Low Testosterone Treatment

There are several options available  to treat Low Testosterone .While some Testosterone Replacement Therapies (TRT) seem effective and easy to administer, each as its own pros and cons .

It is best to consult your doctor about it to find out the most suitable option.

1.Injectable Testosterone

testosterone injection

Intramuscular testosterone has been used for years due to its effectiveness and low cost.

The most commonly used testosterone esters are :

1.Testosterone cypionate

2.Testosterone Enanthate

Though most people do not find any difference between the two,  Cypionate is known to have a “slower release” and stays active longer.

The usual adult dose  in men is 200 mg every two weeks, to a maximum of 400 mg per month.

The injections are administered into large muscles (usually the buttocks or thigh).  Injections can be given in the clinic or you can be taught by our nurse how to administer them yourself.

2.Topical Testosterone Gels

2.Topical Testosterone Gels

Advantages include more constant levels with daily dosing, high patient satisfaction, and avoidance of needles.  Disadvantages include increased cost compared to injectables, the poten­tial for transference of the gel to others (e.g., women and young children) through contact with your skin or clothes, messiness of gel application, and potential skin irritation.  Topical options are listed below:

AndroGel ( also known as TestoGel in some countries ): Testosterone gel (varying strengths).

Testosterone gel

  • AndroGel 1%.  Single-use packets containing 50mg of testosterone in 5g of alcohol-based gel OR metered-dose pump which dispenses 12.5mg of testosterone in 1.25g of alcohol-based gel per pump.  The usual starting dose is 1 packet or 4 pumps daily (about the size of 2 quarters) applied to the shoulders, upper arms, and abdomen.

 

  • AndroGel 1.62%.  Single-use packets containing 40.5mg of testosterone in alcohol-based gel OR metered-dose pump which dispenses 20.25mg of testosterone in alcohol-based gel pump.  The usual starting dose is 1 packet or 4 pumps daily (about the size of 2 quarters) applied to shoulders, upper arms, and abdomen.
    Area of application for T Gel

    Area of application for T Gel

Testim:

testim

  • Testosterone gel (1%).  Single-use tubes, each containing 50mg of testosterone in 5g of oil-based gel.  The usual starting dose is 1 tube daily (about the size of 2 quarters) applied to the shoulders and upper arms.

 

Axiron:

axiron

  • Testosterone solution (2%).  Metered-dose pump/applicator which dispenses 30 mg of testosterone in 1.5 cc solution per pump.  The usual starting dose is 1 pump (about the size of 2 quarters) applied to each underarm daily.

Fortesta:

fortesta

  • Testosterone gel (2%).  Metered-dose pump which dispenses 10mg of testosterone in 0.5g gel per pump.  The usual starting dose is 6 pumps daily (about the size of 2 quarters) applied to the thighs.

 

 

 

 

 

Any time you medically increase hormone levels, there’s a risk for side effects. Specifically, testosterone gel may cause:

  • headaches
  • dry skin or acne
  • hot flashes
  • insomnia (which may be caused by hot flashes at night)
  • anxiety or depression
  • muscle pain and weakness
  • further decrease in libido
  • reduced sperm count

While many of these symptoms aren’t severe, they can become bothersome. It’s important to tell your doctor about any side effects if they persist for more than a few days.

3.Implantable Testosterone

testopel

 

Developed in the 1940s, implantable testosterone is the oldest form of TRT. Pellets, each containing 75 mg of crystalline testosterone, are implanted subcutaneously to provide slow release over 4 to 6 months. Depending on the dose required, 2 to 6 pellets are implanted under the skin of the lower abdomen, upper thighs, deltoid, or gluteal muscles every 3 to 6 months.

Pellets tend to provide stable physiologic levels of testosterone. Although implantable testosterone, like the injectable forms, can cause levels to peak initially, the decline is gradual, over 6 months, so that mood swings and energy fluctuations are seldom recognized by the patient.

 

Because pellets require surgical implantation, their use can be painful. They also have a high rate of extrusion. Furthermore, since their duration of action is long and reversibility is difficult, testosterone pellets are unsuitable for treating elderly patients, in whom adverse effects are more common. Testosterone pellets are not often used in the United States.

The advantages of this therapy include convenience and decreased frequency of dosing.  As this requires a short office procedure, there are risks including bleeding, infection, and pellet extrusion in less than 1% of cases.

Testopel (Subcutaneous Testosterone Pellets):

Cylindrical pellets that are about the size of a grain of rice.  Each pellet contains 75mg of testosterone.  The usual starting dose is 10-14 pellets implanted underneath the skin in the office under sterile condi­tions once every 4 months.

4.Transdermal Testosterone Patch: (i.e. Androderm)

twoPatches

Transdermal testosterone comes as a patch to apply to the skin. It is usually applied each night between 8:00 p.m. and midnight and left in place for 24 hours. Apply testosterone patches at around the same time every evening. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use testosterone patch(es) exactly as directed. Do not apply more or fewer patches or apply the patches more often than prescribed by your doctor.

Areas to apply T Patch

Areas to apply T Patch

Choose a spot on your back, stomach, thighs, or upper arms to apply your patch(es). Be sure that the spot you have chosen is not oily, hairy, likely to perspire heavily, over a bone such as a shoulder or hip, or likely to be under pressure from sitting or sleeping. Do not apply the patch(es) to the scrotum or to a skin area with open sores, wounds, or irritation. Also be sure that the patch will stay flat against the skin and will not be pulled, folded, or stretched during normal activity. Choose a different spot each night and wait at least 7 days before applying another patch to a spot you have already used.

 

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Acne; bitter or strange taste in mouth; change in sex drive; fatigue; gum or mouth irritation; gum pain; gum tenderness or swelling; hair loss; headache.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); breast growth or pain; change in the size or shape of the testicles; dark urine or light-colored bowel movements; depression or mood changes; dizziness; gingivitis; interrupted breathing while sleeping; loss of appetite; nausea; painful or prolonged erection; stomach pain; swelling of the ankles or legs; urination problems; weight gain; yellowing of the skin or eyes.

 

Who Should Not Take Testosterone?

As stated previously, some men shouldn’t take testosterone treatments because they can aggravate symptoms or cause certain health conditions to worsen. Men who have prostate cancer, breast cancer, sleep apnea that is untreated, too many red blood cells (polycythemia), and poorly controlled heart disease should not take testosterone treatments.