In hypogonadal men, most of the symptoms of androgen deficiency are alleviated with androgen replacement. To determine the dose of testosterone to be administered, serum testosterone levels should be measured at appropriate times after drug administration, based on the PK characteristics of the specific preparation. For example, serum testosterone levels peak 12-16 h after application of testosterone patches and return toward baseline by 24 h. Monitoring is thus done approx 12 h after application, and levels should be in the mid-normal range. Because serum T levels are maintained in a steady state by the transdermal gels (see Fig. 2), serum testosterone can be measured at any time. Because the injectable testosterone preparations, such as testosterone enan-thate and cypionate, result in early peaks (i.e., 2-3 d) and troughs (10-14 + d), serum testosterone is measured at day 7 to ensure that serum testosterone levels are within normal limits. Once a stable dose of testosterone replacement is determined, then measuring serum testosterone levels is often unnecessary unless dose adjustments are made.
Because administration of testosterone may unmask histological prostate cancers by increasing serum PSA levels, measuring PSA early after beginning treatment, e.g., 1 to 3 mo is recommended. Thereafter, PSA should be checked yearly according to the uro-logical practice applicable to each man. Hemoglobin and hematocrit should be checked at 3 mo and after each dose adjustment, followed by yearly intervals. Subjects whose hemoglobin level is high before treatment should be monitored more carefully. As with other patients on replacement therapy, a yearly liver function test and lipid profile should be done.
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