Browse the corpus

Testosterone is FDA-approved as replacement therapy in men with low testosterone levels and those with symptoms of hypogonadism. Symptoms highly suggestive of hypogonadism include fewer or diminished spontaneous erections, decreased nocturnal penile tumescence, low libido, sparse beard growth, and shrinking testes. In males, the normal range for early morning testosterone is between 300 ng/dL to 1000 ng/dL but may vary from laboratory to laboratory. Clinicians must distinguish between primary (testicular) and secondary (pituitary-hypothalamic) hypogonadism. This review discusses the mechanism of action, adverse event profile, and other key factors (eg, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent to interprofessional team members who use exogenous testosterone to treat hypogonadism. Objectives: Identify patients who may benefit from androgen replacement therapy based on clinical indications and assessment of hormone levels. Differentiate different types of androgen replacement therapies, such as testosterone preparations, and understand their pharmacokinetics, dosing, and administration routes. Assess the therapeutic response to androgen replacement therapy by regularly monitoring hormone levels, symptom improvement, and potential adverse effects. Select the optimal formulation, dosage, and delivery method of androgen replacement therapy based on patient preferences, adherence, and clinical considerations. Access free multiple choice questions on this topic.

Physicians, advanced practice practitioners, pharmacists, and nurses operating as interprofessional healthcare teams must know the risks, benefits, and contraindications of testosterone replacement therapy. There are conflicting trials on the cardiovascular risks of testosterone therapy, most notably the TOM (Testosterone in Older Men) trial and the TEAAM (Testosterone's Effects on Atherosclerosis Progression in Aging Men) trials. Low testosterone levels have correlated with an increased risk of coronary artery disease.[25][26] A study published in JAMA in 2017 found that testosterone replacement was associated with a lower risk of cardiovascular outcomes.[27] The American Association of Clinical Endocrinologists (AACE) issued a guideline in response to the 2015 FDA labeling requirement on cardiovascular risk. The guideline stated that there is no compelling evidence that testosterone therapy increases cardiovascular risk.[28] On the other hand, testosterone deficiency correlates with falls, sarcopenia, frailty, osteopenia, and osteoporosis.[29] Clinicians must prescribe androgen replacement therapy using a risk-benefit assessment of the patient's clinical needs and risk of adverse reactions. There should be a clear, expected symptomatic benefit to justify continuing treatment beyond the initial clinical trial period of 3 to 6 months. They should employ shared decision-making techniques that include the patient, pharmacist, and nurses and set realistic goals as well as parameters for stopping therapy. Pharmacists should verify dosing, check for potential interactions, and provide thorough counseling for drug administration, which will vary depending on the treatment modality and formulation chosen. Nurses can also counsel patients on dosing and administration and assess treatment effectiveness. Both pharmacists and nurses must inform the prescriber of any concerns they may encounter, so open communication channels and shared decision-making among team members are vital. Monitoring of the patient by the interprofessional team will result in the best outcomes with the fewest adverse events.