Course overview

References

34 citations across 8 Parts. Every source was checked against the original document in August 2026. Works older than five years are cited only where they remain the definitive methodology paper or the landmark trial, and each is annotated with the reason.

Part 1

Physiology of the male hypothalamic-pituitary-gonadal axis

  1. 1.Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. Source Operative society guideline; reaffirmed by the Endocrine Society statement of July 2026.
  2. 2.Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423–432. Validity confirmed 2024. Source
  3. 3.Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999;84(10):3666–3672. Source Landmark methodology paper; still the calculation used by every major free-testosterone calculator.
  4. 4.Travison TG, Vesper HW, Orwoll E, et al. Harmonized reference ranges for circulating testosterone levels in men of four cohort studies in the United States and Europe. J Clin Endocrinol Metab. 2017;102(4):1161–1173. Source
Part 2

Evaluating the man who presents with low-testosterone symptoms

  1. 1.Endocrine Society. Statement on testosterone replacement therapy. July 2026. Source
  2. 2.Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. Source
  3. 3.Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423–432. Source
  4. 4.Grossmann M, Matsumoto AM. A perspective on middle-aged and older men with functional hypogonadism: focus on holistic management. J Clin Endocrinol Metab. 2017;102(3):1067–1075. Source Cited for the reversible-cause framework; the term 'functional hypogonadism' is discouraged in the 2026 statement.
  5. 5.Wittert G, Bracken K, Robledo KP, et al. Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM): a randomised, double-blind, placebo-controlled, 2-year, phase 3b trial. Lancet Diabetes Endocrinol. 2021;9(1):32–45. Source
Part 3

Deciding who is a candidate for therapy

  1. 1.Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE). N Engl J Med. 2023;389(2):107–117. Source
  2. 2.Snyder PJ, Bhasin S, Cunningham GR, et al. Testosterone treatment and fractures in men with hypogonadism. N Engl J Med. 2024;390(3):203–211. Source
  3. 3.Snyder PJ, Bhasin S, Cunningham GR, et al. Effects of testosterone treatment in older men (The Testosterone Trials). N Engl J Med. 2016;374(7):611–624. Source Landmark placebo-controlled benefit data in men aged 65 and older.
  4. 4.US Food and Drug Administration. Class-wide labeling changes for testosterone products: cardiovascular safety and blood pressure. February 2025. Source
Part 4

Selecting a formulation and starting dose

  1. 1.Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. Source
  2. 2.US Food and Drug Administration. Prescribing information: testosterone cypionate injection (Depo-Testosterone). Accessed via DailyMed. Source
  3. 3.US Food and Drug Administration. Prescribing information: testosterone enanthate subcutaneous auto-injector (Xyosted). Accessed via DailyMed. Source
  4. 4.US Food and Drug Administration. Prescribing information: oral testosterone undecanoate (Jatenzo, Tlando, Kyzatrex). Accessed via DailyMed. Source
  5. 5.US Food and Drug Administration. Prescribing information: testosterone gel (AndroGel, Testim, Vogelxo) — includes the boxed warning on secondary exposure in children. Accessed via DailyMed. Source
Part 5

Monitoring therapy

  1. 1.Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. Source
  2. 2.Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423–432. Source
  3. 3.Wei JT, Barocas D, Carlsson S, et al. Early detection of prostate cancer: AUA/SUO guideline. J Urol. 2023;210(1):46–53 and 210(1):54–63. Source
  4. 4.Ohlander SJ, Varghese B, Pastuszak AW. Erythrocytosis following testosterone therapy. Sex Med Rev. 2018;6(1):77–85. Source
Part 6

Troubleshooting therapy that is not working

  1. 1.Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. Source
  2. 2.Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633–641. Amended 2018. Source
  3. 3.Tan RS, Cook KR, Reilly WG. Myocardial infarction and stroke risk in young healthy men treated with injectable testosterone. Int J Endocrinol. 2015;2015:970750. Source Cited only as historical context for supraphysiologic dosing claims circulating in non-clinical channels.
  4. 4.Rambhatla A, Mills JN, Rajfer J. The role of estrogen modulators in male hypogonadism and infertility. Rev Urol. 2016;18(2):66–72. Source Cited for the pharmacology of off-label aromatase inhibition, which no society guideline recommends routinely.
Part 7

