Testosterone replacement therapies exist in a variety of preparations. These include long and short acting intramuscular injections, transdermal and scrotal patches, transdermal gels and oral preparations. The appropriate therapy will be determined in consultation with the patient and specialist. The costs of the varied preparations may be a factor and are given consideration during this discussion.
The goal of testosterone supplementation is to bring testosterone into the normal range but not exceed that range. The therapy should not have unwanted effects on the prostate, serum lipids, or cardiovascular, liver and lung functions. Patients should be able to administer it themselves with minimal discomfort and it should be affordable.
Intramuscular injections do not mimic normal fluctuating testosterone levels. There is a peak above normal levels soon after injection. This falls to below normal before the next injection to produce what some call a "roller coaster" effect. Oral preparations can produce above normal high concentrations of the hormone that vary significantly between administrations and vary significantly between individuals. The use of oral methyltestosterone is not supported by professional organizations because it carries a significant potential for liver toxicity.
A buccal formulation (held between the cheek and gums) was introduced in 2003. It is seen to be safe and effective. The transdermal gel is applied as a cream and produces serum levels of testosterone in the normal range. Users can acquire a degree of control by varying the amount they apply. The gel was introduced in 2000 and long term data on its effects have yet to appear. Scrotal and transdermal patches also create testosterone levels that approximate those produced by normal physiologic processes. The scrotal patch requires that the scrotum be shaved to allow good adhesion. Both the dermal and scrotal patch may engender allergic skin reactions but in most instances, these reactions can be managed with over-the-counter hydrocortisone or antihistamines.
Often a therapy is given a trial of up to three months during which testosterone levels are monitored and symptoms are watched for changes. If the therapy provides benefits and is pursued, testosterone levels, symptom monitoring and routine check ups should be conducted at three month intervals during the first year of therapy. Cholesterol levels and red blood cell production are affected by testosterone and must be monitored during the first year of therapy. There is also a positive relationship between testosterone and prostate cancer.
While the hormone does not cause the cancer, it may enhance its growth if it is present. Age is a risk factor for prostate cancer and studies suggest that a majority of men over 80 may have subclinical (non-symptomatic) prostate cancer. This cancer normally grow slowly and may have started earlier in their lives. This observation makes age a consideration when discussing the therapy.
