title: Testosterone Replacement-Freedom From Symptoms or Hormonal Shackles?
abstract: BACKGROUND
  The question of whether to initiate men on testosterone replacement therapy (TRT) and for how long remains a relevant question to be answered.
  
  
  OBJECTIVE
  To determine when to start patients on TRT, determine the benefits of TRT, and whether starting patients on TRT condemns them to a lifetime of hormonal replacement.
  
  
  METHODS
  A literature review of relevant publications in PubMed was used.
  
  
  METHODS
  Main outcome measures were evidence for initiating TRT, benefits of TRT, pathophysiology of TRT, and evidence for duration of TRT.
  
  
  RESULTS
  Although the exact threshold of serum testosterone levels that define hypogonadism is still strongly debated, the presence of symptoms associated with low levels of testosterone can be considered to help make the diagnosis. Although the proper duration of TRT has yet to be established, maintenance of symptom improvement after discontinuing TRT has been observed, which is a promising result. Studies also have shown a return to hormonal baseline after discontinuation of TRT.
  
  
  CONCLUSIONS
  It has been established that patients with testosterone deficiency benefit from TRT. Preliminary evidence seems to show that men who are initiated on TRT are not condemned to a lifetime of hormonal therapy, although many men might choose to continue treatment because of improvement in their symptoms.
authors.affiliation: University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Nourhan
authors.initials: N
authors.lastname: Ismaeel
authors.affiliation: Department of Urology, University of Texas Medical School at Houston, Houston, TX, USA; University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: run.wang@uth.tmc.edu.
authors.forename: Run
authors.initials: R
authors.lastname: Wang
keywords: Hypogonadism; Testosterone; Testosterone Deficiency; Testosterone Replacement; Testosterone Replacement Therapy