Treatment of Low Testosterone

Treatment of Low Testosterone

A summary of the most commonly-used TRT (testosterone replacement therapy) options is provided below:

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:

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.

 

AndroGel: Testosterone gel (varying strengths).

  • 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.

 

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.

 

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.

 

Injectable Testosterone

Advantages include efficacy and patient satisfaction, weekly to biweekly dosing, and low cost.  Disadvantages include increased fluctuation (peaks and valleys) in testosterone levels compared to daily dosing options and the requirement for needles and possibly self-injection.  The testosterone is supplied in 10cc multiple-dose vials and single-use syringes are supplied as well.  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.

Testosterone Cypionate:

  • 200mg/cc testosterone. Dosing will be discussed by your doctor.

 

Testosterone Enanthate:

  • 200mg/cc testosterone.  Dosing will be discussed by your doctor.

Implantable Testosterone

(Please note this therapy is not currently available at the University of Virginia.)

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.

Transdermal Testosterone Patch: (i.e. Androderm)

No longer recommended due to skin irritation.

Medications Which Do Not Contain Testosterone

These may be advantageous in men who prefer not to take testosterone directly or those in whom taking testosterone directly is not advised (e.g. , men attempting to preserve fertility).  These medications may also be used in combination with the above testosterone formulations.

Additionally, some of these medications are available in low-cost generic formulations. Disadvantages generally include less of a rise in testosterone levels compared to testosterone-containing therapies.  Some of these medications are used off-label to increase testosterone.

Clomiphene citrate (Clomid)

  • 25mg (half of a 50mg tablet) taken daily.  This medication works by increasing the body’s own testosterone production.  It is also used to improve semen quality for fertility in some men.

 

Anastrozole (Arimidex)

  • 1mg tablet taken daily.  This medication works by reducing the conversion of testosterone to estrogen and can raise testosterone levels and reduce estrogen levels.

 

Human Chorionic Gonadotropin (hCG)

  • 500 – 3000 units injected subcutaneously (underneath the skin) every other day.  This medication works by increasing the body’s production of testosterone.  It is used in various regimens to preserve testicular volume, preserve fertility, and re-stimulate the testicles after periods of testosterone administration.