Cardiovascular, prostate, and long-term safety

  1. 1.Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE). N Engl J Med. 2023;389(2):107–117. Source
  2. 2.Snyder PJ, Bhasin S, Cunningham GR, et al. Testosterone treatment and fractures in men with hypogonadism. N Engl J Med. 2024;390(3):203–211. Source
  3. 3.US Food and Drug Administration. Class-wide labeling changes for testosterone products: cardiovascular safety and blood pressure. February 2025. Source
  4. 4.Bhasin S, Lincoff AM, Nissen SE, et al. Prostate safety events during testosterone replacement therapy in men with hypogonadism: a randomized clinical trial (TRAVERSE prostate substudy). JAMA Netw Open. 2023;6(12):e2348692. Source
Part 8

Fertility preservation and restoration

  1. 1.Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline. Fertil Steril. 2021;115(1):54–61 and 115(1):62–69. Source
  2. 2.Crosnoe-Shipley LE, Elkelany OO, Rahnema CD, Kim ED. Treatment of hypogonadotropic male hypogonadism: case-based scenarios. World J Nephrol. 2015;4(2):245–253. Source
  3. 3.Wenker EP, Dupree JM, Langille GM, et al. The use of HCG-based combination therapy for recovery of spermatogenesis after testosterone use. J Sex Med. 2015;12(6):1334–1337. Source
  4. 4.Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. Source

Guideline set

  • AUA 2018 / 2024

    Evaluation and Management of Testosterone Deficiency: AUA Guideline (Mulhall JP, Trost LW, Brannigan RE, et al.) — published 2018, reviewed and validity confirmed 2024.

    Current — validity reconfirmed 2024, no amendment issued since.

    Source
  • Endocrine Society 2018

    Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline (Bhasin S, et al., J Clin Endocrinol Metab. 2018;103(5):1715–1744).

    Still the operative guideline. Reaffirmed by the Society's July 2026 statement on testosterone replacement therapy; a formal revision has not been published.

    Source
  • Endocrine Society 2026 statement

    Endocrine Society. Statement on Testosterone Replacement Therapy (July 2026) — reaffirms symptom-plus-confirmed-low-level diagnosis at any age, discourages the terms 'age-related', 'late-onset', and 'functional' hypogonadism, and states there is insufficient evidence for population-level screening of asymptomatic men.

    Most recent society position statement.

    Source
  • TRAVERSE 2023

    Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med. 2023;389(2):107–117. Noninferior for MACE in 5,246 men with, or at high risk of, cardiovascular disease; excess atrial fibrillation, acute kidney injury, and pulmonary embolism observed.

    Defining cardiovascular safety trial; basis of the 2025 FDA labeling revision.

    Source
  • TRAVERSE fracture substudy 2024

    Snyder PJ, Bhasin S, Cunningham GR, et al. Testosterone Treatment and Fractures in Men with Hypogonadism. N Engl J Med. 2024;390(3):203–211. Clinical fracture incidence was higher, not lower, with testosterone — bone density gains did not translate into fracture reduction.

    Counsel accordingly: do not prescribe testosterone for fracture prevention.

    Source
  • FDA 2025 labeling

    FDA class-wide labeling change for all testosterone products (February 2025): the boxed-context cardiovascular warning language was revised in light of TRAVERSE, a warning regarding blood-pressure increases was added, and the indication remains limited to classical hypogonadism due to established disease.

    Current labeling standard for all marketed testosterone products.

    Source
  • T4DM 2021

    Wittert G, Bracken K, Robledo KP, et al. Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM). Lancet Diabetes Endocrinol. 2021;9(1):32–45.

    Supports the lifestyle-first framing; testosterone is not a diabetes therapy.

    Source
  • TTrials

    Snyder PJ, et al. The Testosterone Trials — a coordinated set of seven placebo-controlled trials in 790 men aged 65+ addressing sexual function, physical function, vitality, cognition, anemia, bone, and coronary plaque.

    Historical benchmark for realistic benefit expectations in older men.

    Source