Guidelines for evaluation and treatment of androgen deficiency syndromes in adult men
J Clin Endocrinol Metab 91: 1995-2010, 2006.

Check/Make diagnosis if:

• only in men with consistent symptoms and signs and unequivocally low serum testosterone levels

Labs:

• morning total testosterone
• confirm by repeating the morning total testosterone
• in some patients also measure free or bioavailable testosterone level

Initiate Therapy:

• for symptomatic men
• with low testosterone levels
• to induce and maintain secondary sex characteristics
• to improve their sexual function, sense of well0being, muscle mass and strength, and bone mineral density

Do not initiate therapy (contraindications):

• patients with breast or prostate cancer
• palpable prostate nodule or induration
• PSA greater than 3 without further urological evaluation
• erythrocytosis
• hyperviscosity
• untreated OSA
• severe lower urinary tract symptoms with International Prostate Symptom Score (IPSS) > 19
• class III, IV heart failure

Monitoring, when therapy initiated:

• goal testosterone in mid-normal range with any approved formulation