Testosterone Replacement Therapy

Source: SGH endocrine update 2026

Parameter	Baseline / before TRT	3–6 months after initiation	12 months	Annually thereafter
Clinical response / symptoms	✓	✓	✓	✓
Adverse effects / formulation-specific issues	✓	✓	✓	✓
Total testosterone	Baseline 2x confirmed low fasting morning TT to diagnose	3–6 months after initiation	✓	✓
Haematocrit	✓	3–6 months	✓	✓
PSA	✓ especially age 55–69, or 40–69 if higher prostate cancer risk	3–12 months	According to prostate cancer screening guidance	Age/race/risk-based screening guidance
DRE	✓	3–12 months	According to prostate cancer screening guidance	Age/risk-based screening guidance
LUTS	✓ (Avoid if severe LUTS)	✓	✓	✓

Baseline evaluation of prostate health

1. Evaluate prostate cancer risk

• History:
  • History of Prostate Ca / biopsy / surgery
  • Prostate Ca in 1st degree family
• Digital Rectal Examination:
  • Perform Digital Prostate Exam
• PSA Level:
  • Check baseline PSA level in men age 55–70 years
• Risk Estimation Tool:
  • Online tool to estimate baseline risk of prostate Ca (e.g., Prostate Cancer Prevention Trial Risk Calculator)

2. Evaluate lower urinary tract symptoms (LUTS)

• Symptom Score:
  • International Prostate Symptom Scale Score
  • If > 19, is a relative contraindication to starting TRT
• Medications:
  • Check medications for LUTS (e.g., 5-α reductase inhibitors)

PSA

Consider holding off TRT and referral to urology if…

• Total PSA > 4 ug/L or ↑ 1.4 ug/L in a year
• AbN DRE
• ↑ LUTS