I'm considering low testosterone treatment. What are the different types of testosterone replacement therapy?

Answers from Todd B. Nippoldt, M.D.

Several testosterone delivery methods exist to treat low testosterone. Choosing a specific therapy depends on your preference of a particular delivery system, the side effects and the cost. Methods include:

  • Injection. Testosterone injections are given in a muscle. Your symptoms might fluctuate between doses depending on the frequency of injections.
  • Patch. A patch containing testosterone (Androderm) is applied each night to your back, abdomen, upper arm or thigh. The site of the application is rotated to maintain seven-day intervals between applications to the same site, to lessen skin reactions.
  • Gel. Depending on the brand, you either rub testosterone gel into your skin on your upper arm or shoulder (AndroGel, Testim), apply with an applicator under each armpit (Axiron) or pump on your inner thigh (Fortesta). As the gel dries, your body absorbs testosterone through your skin. Gel application of testosterone replacement therapy appears to cause fewer skin reactions than patches do. Don't shower or bathe for several hours after a gel application, to be sure it gets absorbed. A potential side effect of the gel is the possibility of transferring the medication to another person. Avoid skin-to-skin contact until the gel is completely dry or cover the area after an application.
  • Gum and cheek (buccal cavity). A small putty-like substance, gum and cheek testosterone replacement (Striant) delivers testosterone through the natural depression above your top teeth where your gum meets your upper lip (buccal cavity). This product sticks to your gumline and allows testosterone to be absorbed into your bloodstream.
  • Implantable pellets. Testosterone containing pellets (Testopel) are surgically implanted under the skin and need to be placed every three to six months.

Taking testosterone orally isn't recommended for long-term hormone replacement because it might cause liver problems.

Keep in mind that testosterone therapy carries various risks, including contributing to sleep apnea, stimulating noncancerous growth of the prostate, enlarging breasts, limiting sperm production, stimulating growth of existing prostate cancer and blood clots forming in the veins. Recent research also suggests testosterone therapy might increase your risk of a heart attack.

If testing shows that you have low testosterone, talk to your doctor to ensure that the cause is determined. If testosterone replacement is an option for you, discuss with your doctor the risks, benefits and treatment monitoring plan.

Jul. 10, 2014