Arnaav Walia, Peyton Coady, Beatriz Sofia‐Hernandez, Haarika Gudlavalleti, Adnan El‐Achkar, Shannon Elise Dunnam, Vinayak Madhusoodanan, Taylor P. Kohn, Mohit Khera
ABSTRACT Testosterone replacement therapy has evolved significantly in recent years, driven by high‐quality clinical evidence and expanded treatment options. The 2023 TRAVERSE trial provided definitive cardiovascular safety data, leading to FDA removal of black box warnings in 2025 and altering the clinical approach to testosterone therapy. Concurrent developments in delivery methods—including subcutaneous administration and oral formulations—have improved patient convenience and adherence. Modern diagnostic approaches incorporate advanced biomarkers and genetic testing to enable more individualized treatment selection, while contemporary monitoring protocols utilize risk‐stratified surveillance. Special populations, including men with cardiovascular disease, fertility concerns, and prostate cancer history, can now be evaluated using evidence‐based approaches that weigh potential benefits against safety considerations. This review examines the current state of testosterone replacement therapy in 2025, including diagnostic approaches, treatment formulations, monitoring strategies, and clinical considerations for specific patient populations. The shift from categorical contraindications to individualized assessment reflects the growing evidence base supporting testosterone therapy when appropriately indicated and monitored.