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Key monitoring recommendations include: Baseline testosterone assessment for men with symptoms of hypogonadism before starting semaglutide Evaluation of new or worsening symptoms during treatment with comprehensive metabolic and hormonal testing as clinically indicated Continued monitoring for patients on testosterone replacement therapy according to standard guidelines Consideration of nutritional status, sleep quality, and psychological factors when interpreting symptoms Referral to endocrinology for complex cases or when hormonal abnormalities are identified Patients should be counseled that significant weight loss itself typically improves testosterone levels in men with obesity and that any concerning symptoms should be reported promptly for appropriate evaluation

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doi: 10.1136/bmj.i610