How Does TRT Monitoring Work?

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Testosterone is an essential male sex hormone that’s involved in many bodily processes and helps maintain bone strength, muscle mass, and sexual function. Its deficiency can cause serious health problems, including low sex drive and loss of muscle mass.

Most men with low testosterone are recommended TRT that involves the administration of exogenous testosterone to bring blood testosterone levels within the normal range.

Success with TRT depends on how well it’s monitored as monitoring ensures you get optimal results while avoiding TRT side effects.

Keep reading the article to learn what exactly is done during TRT monitoring and why it’s important.

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Importance of monitoring testosterone replacement therapy (TRT)

TRT monitoring involves checking your overall health, the effects of TRT, and your testosterone levels throughout the treatment. Initially, it is done every 3 to 6 months. Once your testosterone levels become stable, your doctor may suggest an annual checkup.

TRT monitoring is mainly done to make sure:

• You achieve your health goals via TRT.
• Your testosterone levels stay within the normal range.
• Your low T symptom improve.
• You don’t develop any TRT side effect and if there is any, you identify it early to prevent complications.
• Your related hormones and overall health stay on the right track.

How does TRT monitoring work?

Every man is unique and responds differently to TRT based on his health, age, genes and other similar factors.

Before starting TRT: Your baseline hormone panel is done to check how your hormone levels and overall health look like naturally, before any treatment.

A complete hormone panel may include tests for total testosterone, free testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, sex hormone binding globulin (SHBG), prolactin, thyroid function test, and complete blood count (CBC).

These tests also help your endocrinologist understand whether you are the right TRT candidate.

After starting TRT: Your healthcare provider will see you in 3 to 6 months to check how your body is responding to the treatment and what your current testosterone levels are.

If your testosterone level is within the desired range and your body is responding well to the treatment, they may keep your testosterone dosage the same.

But if your testosterone levels are less or more than the required amount, they will tweak the dosage to make sure you get desired results and feel your best. They may also adjust your treatment plan depending on your TRT side effect.

Long-term follow up: When your testosterone levels have stabilized and your body has started responding well to the treatment, long-term follow up becomes essential for continued safety and treatment effectiveness.

Labs will be done every 6 to 12 months (or more frequently if there are some risks involved) to check your hormone levels and overall health.

What specific parameters must be monitored during testosterone therapy?

During TRT, several health markers are consistently monitored to ensure you achieve your TRT goals safely. Generally, it involves blood pressure analysis, testosterone blood test, a full blood panel, a physical examination, and a general health questionnaire.

Most healthcare providers customise monitoring according to each patient’s individual needs and treatment plan.

Here is what’s generally analysed during TRT monitoring:

Total testosterone and free testosterone levels

Doctors conduct testosterone tests throughout the treatment to ensure the hormone is within normal range. Through this test, they analyse your total testosterone and free testosterone levels and compare them with the testosterone levels you had before starting TRT.

They will check your testosterone levels every 3 to 6 months during the first year of the treatment. When levels become stable, testosterone testing will be generally done once per year.

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Low T symptom tracking

During testosterone monitoring, your doctor will ask a few questions to see how much TRT has helped you manage your low testosterone symptoms, such as muscle loss, low mood, decreased libido and erectile dysfunction. They may increase your dose if no change is observed.

Treatment side effects

Like any other treatment, TRT also has potential side effects, including acne, male breast enlargement, etc. Your doctor will watch out for these effects to help you manage them in the best possible way.

Prostate-specific antigen (PSA)

Studies don’t show any correlation between prostate cancer development and TRT, but they do tell that the treatment can stimulate cancer growth in men who already have it, or it may increase the risk of prostate cancer in men with certain medical conditions.

The PSA test is done to screen for prostate cancer. In this test, your PSA count is calculated. PSA is a protein produced by the prostate. Men with prostate cancer, inflammation or enlargement have a higher PSA level than healthy men.

Estradiol (estrogen)

A small portion of testosterone is converted into estradiol in all healthy men. However, TRT can accelerate this process (mostly when testosterone levels become much higher than your natural baseline) and lead to higher estradiol levels than normal.

This causes problems like development of male breasts (gynecomastia) and water retention.

Estradiol test is done to ensure you have healthy estrogen levels.

Lipid profile

Testosterone can influence lipid levels and increase cardiovascular risk in some patients. That’s why your cholesterol and triglyceride levels are regularly monitored to ensure safety.

