Types of Testosterone Replacement Therapy (TRT) Available:
1. Injectable Testosterone: Intramuscular (IM) or subcutaneous (SQ) injections
Preparations:
Testosterone gel (e.g., AndroGel, Testim, Fortesta): Applied daily to clean, dry skin (usually on the shoulders, upper arms, or abdomen).
Testosterone patch (e.g., Androderm): Applied daily, typically on the back, abdomen, upper arms, or thighs.
Dosing and Considerations:
– Topical forms are applied daily.
– Easy to use but can transfer to others through skin contact, so it is essential to avoid skin-to-skin contact after application and wash hands thoroughly. This method offers convenience but may not be suitable for all patients, especially those who have sensitive skin or concerns about transferring the medication.
3. Testosterone Pellets: Subcutaneous testosterone pellets
Preparations:
Testopel: Small pellets containing testosterone are implanted under the skin (usually in the hip or buttocks).
Dosing and Considerations:
– Implanted every 3-6 months, depending on individual needs.
– Pellets provide a steady release of testosterone over an extended period, reducing the frequency of administration. However, the implantation procedure is invasive, and there is a risk of infection or the pellets extruding from the skin.
Oral Testosterone: Oral capsules or tablets
Preparations:
Testosterone undecanoate (e.g., Andriol): Absorbed via the lymphatic system, avoiding first-pass metabolism by the liver.
Dosing and Considerations:
– Typically taken 1-2 times daily with meals.
– Oral testosterone is less commonly prescribed due to concerns over potential liver toxicity, though it is an option for patients who cannot tolerate other forms of TRT. It is generally reserved for cases where other routes are unsuitable.
Buccal Testosterone: Buccal tablets
Preparations:
Striant: Buccal tablets placed between the gum and cheek.
Dosing and Considerations:
– Typically applied twice daily.
– Buccal tablets are discreet and effective, though they may cause gum or mouth irritation in some individuals. They offer an alternative for those who do not prefer injections or topical treatments but require consistent dosing.
Topical Testosterone: Gels, creams, and transdermal patches
Preparations:
Testosterone gel (e.g., AndroGel, Testim, Fortesta): Applied daily to clean, dry skin (usually on the shoulders, upper arms, or abdomen).
Testosterone patch (e.g., Androderm): Applied daily, typically on the back, abdomen, upper arms, or thighs.
Dosing and Considerations:
– Topical forms are applied daily.
– Easy to use but can transfer to others through skin contact, so it is essential to avoid skin-to-skin contact after application and wash hands thoroughly. This method offers convenience but may not be suitable for all patients, especially those who have sensitive skin or concerns about transferring the medication.
Nasal Testosterone: Nasal gel
Preparations:
Natesto: A testosterone nasal gel applied to the inside of the nostrils.
Dosing and Considerations:
– Typically applied 2-3 times daily.
– This method offers an alternative for those who prefer not to use injections or topical treatments. However, it can cause nasal irritation and is less commonly used than other formats.