Table 2. Hypogonadism symptoms, indications/contraindications for TRT.

Parameters	Signs and symptoms for decreased levels	Indications for TRT	Contraindications for TRT
Total testosterone: 300–1,080 ng/dL	• Sexual symptoms, in particular low libido, decreased spontaneous and sex-related erections	• Testosterone deficiency is based on the presence of both abnormal laboratory measurements and clinical symptoms/signs	• History of breast or prostate cancer; elevated plasma levels of PSA (>4 ng/mL) and/or biopsy confirmed prostate cancer
	• Infertility	• Patients need to report symptoms of androgen deficiency and have a total serum T level lower than 300 ng/dL	• Abnormal findings at DRE of the prostate raising a suspicion of cancer
	• Anemia	• The threshold for low testosterone as being consistently <300 ng/dL on at least two serum total testosterone measurements obtained in an early morning fashion, preferably using the same laboratory with the same method/instrumentation	• Hematocrit level of at least 52% at baseline
	• Bone mineral density loss		• Patient at risk of cardiovascular events
	• Diabetes mellitus		• MI or stroke within the past 3–6 months
	• Loss of muscle and increase in adiposity		• Severe diseases such as terminal cardiac disease, severe diabetes mellitus, severe obstructive LUTS (IPSS >19), polycythemia, or serious renal and liver disease that might be aggravated by T administration
	• Reduced energy, reduced endurance, diminished work and/or physical performance		• Young infertile men and patients who are interested in future fertility
	• Fatigue, especially in the afternoon
	• Visual field changes (bitemporal hemianopsia)
	• Anosmia
	• Depression
	• Poor concentration
Free testosterone: 47–244 pg/mL	• Impaired memory
Bioavailable testosterone: 131–682 ng/dL	• Irritability

TRT, testosterone replacement therapy; PSA, prostate-specific antigen; MI, myocardial infarction; DRE, digital rectal exam; LUTS, lower urinary tract symptoms; IPSS, international prostate symptom score; T, testosterone.