If hematocrit is more than 54%, stop therapy until hematocrit decreases to a safe level; evaluate the patient for hypoxia and sleep apnea; reinitiate therapy with a reduced dose. The hematocrit should be checked at baseline, at 3 and 6 months, and then annually. Patients on testosterone gel may have levels checked anytime after at least 1 week of therapy.45 In all cases, bioavailable testosterone levels should also be monitored as testosterone therapy lowers SHBG. There are clinical practice guidelines from the Endocrine Society for monitoring patients receiving TRT.45 Testosterone level, digital rectal exam, PSA, hematocrit, BMD, lipids, and liver function tests should be checked at baseline then evaluate the patient 3 and 6 months after treatment starts and then annually to assess whether symptoms have responded to treatment and whether the patient is suffering from any adverse effects. Long-term Health Considerations A balanced diet rich in healthy fats, proteins, and essential nutrients is beneficial for overall hormonal health. Additionally, adequate sleep and stress management techniques, such as mindfulness or meditation, can further optimize testosterone levels. Understanding these lifestyle factors can empower patients to approach their health holistically, complementing their TRT journe

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