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   DIR Return to: TRT Studies
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       #Post#: 5639--------------------------------------------------
       Who Should Use TRT?
       By: Road2HardCoreIron Date: November 15, 2024, 7:20 pm
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       Who Should Use TRT?
       Today, 08:19 PM
       We recommend making a diagnosis of hypogonadism only in men with
       symptoms and signs consistent with testosterone (T) deficiency
       and unequivocally and consistently low serum T concentrations.
       We recommend measuring fasting morning total T concentrations
       using an accurate and reliable assay as the initial diagnostic
       test. We recommend confirming the diagnosis by repeating the
       measurement of morning fasting total T concentrations. In men
       whose total T is near the lower limit of normal or who have a
       condition that alters sex hormone-binding globulin, we recommend
       obtaining a free T concentration using either equilibrium
       dialysis or estimating it using an accurate formula. In men
       determined to have androgen deficiency, we recommend additional
       diagnostic evaluation to ascertain the cause of androgen
       deficiency. We recommend T therapy for men with symptomatic T
       deficiency to induce and maintain secondary sex characteristics
       and correct symptoms of hypogonadism after discussing the
       potential benefits and risks of therapy and of monitoring
       therapy and involving the patient in decision making. We
       recommend against starting T therapy in patients who are
       planning fertility in the near term or have any of the following
       conditions: breast or prostate cancer, a palpable prostate
       nodule or induration, prostate-specific antigen level > 4 ng/mL,
       prostate-specific antigen > 3 ng/mL in men at increased risk of
       prostate cancer (e.g., African Americans and men with a
       first-degree relative with diagnosed prostate cancer) without
       further urological evaluation, elevated hematocrit, untreated
       severe obstructive sleep apnea, severe lower urinary tract
       symptoms, uncontrolled heart failure, myocardial infarction or
       stroke within the last 6 months, or thrombophilia. We suggest
       that when clinicians institute T therapy, they aim at achieving
       T concentrations in the mid-normal range during treatment with
       any of the approved formulations, taking into consideration
       patient preference, pharmacokinetics, formulation-specific
       adverse effects, treatment burden, and cost. Clinicians should
       monitor men receiving T therapy using a standardized plan that
       includes: evaluating symptoms, adverse effects, and compliance;
       measuring serum T and hematocrit concentrations; and evaluating
       prostate cancer risk during the first year after initiating T
       therapy.
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