Michael A. Werner, M.D.

Treating Low Testosterone
There are numerous ways to deliver testosterone treatments to the body.  These are: oral medications, injections, transdermal patches and gels (i.e. through the skin), and implantable long-acting slow-release pellets.

Oral medications
In the United States, this method of testosterone replacement is not available.  The reason is that when taken orally, the testosterone travels through the digestive tract.  Other medications taken orally, like those used for cholesterol, pass through the liver, where it concentrates at high levels and has been known to cause jaundice and liver inflammation.  So, oral medications for testosterone replacement have not been approved by the FDA.  Research is under way to explore safer ways of delivering testosterone orally.  

Testosterone injections
The two most common testosterone injections are testosterone cypionate and testosterone enanthate. These may be self-administered by the patient on a weekly basis. The advantages of the injections are that they are relatively inexpensive and can be administered independently from an office visit to see a doctor or nurse. The disadvantages are of significant medical concern:

For these reasons, these injections are usually used as a secondary option where cost or convenience outweigh the risks.

Testosterone Patch (Androderm)
This has proven to be an effective way of delivering testosterone to the patient.  However, many patients complain of irritation.  Some patients find that they can relieve this by applying a small amount of cortisone cream before they place the patch on.

Testosterone Gels (Androgel and Testim)
The most common method for testosterone replacement is use of the gels, Androgel and Testim, which are both FDA approved. You would apply the gel on a daily basis, typically on the back, arms and chest. It’s more convenient to apply the gel at night before going to bed so it doesn’t get on clothing or furniture. You would apply the gel, wait till it dries and then put on a T-shirt; in the morning, you wash it off when you take the shower. Most patients can get good levels of testosterone replacement with the gels. Some men do not like the smell and do not like to have a daily regimen. It is also important that the medication not be transferred to the patient's partner or other members of the household, particularly children. Thus, many patients with small children or pregnant wives prefer not to use the gels.

Testosterone Pellets (Testopel)
This has become a popular way of receiving testosterone replacement. Like the gels and patches, they are bio-identical testosterone, a generally preferred type of testosterone replacement. The pellets are placed underneath the skin once every three months. A local anesthetic is administered via injection, and then between 10 and 14 pellets are placed under the skin. A butterfly dressing is then applied.
The main advantage of the pellets is that it is a very convenient method of receiving bio-identical testosterone replacement. The disadvantage of the pellets approach is that it involved a procedure, though a very small one, which needs to be done every three months. There is also a small risk of bleeding and infection.