What Are Your Options for Testosterone Replacement Therapy? -- By Dr. Stephen Stevenson
When I was diagnosed with hypogonadism 13 years ago by a reproductive endocrinologist, I started on testosterone replacement therapy. Over the years, I have used several different testosterone medications, including topical compounded testosterone gels and creams, intramuscular weekly testosterone injections, and most recently subcutaneous testosterone injections.
Testosterone replacement therapy has improved my sexual function, helped me to maintain my muscle mass as I have aged, improved my mood and energy, and has significantly improved the quality of my life. In this blog I’d like to discuss the various testosterone replacement therapies available and some of their pros and cons of each.
The most popular testosterone replacement medications are topical preparations and injectable testosterone. Topical preparations are applied directly to the skin, usually once daily, and include gels, creams and patches. Topical patches usually do an excellent job of maintaining steady testosterone levels but are generally one of the more expensive options and frequently cause skin reactions at the application site.
Topical gels and creams are generally less expensive than patches and also maintain steady testosterone levels but have the potential risk of exposing other individuals through skin to skin contact with the user. This inadvertent exposure can generally be avoided with some simple precautions.
Injectable testosterone is generally the least expensive delivery system. Intramuscular injections, which are generally done either weekly or biweekly, can cause significant fluctuations in testosterone levels and subsequently fluctuations in libido and mood. They can also be somewhat painful and are more likely to cause abnormal elevations of red blood cells and estrogen levels. Some people also find it difficult to give themselves injections, which may necessitate weekly or twice-weekly trips to a clinic.
Testosterone injections can also be done subcutaneously. This is similar to insulin injections which use a much smaller needle that is injected just below the skin. These are relatively painless and generally done 2–3 times weekly. They provide much more consistent testosterone levels than intramuscular injections because they are administered into the fatty tissue, and the testosterone is slowly absorbed over time. This causes fewer problems with fluctuation in libido and mood than intramuscular injections.
A couple of less popular testosterone delivery systems include buccal tablets and testosterone pellets. Buccal testosterone is designed to adhere to the gum or inner cheek. It provides a controlled and sustained release of testosterone through the buccal mucosa and is applied twice a day. Like the patches, it is typically one of the most expensive delivery methods. It can also cause irritation of the gums as well as alterations in taste.
Testosterone pellets are surgically implanted just below the skin. They last for approximately 3–4 months. Pellets present the potential for infection, pain at the implant site, or expulsion of the pellets. They also can be quite expensive.
Regardless of the delivery system testosterone replacement therapy can make a significant impact on the quality of life but all have some accompanying risks. We’ll review some of these risks and how to minimize them in an upcoming blog.
Dr. Stephen Stevenson is a specialist in men's hormone therapy as well as in functional medicine. Come see him at Atma Clinic -- your first visit is free -- by calling us at 785/760-0695.