Testosterone replacement therapy for the primary care physician

Testosterone replacement therapy (TRT) can have significant beneficial effects in the appropriate hypogonadal male patient. Testosterone deficiency is common in primary care practice and recognition of the signs and symptoms of this abnormality will allow physicians to choose appropriate interventions. The symptoms of clinical hypogonadism include muscle weakness, fatigue, mood changes and a reduced libido. Signs include a reduced muscle mass, osteoporosis, anemia and increased adiposity. While routine screening for testosterone deficiency, determination of testosterone levels in high risk populations, including obesity and diabetes, will help the clinician direct TRT to the patients most likely to benefit from therapy. In this article the syndrome of male hypogonadism is discussed, together with therapeutic choices available to the primary care physician.