Initiation of treatment and followup

Appropriate investigations to rule out contraindications before starting T therapy are DRE, determination of PSA, and possibly transrectal ultrasonography. If, after 3-6 months, the signs and symptoms causing the initiation of therapy do not improve, androgen administration should be reconsidered.

The second annual Andropause consensus meeting recommended performing DRE and serum PSA before treatment, at three and six months, and yearly thereafter [215]. In addition to that recommendation, a PSA level could be obtained one month after initiation of therapy to capture the patient with a previously undiagnosed prostate cancer that may be behaving in a very aggressive fashion following T-replacement. ISSAM and WHO guidelines also recommend periodic hematologic assessment, i.e.

before treatment, quarterly for one year, and then annually, to detect possible iatrogenic polycythemia [2,168]. It may also be useful to monitor serum T, especially when under- or overdosing is suspected. Blood has then to be sampled at appropriate times, depending on the T preparation that is used, and its specific pharmacokinetics.

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