The decision to offer testosterone treatment to older men with low testosterone levels should be guided by an individualized assessment of potential benefits and risks. Testosterone deficiency needs to be evaluated using reliable assays for the measurement of total and free testosterone levels. Patients should also be evaluated for conditions that are likely to respond to testosterone replacement therapy (TRT) as well as conditions that could be adversely impacted, such as prostate cancer, erythrocytosis, heart failure, or a hypercoagulable state. It is important to consider each patient’s burden of symptoms, individual preferences, and risk tolerance against the uncertainty of long-term benefits and risks, the burden and risks of monitoring, and the cost.