Hematocrit and hemoglobin

TRT can increase red blood cell count, making the blood thicker. This in turn increases the risk of blood clot formation, high blood pressure, and cardiovascular events.

Testing blood counts regularly is important as it helps detect the problem earlier and prevent its serious consequences. In most cases, if the blood count is higher than normal, doctor reduce testosterone dosage.

Liver function test

LFTs are often done for patients with liver issues or those who are taking oral testosterone (as testosterone pills can impact liver health).

Blood pressure

Your blood pressure will be monitored every time you visit the clinic. If you are on the at-home program, you will have to check it regularly on your own.

Blood pressure is used as an indicator of overall health. As mentioned earlier, TRT may increase the risk of high blood pressure and heart stroke; therefore, evaluating your blood pressure is required to help avoid these potential side effects.

What else you need to know about monitoring testosterone therapy

Keep your expectations real

Although TRT helps with male hypogonadism symptoms, it may not improve your condition as much as you expect. It is mainly because many factors are involved in improving your health. For instance, low testosterone alone may not be the culprit behind poor sex drive. It may be due to lack of sleep, excessive weight, low self-esteem, or a certain health condition as well.

Choose a simpler and more effective TRT method

Testosterone is available in many forms such as testosterone injections, testosterone gels, and testosterone patches. Each method has its unique pros and cons. A method that works for someone else may not be as effective for you as it was for them.

Discuss the pros, cons, methods of application, and effects of each option with your doctor to choose a TRT method that best suits your needs.

TRT is a lifetime commitment

TRT is a lifelong procedure. You cannot take it on and off and expect your testosterone levels to stay stable.

When you stop taking testosterone, your levels will basically go back to what they used to be before starting TRT. Your symptoms of low testosterone will also return.

So, before you start your TRT journey, prepare yourself fully for this lifelong commitment.

Keep track of your results and side effects

If you are new to TRT, you should note down your symptoms and side effects, so you can discuss them with your doctor the next time you visit him.

In our busy routines, we tend to easily forget how we were feeling or doing the past week. We suggest you keep making notes until your next session, so you don’t have any trouble explaining your condition to the doctor.

FAQs about monitoring TRT

Can any person have TRT?

TRT is an effective treatment, but it is not for all. It is only prescribed to men with low T symptoms that too if they don’t have prostate cancer and cardiovascular disease development risk. Your doctor may suggest natural ways of increasing testosterone or other medical options if you are not the right candidate for TRT.

How much does TRT cost?

TRT cost depends on different factors, which is why it is hard to give an exact number. Common factors that influence TRT cost are:

• Mode of testosterone administration
• Frequency of administration
• Your location
• Insurance coverage

If you are considering TRT cost, know that the treatment does not cure low T; it simply elevates your testosterone levels. It means you will have to take it and pay for it throughout your life to keep your testosterone levels stable.

How to get started with TRT?

If you think you are testosterone deficient, consult an endocrinologist or a hormone specialist to confirm it. They will first diagnose low T and its cause and then prescribe testosterone after a careful evaluation.

Do you have to take TRT forever?

TRT is a lifelong procedure. It doesn’t cure low T cause but provides exogenous testosterone so you can manage low T symptoms. When you stop TRT, your testosterone levels reduce again and symptoms also return.

Summing it up

Some men believe getting testosterone is all they need to fix their low T condition. Remember that testosterone administration and treatment monitoring go hand in hand.

In addition to receiving testosterone, you need to monitor your testosterone levels as well to ensure they stay stable and TRT does not cause potential side effects.

A TRT monitoring session usually involves a questionnaire, blood count test, and testosterone test. Your doctor will design a monitoring schedule based on your individual needs.

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References/Further reading/Bibliography/Scientific studies 

Baillargeon, J., Urban, R.J., Kuo, Y.F., Holmes, H.M., Raji, M.A., Morgentaler, A., Howrey, B.T., Lin, Y.L. and Ottenbacher, K.J., 2015. Screening and monitoring in men prescribed testosterone therapy in the US, 2001–2010. Public health reports, 130(2), pp.143-152.

Mulhall, J.P., Trost, L.W., Brannigan, R.E., Kurtz, E.G., Redmon, J.B., Chiles, K.A., Lightner, D.J., Miner, M.M., Murad, M.H., Nelson, C.J. and Platz, E.A., 2018. Evaluation and management of testosterone deficiency: AUA guideline. The Journal of urology, 200(2), pp.423-432.

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