know little about, body mass index, and a cookie cutter approach should not be used!


Nelson Vergel

Many doctors are not doing a good job at monitoring TRT as found by this study.

Baillargeon J, Urban RJ, Kuo YF, Holmes HM, Raji MA, et al. Screening and monitoring in men prescribed testosterone therapy in the U.S., 2001-2010. Public Health Rep. 2015;130(2):143-52.

OBJECTIVES: The Endocrine Society recommends testosterone therapy only in men with low serum testosterone levels, consistent symptoms of hypogonadism, and no signs of prostate cancer. We assessed screening and monitoring patterns in men receiving testosterone therapy in the U.S.

METHODS: We conducted a retrospective cohort study of 61,474 men aged >/=40 years, and with data available in one of the nation's largest commercial insurance databases, who received at least one prescription for testosterone therapy from 2001 to 2010.

RESULTS: In the 12 months before initiating treatment, 73.4% of male testosterone users received a serum testosterone test and 60.7% received a prostate-specific antigen (PSA) test. Among men who were tested, 19.5% did not meet Endocrine Society guidelines for low testosterone. In the 12 months after initiating treatment, 52.4% received a serum testosterone test and 43.3% received a PSA test. Multivariable analyses showed that those seen by either an endocrinologist or urologist were more likely to receive appropriate tests.

CONCLUSIONS: A substantial number of men prescribed testosterone therapy did not receive testosterone or PSA testing before or after initiating treatment. In addition, almost one out of five treated men had baseline serum testosterone values above the threshold defined as normal by the Endocrine Society. Men treated by endocrinologists and urologists were more likely to have been treated according to guideline recommendations than men treated by other specialties, including primary care.

Nelson Vergel

This is a typical hormone and wellness panel done before initiating testosterone replacement therapy

If you have insurance, hopefully you can get these tests paid for.

Pre  TRT Male Hormone   Wellness Panel   Discounted Labs.jpg
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Nelson Vergel


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