How should we monitor men receiving testosterone replacement therapy?
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Monitor hematocrit and bone mineral density (BMD) (strength of recommendation [SOR]: B, meta-analysis of non−patient-oriented outcomes). Monitoring prostate-specific antigen (PSA), performing prostate digital rectal examination, and observing symptom response to testosterone are also recommended, although direct evidence is lacking (SOR: C, consensus opinion). Monitoring lipid levels is unnecessary (SOR: A, based on several meta-analyses), as is monitoring testosterone levels (SOR C, consensus opinion). Unless the patient is taking oral testosterone, no evidence exists for or against monitoring liver function (SOR: C, consensus opinion).
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