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After blood tests, ruling out a long list of treatable medical conditions and making sure that one is showing symptoms for low-T, TRT Therapy (testosterone replacement therapy) is initiated. Subsequent monitoring is done to confirm the testosterone dose is optimal.
The goal for the majority of patients is a total testosterone in at least the mid to normal range of 400 to 600 ng/dL. Aim for higher levels in younger patients and lower levels in older patients is acceptable.
Once the dose is optimized, levels are not repeated often. Maybe once a year, unless symptoms are present or the dose changes. A baseline CBC before treatment at 3 months, 6 months and then annually after that is required.
According to the guidelines, the patient should be evaluated at 3 to 6 months after treatment initiation and then annually to assess whether symptoms have responded to treatment and whether the patient is suffering from any adverse effects.Sometimes the dose is decreased, while increasing the frequency of injections. For example, instead of 400 mg IM every month, 100 to 150 mg IM every 7 to 10 days might be prescribed.
Every one responds uniquely to testosterone replacement therapy. The amount of time it takes to notice certain benefits depends on current testosterone levels, the cause of low testosterone, and other biological factors such as obesity, comorbidities like diabetes or hypertension.
An increase in sex drive which can be noticed as early as 3 weeks is the quickest sign of testosterone therapy dose prescribed is on track. Increase in bone strength takes the longest time to manifest which can be anywhere from 6 months to an year, this also depends on how physically active one is, although bone strength increases a bit even with being sedentary but not advised.
While it is normal to want to feel a spring in the step as soon as possible, it is important to be patient while TRT works its magic, and crucial to finish the entire course being used first.
Hypogonadism is a collection of symptoms, and each target symptom will need a specific time frame to see desired results in response to androgen replacement treatment. Improvement in hypogonadal symptoms and signs occur at different times for different organ systems. TRT options should be first based on symptoms and second on hormone concentrations, which should be evaluated on a symptom-specific basis. In the event that there is no symptomatic relief after reaching the specified target testosterone levels or remain testosterone deficient in the setting of symptom/sign of improvement, testosterone therapy might be even discontinued.
In 2008, the ISSAM(International Study for the Study of Ageing Male) described 3 to 6 months as a reasonable time interval for the improvement of libido, sexual and muscle function, and body fat, and 2 years for the improvement of bone density. Data regarding the time of the start of improvements and stabilization of each symptom were added to the accumulated data in 2015. In trials, patients with low testosterone have demonstrated statistically significant improvements in erectile function, sex drive, anemia, bone mineral density, lean body mass , and depressive symptoms.
If after a few weeks no improvements noticed testosterone dose, delivery, frequency might need a change.
If you have been on testosterone replacement therapy for several weeks and not noticing improvements, it is a good time to check in for a change in dosage, delivery or frequency to ensure you get the full benefits of TRT.
It is important never to stop treatment without talking to your doctor first, even if no side effects are present. Medical supervision is crucial when starting, changing or stopping your dose of testosterone.