The Panel explicitly uses the term testosterone therapy rather than testosterone replacement therapy or testosterone supplementation to be in keeping with the beliefs of the current thought leaders in the field. Thus, a patient is considered testosterone deficient and a candidate for testosterone therapy only when he meets both criteria. To be scientifically accurate, the Panel chose the term testosterone deficiency. Ultimately, the AUA and the Testosterone Panel were committed to creating a Guideline that ensures that men in need of testosterone therapy are treated effectively and safely. Clinicians may use aromatase inhibitors, human chorionic gonadotropin, selective estrogen receptor modulators, or a combination thereof in men with testosterone deficiency desiring to maintain fertility. Testosterone therapy should not be commenced for a period of three to six months in patients with a history of a cardiovascular events. Consultation with healthcare professionals ensures safe and effective administration, optimizing the benefits of testosterone treatment. Testosterone replacement therapy (TRT) can be administered via injections into several muscle sites. One key advantage is the ease of self-administration, as SubQ injections are generally considered less painful and easier to perform. Firstly, IM injections ensure deeper penetration into the muscle tissue, leading to faster absorption and potentially more rapid onset of therapeutic effects. SubQ injections are perfect for smaller amounts of Testosterone or for those that are too immobile to actually reach the muscle tissue on their body. Eating enough protein can help you maintain healthy testosterone levels and can aid in fat loss, which may be beneficial, too. Resistance training, such as weightlifting, has been shown to boost testosterone levels in the short term. According to a 2020 literature review, the effects on testosterone levels can vary based on several factors, including the type of exercise and the training intensity. The frequency of testosterone injections varies depending on your prescribed treatment plan. TRT clinics, or Testosterone Replacement Therapy clinics, are medical facilities that specialize in diagnosing and treating individuals with low testosterone levels. Moreover, the use of longer needles in IM injections ensures proper deposition of testosterone deep into the muscle, minimizing the risk of leakage or displacement. Specifically, the odds ratio for developing ED in men with total testosterone 6 used a single question to define ED and also showed an increase in ED risk as total testosterone levels decreased. In a small study of young men with acute respiratory infections, mean total testosterone levels declined by 10%, with some cohorts experiencing reductions of up to 30%.25 Where possible, clinicians should use LCMS to measure total testosterone levels to maximize accuracy and limit CV between tests in men undergoing testing, particularly in men with very low total testosterone levels. It was decided that a cut-off value was critical to define testosterone deficiency and that this cut-off be based on at least two total testosterone levels drawn in an early morning fashion at the same laboratory using the same assay. Prior to initiating treatment, clinicians should counsel patients that, at this time, it cannot be stated definitively whether testosterone therapy increases or decreases the risk of cardiovascular events (e.g., myocardial infarction, stroke, cardiovascular-related death, all-cause mortality). The care of testosterone deficient patients should focus on accurate assessment of testosterone levels, symptoms and signs as well as proper on-treatment monitoring to ensure therapeutic testosterone levels are reached and symptoms are ameliorated. There is a great deal of variability across studies with respect to the forms of testosterone measured (total versus free), the assays utilized to measure testosterone, the time of day when the sample is obtained, and the number of testosterone measurements taken. However, as the testosterone literature uses absolute values to define low testosterone, the absolute value is ultimately the most important factor to determine whether patients may expect to achieve benefits with testosterone therapy. As an example, a total testosterone value of 250 ng/dL may be considered low based on the current guideline but be marked within the normal range by the laboratory. Well-established reference ranges constitute the essential basis for identifying whether the circulating levels of a particular analyte, testosterone in this case, are normal or low. Other population-based studies have attempted to measure prevalence, but have not used standard methodology, which makes arriving at a definitive number of testosterone deficiency difficult.
