Low Testosterone

Todd M. Tartavoulle, MN, RN; Demetrius J. Porche, DNS, PhD


Journal for Nurse Practitioners. 2012;8(10):778-786. 

In This Article

Symptom Relief, Contraindications, and Screening/Monitoring

TRT has been associated with an improvement in libido, sexual function, mood, and energy levels. After 6 months of TRT, lean body mass and BMD at the hip and spine may improve and body fat may decrease, resulting in smaller waist circumference, which in turn has a direct effect on circulating acids and insulin resistance.[7] TRT may decrease proinflammatory cytokines (interleukin-6, c-reactive protein), decrease total cholesterol and LDL, and improve insulin resistance.[7]

Prostate and breast cancer are absolute contraindications for TRT (Table 5).[1] Precautionary contraindications are based on the potential for prostate and breast cancer cell growth in testosterone-dependent tumors.

Baseline screening and treatment monitoring are required to evaluate both the efficacy and safety of TRT. Recommended baseline assessments are voiding function or history; digital rectal exam (DRE); serum testosterone level; prostate-specific antigen (PSA) testing with prostate biopsy if PSA is > 4.0 ng/mL, if it increases substantially over a short period, or DRE is abnormal; history of sleep apnea; and hematocrit or hemoglobin.[6]

Clinicians should monitor PSA levels and perform a DRE regularly while the man is receiving treatment because of prostate cancer concerns. The clinical response of testosterone should be evaluated at 3 months and 1 year. A DRE and prostate symptomatology should be assessed every 6 to 12 months. Before TRT, a baseline PSA should be measured. After TRT, the PSA should be measured quarterly during the first year, then annually. Regardless of baseline PSA, an increase ≥ 4.0 ng/mL or rapidly increasing PSA levels are widely accepted criterion for urologic referral or prostate biopsy.[6]

BMD measurements should be obtained at baseline and 1 to 2 years after TRT has been initiated. TRT for 1 year has been shown to increase BMD of the lumbar spine.[2]

Testosterone may cause eryhthropoiesis; therefore, hematocrit monitoring is essential. Hematocrit values greater than 54% usually require TRT to be discontinued.[1]