In this clinical scenario, an argument can be made to continue testosterone therapy. An exception can be made if patients do not have symptoms but have documented BMD loss. Testing intervals are the expert opinion of the Panel and are provided as a guide to aid clinicians in the follow-up of such patients. Please refer to Table 7 below for a summary of follow-up testing for men being treated for testosterone deficiency. Patients who are on long-acting SQ pellets require two separate assessments of testosterone to determine the dose and frequency required. With respect to testosterone specifically, Grober et al. conducted an analysis of compounded testosterone creams/gels from 10 pharmacies in Toronto, Canada.410 Each pharmacy was given two prescriptions for 50 mg of testosterone, separated by 1 month to assess both intra-pharmacy and inter-pharmacy consistency. Self-injecting testosterone can generally be a safe and effective way to manage hormone therapy when done correctly with prescribed testosterone. LH, which is routinely measured by immunoassay, may help to establish the etiology of testosterone deficiency and can be an important factor in determining if adjunctive tests should be ordered (Appendix C - refer to the Appendix C section in the left menu). Their role in diagnosing testosterone deficiency is unclear, and they should not be used at the expense of a full patient evaluation, including laboratory testosterone measurement. Screening questionnaires are not an appropriate tool to identify candidates for testosterone therapy. The goal of testosterone therapy is the normalization of total testosterone levels combined with improvement in symptoms or signs. Men with mild testosterone deficiency and whose weight is above the recommended range and/or who are physically inactive should be encouraged to consider low-risk lifestyle modifications followed by reassessment of testosterone levels, signs, and symptoms before deciding to start testosterone therapy. Testosterone deficient patients should be informed that low testosterone levels place them at risk for these major cardiovascular events and clinicians should assess all testosterone deficient patients for ASCVD risk factors, both fixed (e.g., older age, male gender) and modifiable (e.g., dyslipidemia, hypertension, diabetes, current cigarette smoking). PSA secretion is an androgen dependent phenomenon, and the rise of PSA levels in patients on testosterone therapy is primarily dependent upon baseline total testosterone levels. The cut-off of 300 ng/dL was chosen based on the mean total testosterone levels cited in the best available literature with a view to maximizing the potential benefit from prescribing testosterone while minimizing the risks of such treatment. Mean peak total testosterone levels are dose-dependent, with a mean of 746, 866, and 913 ng/dL noted with 8, 10, and 12 pellets administered (not BMI adjusted).446 The duration of effect is similar, however, and is relatively independent of dosing. Men with total testosterone level 315 ng/dL declined from 100% at 4 weeks to 86%, 75%, and 14% by 12, 20, and 24 weeks, respectively.Mean peak total testosterone levels are dose-dependent, with a mean of 746, 866, and 913 ng/dL noted with 8, 10, and 12 pellets administered (not BMI adjusted).446 The duration of effect is similar, however, and is relatively independent of dosing. In a firm swift motion press the needle into the injection site. Clean your selected injection site with another alcohol wipe. Squirt a tiny bit of the testosterone out of the tip of the needle. Pull back the plunger of the syringe, again to your desired dose, this time drawing the liquid testosterone into the syringe. Now, with the needle still in the vial, invert and lift the vial, so you can draw the testosterone down, into the syringe. IM injections involve injecting testosterone directly into the muscle tissue. SubQ injections involve injecting testosterone into the fatty tissue just below the skin. Subcutaneous (SubQ) and intramuscular (IM) are two common methods of administering testosterone injections. Testosterone injections are a common method of administering testosterone for individuals undergoing hormone replacement therapy – or for those looking to garner more gains. For testosterone injections, 23-gage, 1-inch and 25-gage, 1-inch needles are standard. A study by Pastuszak et al. (2015)355 found a significant increase in biochemical recurrence in high-risk patients who received testosterone therapy after RT or RT/ADT. While this period of waiting might preclude the need for testosterone therapy by allowing testosterone to return to normal levels organically, it is possible that men who underwent long courses of ADT may not regain physiological testosterone levels even one year after cessation of ADT.349, 350 Available studies are retrospective in nature but have suggested that post-RT patients (with or without ADT exposure) placed on testosterone therapy do not experience recurrence of prostate cancer. Currently published studies have not demonstrated an increased risk of biochemical cancer recurrence in post-RP patients who are on testosterone therapy, nor does it define the optimal timing for commencement of testosterone therapy. Included studies had significant heterogeneity with the populations themselves, methods of assessment, study durations, baseline population characteristics, and number of participants, leading the Panel to conclude that there is currently insufficient evidence to determine if testosterone therapy impacts QoL in a meaningful way. The two main methods of injecting testosterone are intramuscular (IM) and subcutaneous (SubQ) injections. Both SubQ and IM injections can be safe methods for testosterone administration when performed correctly. Well, for everyone that assumes the SUBQ route wouldn’t be effective, a 2006 study has found it to be remarkably effective at increasing Testosterone levels. These factors, combined with convenience and patient preference, make SubQ injections a viable option for testosterone administration. Additionally, SubQ injections have a lower risk of hitting blood vessels or nerves, reducing the likelihood of complications. SubQ injections have their own merits when it comes to testosterone administration. IM injections offer several advantages over SubQ injections for testosterone administration.
