It is vital to establish a definitive diagnosis of hypogonadism before starting testosterone replacement therapy, as the treatment is lifelong. Maximal efficacy with minimal adverse effects is achieved through individually tailored treatment and thorough monitoring after treatment initiation.
- In men with hypogonadism, testosterone deficiency is a clinical diagnosis confirmed by hormone assays.
- A definitive clinical diagnosis (including testicular examination) needs to be made before starting testosterone treatment.
- There is no role for a ‘trial’ of testosterone replacement therapy (TRT).
- There is no evidence of benefit from TRT in testosterone deficiency resulting from chronic disease, ageing or obesity.
- TRT needs to be initiated by or in consultation with a specialist.
- The best way of maximising the benefit and minimising the risk of TRT is to treat only men for whom the benefit is proven; that is, those with properly established androgen deficiency due to pathological hypogonadism.