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. TRT may decrease proinflammatory cytokines (interleukin-6, c-reactive protein), decrease total cholesterol and LDL, and improve insulin resistance.
Prostate and breast cancer are absolute contraindications for TRT (Table 5). 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.
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.
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.
Testosterone may cause eryhthropoiesis; therefore, hematocrit monitoring is essential. Hematocrit values greater than 54% usually require TRT to be discontinued.
Journal for Nurse Practitioners. 2012;8(10):778-786. © 2012 Elsevier Science, Inc.