The Pros and Cons of Testosterone Therapy Methods

Most people consider testosterone therapy because they have a medical condition in which their body is not producing enough testosterone, or they are experiencing age-related declines in testosterone. Low testosterone, also called symptomatic hypogonadism, means that your testosterone levels are low enough that they are causing symptoms such as:

  • Decreased sex drive
  • Decreased energy levels
  • Erectile dysfunction
  • Mood changes
  • Swollen or tender breasts
  • Sleep problems
  • Difficulty concentrating
  • Muscle loss
  • Increased fat, especially abdominal fat

If you have talked to your doctor about the symptoms you are experiencing, and they are consistent with low testosterone, the next step is to check your testosterone levels.

Men's Standard Hormone Panel

Men's Advanced Hormone Panel

If your lab work indicates that you have low-T and that you would benefit from testosterone replacement therapy, the next step is determining a delivery method. Each of these methods has pros and cons. Like all medications and supplements, there are problems associated with testosterone replacement therapies. Discuss the risks and benefits of testosterone replacement therapy with your doctor to maximize your benefits and minimize the risks.

Injections

Testosterone injections have been a standard method of treatment for decades. Testosterone injections come as testosterone cypionate (Depo-Testosterone), testosterone enanthate (Xyostad), and testosterone undecanoate (Aveed).

Testosterone enanthate can be injected subcutaneously (just under the skin). The FDA approved a convenient testosterone enanthate auto-injector in October 2018. Testosterone cypionate is a synthetic derivative of testosterone in the form of an oil-soluble ester. Compared to other forms of testosterone, it has a slow release rate after injection and a longer half-life.

Pros

Testosterone injections can be administered at home using a home injection kit. They are typically given weekly, though it is important to follow your doctor's prescribing instructions. The needle for injection is small, and typically, the medication is injected just under the skin.

Testosterone injections can provide a consistently stable testosterone level without the mess associated with creams or gels or the pain associated with injecting testosterone pellets.

Cons

If the injection site is not sterilized prior to injection, there is a risk of infection, redness or swelling.

Buccal Testosterone

Buccal testosterone is a putty-like substance that comes as a tablet-shaped pouch. It is applied to the crevice between the upper lip and gum, where it is absorbed across the mucosa of the mouth. The patches are applied alternating between just above the right and left incisors. The patches must be applied on the upper gum, not the lower gum, every 12 hours or so.

Pros

You can chew gum, smoke, brush your teeth and drink liquids with the patch in place. However, these activities may affect medication absorption. The patches are easy to use and are unobtrusive.  

Cons

The patch can easily be dislodged and should never be chewed or swallowed. Since there are only two application sites, your gums can easily become irritated.

Testosterone in a buccal form can cause the following side effects:

  • irritation, redness, pain, tenderness, swelling, toughening, or blistering of gums
  • swollen or tender lips
  • unpleasant or bitter taste in the mouth
  • impaired ability to taste foods

Pellets

Subcutaneous pellets are small pill-like pellets that are injected right under the skin via a minor procedure in your doctor's office. Testopel is an example of an implantable pellet.

Pros

Testosterone pellets are implanted and last several months, generally three to six months. The ease of use makes testosterone pellets a good option for some men.

Cons

The pellets must be implanted in your doctor's office, and there is the potential for the pellet to work its way out through the skin. Since the pellets are injected, the dosage cannot easily be adjusted. In addition, implanting testosterone pellets causes a break in the skin, so there is the risk of infection or scarring.

Patches

Testosterone patches are applied directly to the skin. They should be applied as soon as the pouch is opened, typically at the same time each night. The ideal time for applying a testosterone patch is between 8:00 pm and midnight. Each patch is left in place for 24 hours. Unless directed otherwise by your doctor, only one patch should be applied each day.

Pros

Testosterone patches tend to be easier to apply than testosterone gels and decrease the risk of accidental transfer of testosterone to women or children.

Cons

Testosterone patches should not be applied to oily or hairy skin, areas of increased perspiration, over a bone, or places where pressure is applied when sitting or lying down. You need to choose a different spot each night for the application, and the same spot cannot be reused for a minimum of seven days.

Side effects from testosterone patches may include:

  • burn-like blisters, redness, pain, or itching at the application site

Gels

Testosterone gels are directly absorbed through the skin. Where the gel is applied depends on the brand. For example, AndroGel, Testim, and Vogelxo are applied to the upper arm or shoulder. Fortesta is applied to the front or inner thigh.

Testosterone gels are usually applied once daily in the morning to clean, dry skin. It is important to cover the application site as soon as the gel has dried to prevent accidental transfer.

Pros

Testosterone gels are easy to apply and allow for a steady release of testosterone. There is no need for needles or training to give injections. The gel dries quickly and could easily become part of your daily routine.

Cons

Testosterone gels should not be applied directly to the penis or scrotum or to any skin surface that is cracked or covered with a rash. Gels may be messy to apply and irritate the skin.

Testosterone gels carry a black box warning that accidental transfer of testosterone gel to women or children can cause serious health problems. Bed linens and towels may also have testosterone gel on them.

Side effects specific to testosterone gels include:

  • watery eyes
  • headaches
  • dry or itchy skin
  • diarrhea
  • skin redness or irritation

Nasal Gels

Natasto is a nasal gel that the FDA approved in 2014. It is rapidly absorbed from the inside lining of the nose. It is typically applied every six to eight hours or as directed by your doctor.

Pros

Natasto is easy to self-administer and does not have the risk of transfer to women and children that skin-applied gels might have. The nasal gel adheres to the lining of the nose and should not cause a runny nose or drainage.

Cons

The nasal gel may be difficult for some people to administer. If you have a cold or nasal congestion, you may need to contact your doctor for instructions on administering the medication.

Testosterone nasal gels may cause the following side effects:

  • headache
  • cough
  • sinus pain
  • changed sense of smell

Other Things to Consider

In addition to these options, an oral pill form of testosterone undecanoate is available. The FDA approved it in March 2019. This medication comes with a black box warning that it may cause high blood pressure. The FDA has only approved this option for men with low testosterone secondary to a medical condition, not age-related. According to the FDA, the high blood pressure risk outweighs the benefits of treating age-related low T.

There are many options for administering testosterone. If you have symptoms of low testosterone, make an appointment with one of the medical specialists at Invigor Medical. They will evaluate your personal history and lab work and determine whether you are a candidate for testosterone replacement therapy.

While undergoing testosterone replacement therapy, it is essential to follow up with your doctor regularly for lab work and monitor any side effects you might be experiencing.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it's important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we've included in this guide is merely meant to be informational and does not constitute medical advice. 

REFERENCES:

  1. Mayo Clinic. (2017). Testosterone Therapy: Mayo Clinic Radio [Video]. Retrieved from https://www.youtube.com/watch?v=BOtv4zIaN88
  2. Miller, E. (2020). Testosterone Therapy. Drugwatch. https://www.drugwatch.com/testosterone/
  3. Medline Plus. (2018). Testosterone Transdermal Patches. Retrieved from https://medlineplus.gov/druginfo/meds/a601118.html
  4. Medline Plus. (2017). Testosterone Nasal Gel. Retrieved from https://medlineplus.gov/druginfo/meds/a615025.html
  5. Medline Plus. (2018). Testosterone Topical. Retrieved from https://medlineplus.gov/druginfo/meds/a605020.html
  6. Medline Plus. (2018). testosterone Buccal. Retrieved from https://medlineplus.gov/druginfo/meds/a603034.html
  7. Medline Plus. (2019). Testosterone Injection. Retrieved from https://medlineplus.gov/druginfo/meds/a614041.html
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