Point of care

Provider Reference

Everything you need during the visit, on one page. Formulations in generic (Brand) format, action thresholds, and the monitoring calendar.

Diagnostic requirements

Timing: Fasting, 7:00–10:00 a.m. (or within a few hours of waking for shift workers)
Confirmation: Two low early-morning values on separate days, same lab and assay
Threshold prompt: Total testosterone below roughly 300 ng/dL in a symptomatic man — assay-dependent
Add SHBG when: Total is 200–400 ng/dL, symptoms and level disagree, or an SHBG-altering condition is present
Classify with: LH and FSH — high = primary, low or inappropriately normal = secondary
Do not draw during: Acute illness, hospitalization, or shortly after surgery

Hematocrit action thresholds

Below 50%: Continue; routine monitoring
50–53%: Recheck; address smoking, OSA, dehydration; consider shortening interval or reducing dose
54% or above: Hold or reduce; evaluate for OSA; consider transdermal switch; consider phlebotomy

Prostate referral triggers

PSA velocity: Increase greater than roughly 1.4 ng/mL within any 12-month period
Examination: New palpable nodule or induration
Absolute value: PSA above the age-appropriate threshold
Symptoms: Significant lower urinary tract obstructive symptoms

Monitoring calendar

Baseline: Two morning testosterone values, LH/FSH, SHBG as indicated, CBC, PSA if age ≥40, DRE, blood pressure
3 months: Testosterone timed to formulation, hematocrit, PSA if applicable, symptoms, blood pressure
6 months: Hematocrit, testosterone if dose changed, symptoms
12 months: Testosterone, hematocrit, PSA if applicable, full reassessment of benefit
Annually: Testosterone, hematocrit, blood pressure, symptoms, continued indication

Do not initiate

Oncologic: Active breast cancer; active untreated prostate cancer
Fertility: Desire for conception in the near term
Hematologic: Baseline hematocrit above roughly 54%
Respiratory: Untreated severe obstructive sleep apnea
Cardiac: Uncontrolled or severe heart failure; MI or stroke within 3–6 months
Urologic: Severe uncontrolled lower urinary tract symptoms
Thrombotic: Thrombophilia or unprovoked VTE pending hematology input

Therapeutic targets

Total testosterone: Mid-normal range, roughly 400–700 ng/dL, timed to formulation
Not the target: Supraphysiologic levels above 900–1000 ng/dL — more adverse effects, no added benefit
Symptom reassessment: At 3 months and 6 months; reassess the specific targeted symptom
Adequate trial: 3–6 months at a therapeutic level before declaring non-response

Formulary

Testosterone formulations

Testosterone cypionate (Depo-Testosterone)

IM or SC injection

Higher erythrocytosis risk

Typical dosing: 50–100 mg weekly, or 100–200 mg every 2 weeks
When to draw the level: Trough for weekly dosing; midway between doses for every-2-week dosing
Notes: Least expensive option. SC administration is common practice and generally off-label; better tolerated than IM.

Testosterone enanthate (Xyosted (SC auto-injector))

SC injection, weekly

Moderate erythrocytosis risk

Typical dosing: 50–100 mg SC weekly
When to draw the level: Trough, before next weekly dose
Notes: Boxed warning for blood pressure increase. Check BP at every visit.

Testosterone gel 1.62% (AndroGel)

Topical, shoulders and upper arms

Lower erythrocytosis riskTransference warning

Typical dosing: 20.25–81 mg daily
When to draw the level: 2–8 hours after application, after ~2 weeks of steady use
Notes: Boxed warning for secondary exposure. Cover the site, wash hands, avoid skin contact with women and children.

Testosterone gel 1% (Testim / Vogelxo)

Topical, shoulders and upper arms

Lower erythrocytosis riskTransference warning

Typical dosing: 50–100 mg daily
When to draw the level: 2–8 hours after application at steady state
Notes: Boxed warning for secondary exposure. Alcohol vehicle can irritate skin.

Testosterone solution 2% (Axiron)

Topical, axillary

Lower erythrocytosis riskTransference warning

Typical dosing: 30–120 mg daily
When to draw the level: 2–8 hours after application at steady state
Notes: Applied with a metered applicator to the axilla. Transference risk persists.

Testosterone transdermal system (Androderm)

Transdermal patch, nightly

Lower erythrocytosis risk

Typical dosing: 2–6 mg daily
When to draw the level: Morning, after overnight wear
Notes: High rate of application-site skin reaction. Rotate sites.

Testosterone undecanoate injection (Aveed)

Deep IM injection

Moderate erythrocytosis risk

Typical dosing: 750 mg at baseline, 4 weeks, then every 10 weeks
When to draw the level: Just before the next injection
Notes: REMS program. Risk of pulmonary oil microembolism and anaphylaxis; observe 30 minutes post-injection.

Testosterone undecanoate oral (Jatenzo / Tlando / Kyzatrex)

Oral, twice daily with food

Lower erythrocytosis risk

Typical dosing: Product-specific; titrate per labeling
When to draw the level: Product-specific; generally a few hours post-dose
Notes: Boxed warning for blood pressure increase. Must be taken with food for absorption. Not hepatotoxic like methyltestosterone.

Testosterone pellets (Testopel)

Subcutaneous implant

Moderate erythrocytosis risk

Typical dosing: Typically 6–12 pellets every 3–6 months
When to draw the level: End of the dosing interval
Notes: Office procedure. Extrusion and site infection risk. Dose cannot be reversed once implanted.

Testosterone nasal gel (Natesto)

Intranasal, three times daily

Lower erythrocytosis risk

Typical dosing: 11 mg per nostril three times daily
When to draw the level: Product-specific
Notes: Short-acting kinetics may partially spare LH/FSH suppression. Three-times-daily dosing limits adherence.

This reference summarizes current labeling and professional society guidance for educational purposes. Verify product labeling, availability, and formulary coverage before prescribing. Several uses described in this course, including subcutaneous administration of testosterone cypionate and the use of hCG, clomiphene citrate, and aromatase inhibitors in men, are off-label in the United States.