Testosterone lowers total cholesterol
A meta-analysis of 30 RCTs (1642 men, 808 on testosterone therapy, 834 on placebo) that assessed testosterone’s effect on lipid levels found that testosterone reduced total cholesterol levels by 16 mg/dL (95% CI, 6-26 mg/dL); effects on all other lipid fractions weren’t significant.5
A second meta-analysis of 16 RCTs (578 men, 320 on testosterone therapy, 258 on placebo) similarly showed that testosterone lowered total cholesterol levels by 8 mg/dL (95% CI, 4-14 mg/dL) and that its effects on other lipid fractions weren’t significant.2 The previously mentioned meta-analyses of 19 and 30 RCTs found no significant difference in cardiovascular events between testosterone- and placebo-treated groups.1,5
Optimal testosterone level is unknown
Data are inadequate to determine the optimal serum level of testosterone for efficacy and safety.3 Expert opinion suggests that because therapy is empiric, monitoring clinical response may help guide treatment more than testosterone level.6
What about the liver?
Oral testosterone can be associated with hepatotoxicity; it is seldom used in the United States. Liver monitoring is unnecessary for patients receiving testosterone by injection, patch, or transbuccal tablet.7,8
Recommendations
Consensus guidelines for monitoring men on testosterone therapy overlap considerably with regard to monitoring clinical effectiveness, prostate measures, hematocrit, and BMD (TABLE).3,6,9,10 Assessing testosterone level is recommended, with the aim of achieving levels in the mid-normal range.10
Table
Monitoring testosterone therapy: What the consensus guidelines say
| Organization | First follow-up | DRE | PSA test | Testosterone levels | Hematocrit | BMD | Lipids |
|---|---|---|---|---|---|---|---|
| American Association of Clinical Endocrinologists9 | q 3-4 mo in first year | q 6-12 mo | Annually | q 6 mo x 3, then annually | q 1-2 y | At 6-12 wk, then annually | |
| American Society for Reproductive Medicine6 | At 2-3 mo | In first 2-3 mo | At 3 and 6 mo, then annually | At 3 and 6 mo, then annually | At 3 and 6 mo, then annually | At 2 y | |
| The Endocrine Society10 | At 3 mo, then annually | At 3 mo, then per routine guidelines | At 3 mo, then per routine guidelines | At 3 mo | At 3 mo, then annually | At 1-2 y | |
| European Association of Urology3 | At 3 mo | At 3 and 6 mo, then annually | At 3 and 6 mo, then annually | At 3 mo, then annually | q 1-2 y | ||
| BMD, bone mineral density; DRE, digital rectal exam; PSA, prostate-specific antigen. | |||||||