Treating Low Testosterone
Testosterone treatment can be delivered to the body in a number of ways, each with its own benefits and drawbacks. There are oral medications, injections, transdermal patches and gels (i.e. through the skin), and implantable long-acting slow-release pellets.
Oral medications
Today, oral medications are not available for testosterone replacement in the United States. When testosterone is administered orally, it travels through the digestive tract. Medications that are taken by mouth – such as cholesterol medication as one example – pass through the liver where it can become concentrated at levels causing cholestasis jaundice and liver inflammation in some patients. Thus, there are no oral medications for testosterone replacement approved by the FDA in the United States. Research is currently underway to explore safer oral agents for supplementing testosterone.
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:
- The testosterone in these injections is not bio-identical testosterone.
- With Injections, the testosterone levels in a man's body peak and fall, rather than remaining at a consistent level of distribution into the bloodstream. This is why, when prescribed, weekly injections are preferred.
- Injections tend to cause increased red blood cell concentration (hematocrit). When the concentration becomes too high, there is an increased risk of cardiovascular events, including heart attacks and strokes. Patients are often encouraged to donate blood regularly, or have periodic blood draws to assess this condition.
- The testosterone in the injections may generate a negative effect on cholesterol and lipids.
For these reasons, these injections are usually used as a secondary option where cost or convenience outweigh the risks
For these reasons, these injections are usually used as a secondary option where cost or convenience outweigh the risks.
Testosterone Patch (Androderm)
The patch is a very successful way to administer adequate concentrations of testosterone to the patient. Unfortunately, it is very rarely tolerated well by patients as it usually causes significant local irritation. Some patients can relieve this by applying a small layer of topical cortisone cream on the skin prior to placing the patch.
Testosterone Gels (Androgel and Testim)
The most common method for testosterone replacement is use of the gels, Androgel and Testim. These gels are both FDA approved. They are applied on a daily basis by the patient, typically on the back, arms and chest.
It can be more convenient to have patients apply the gels at night before going to bed to avoid any transfer to clothing or furniture. Men are encouraged to apply the gel, wait till it dries and then put on a T-shirt; in the morning, they wash it off when they 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)
The testosterone pellets have become an increasingly 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 (where??). 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.