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Testosterone Replacement Therapy: Why Monitoring is Important (Part 1)

by Ryan McTeigue on July 13, 2023

You might be curious about what happens with your testosterone replacement therapy after being diagnosed with low Testosterone. It's essential to be monitored on a regular basis so you can feel great while receiving treatment that is specifically tailored to your needs. Our team uses monitoring to ensure that you benefit the most from your treatment. Since testosterone replacement therapy is tailored to you, we routinely check your progress to ensure that you are feeling your best which translates to your test results.


How Does Monitoring of Testosterone Replacement Work?

So basically, how does monitoring work when you have testosterone deficiency and start TRT? This is strongly influenced by your specific situation and general health. However, we usually begin by assessing your baseline health with a detailed medical history and laboratory testing. Before beginning testosterone replacement treatment, this aids our medical professionals in determining your current state of health. Elite BioScience uses these initial figures to keep track of your testosterone levels and overall health. Throughout testosterone therapy, our staff keeps an eye on your progress and safety. In most cases, we begin by monitoring you at least once every six months to perform some straightforward exams and bloodwork. We refer to these as semi-annual labs. This assists in therapy optimization and enables us to assess how well testosterone injections are benefiting you. We might advise having these labs done annually after we've helped you optimize your treatment plan and your health appears to be stable.


Below are the different components of our monitoring protocol which also includes lab tests and their significance.


Blood Pressure Monitoring

Blood pressure that is healthy is about 120/80 or lesser. You are pre-hypertensive if your blood pressure rises to anywhere between 125/85 and 139/89. You have hypertension if your blood pressure is 140/90 and above. Anyone with a blood pressure reading over 180/100 is experiencing a severe hypertensive crisis.
It’s vital to regularly check blood pressure on men receiving Testosterone Replacement Therapy (TRT).  Testosterone being an anabolic hormone, it stimulates erythropoiesis, the bone marrow produces more red blood cells (RBC).  Undetected and unmanaged increase in RBCs may cause the blood to thicken and potentially cause a clot and you have a heart attack or a stroke.
When your blood pressure rises too high, it can also put too much strain on your blood vessels, potentially causing a crack. If the blood vessels rupture, the clotting that results (your body's attempt to stop internal bleeding) can disrupt healthy blood flow, predisposing to heart problems, strokes, peripheral arterial disease, and other cardiovascular illnesses.

Reference:  Testosterone use causing erythrocytosis


Blood Testosterone Testing

Before and during treatment, we'll check your blood testosterone levels, which serves to guide appropriate doses. The entire purpose of TRT is to boost your testosterone levels. A normal testosterone range is between 350 and 1070 ng/dL.
We typically advise checking testosterone levels once every 3 to 6 months for the first year or so after beginning testosterone treatment. We might advise testing once a year if they continue to be steady. This assists in determining your dosage and enables us to monitor your progress during therapy.
If your total and free testosterone are low despite TRT, we may increase the dose to optimize blood T levels. More importantly, we also want to prevent highly elevated serum testosterone that can lead to excessive estradiol, acne, oily skin, hair loss, testicular shrinking, and increased blood viscosity due to high red blood cells.


PSA Tests During Testosterone Replacement

PSA testing is also an essential component of keeping track of your testosterone therapeutic process. It's important to note that research hasn't found evidence that testosterone therapy increases your risk of prostate cancer, but it can encourage the development of pre-existing cancer. PSA testing is one method of screening for prostate cancer, and depending on your risk factors, we recommend monitoring this during your treatment.


Reference: Rising PSA during Testosterone Replacement Therapy


Lipid Profile Monitoring

Endogenous testosterone is linked to a lipid profile that is called anti-atherogenic. This means testosterone prevents the formation of plaque in the blood vessels. This is characterized with higher HDL-c and lower total cholesterol and triglycerides. However, some studies demonstrate that TRT may also lower HDL-c, but it is usually combined with a reduction in total cholesterol and LDL-c.
Anything over 40 mg/dL of HDL cholesterol is considered normal. Experts estimate that a reduction in HDL cholesterol of merely 5 mg/dL can result in a 25% increase in the risk of coronary heart disease. In order to be sure you are not at risk for heart disease, monitoring your lipid profile particularly your HDL, is advised.

Reference: An update on testosterone, HDL and cardiovascular risk in men



On the second part of this article, we will talk about the importance of assessing the liver, kidney, thyroid and iron levels during Testosterone therapy.