| name | icsm-testosterone-monitoring-schedule |
| description | This skill outlines the monitoring schedule for testosterone therapy, detailing baseline, 3‑month, 6‑month, and yearly assessments of symptoms, adverse events, total testosterone, hematocrit, PSA, and DRE. Use it when a patient is receiving testosterone and the clinician asks what labs and checks are needed today or when the next monitoring visit should occur. |
Follow testosterone therapy monitoring schedule
STEP 1 — Gather Information
Confirm the patient is on testosterone therapy, note the date of initiation, and record the date of the last monitoring visit; collect any new symptoms or adverse events reported since the last check.
STEP 2 — Rule In / Rule Out
If the time since the last visit matches a scheduled interval (baseline, 3 months, 6 months, or >12 months), proceed to classify the required assessments; otherwise, inform the patient that no monitoring is due today and schedule the next visit based on the interval.
STEP 3 — Classify or Stratify
Determine which assessments are due for this visit: symptoms evaluation and adverse events are always checked; total testosterone and hematocrit are due at baseline, 3 months, 6 months, and yearly; PSA is due at baseline, 3 months, 6 months, and yearly; DRE is due at baseline and 6 months (per Table 4).
STEP 4 — Decide
Order the indicated laboratory tests (total testosterone, hematocrit, PSA), perform symptom and adverse event review, and conduct DRE if the visit aligns with the 6‑month or baseline point; document results and adjust testosterone dose if hematocrit exceeds 54% or if symptomatic adverse events arise.
Clinical Guardrails / Mimics / Pitfalls
Do not omit hematocrit monitoring due to the risk of testosterone‑induced polycythemia; avoid delaying PSA or DRE when indicated, as prostate assessment is required before and during therapy; never rely solely on symptom changes without corroborating labs; ensure testosterone is drawn fasting between 07:00–11:00 h for accurate interpretation.
Concrete Clinical Example
A 52‑year‑old man started testosterone enanthate 100 mg weekly 4 months ago. He reports no new symptoms. According to the schedule, a 3‑month visit is overdue; you order total testosterone, hematocrit, PSA, review symptoms and adverse events, and note that DRE is not required until the 6‑month mark. His hematocrit is 52 %, testosterone is 520 ng/dL, PSA 1.1 ng/mL; you continue the current dose and schedule the next visit in 3 months (for the 6‑month assessment).
Source: Male hypogonadism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024), International Society for Sexual Medicine, 2025, https://doi.org/10.1093/sxmrev/qeaf036
