There are several approved ways to replace testosterone. They fall into a few broad categories, with various brand names you might see:
- Injections (intramuscular or subcutaneous)
- Short- to intermediate-acting: testosterone cypionate, testosterone enanthate, or testosterone propionate.
- Long-acting: testosterone undecanoate (injections given less often, e.g., every 10–14 weeks after loading dose in some regimens).
- Pros: often cheapest per dose; flexible dosing schedules.
- Cons: fluctuating testosterone levels between injections; require clinic visits or self-injection; risk of mood changes or erection issues with peaks/troughs.
- Gels, creams, or solutions applied to the skin (transdermal)
- Examples: AndroGel, Testim, Fortesta (gels); Vogelxo (gel); various topical solutions.
- Pros: resemble natural daily rhythm; easy to use.
- Cons: skin irritation; risk of transferring testosterone to others through skin contact (especially children or pregnant people); must apply carefully.
- Patches
- Example: Androderm (transdermal patch).
- Pros: simple daily use.
- Cons: skin irritation; easier to miss a dose; similar transfer concerns as gels.
- Pellets implanted under the skin
- Example: Testopel (sustained-release testosterone pellets).
- Pros: long-lasting (about 3–6 months); few daily maintenance needs.
- Cons: minor surgical procedure for implantation; pellet can migrate or require removal/replacement.
- Oral testosterone
- Older forms: methyltestosterone (less commonly used today due to liver concerns).
- Oral testosterone undecanoate (e.g., Jatenzo) is a newer, or recently used, oral option.
- Pros: very convenient (oral).
- Cons: liver metabolism concerns with older formulations; some newer forms require taking with meals and have monitoring needs.
- Nasal and buccal forms
- Nasal: Natesto (nasal spray).
- Buccal: Striant (buccal tablets placed at the gum line).
- Pros: avoids first-pass liver impact (for some forms); convenient for some patients.
- Cons: nasal or mouth irritation; dosing schedule can be frequent.
How to choose
- Your doctor will consider symptoms, baseline testosterone levels, age, comorbidities, risk factors (e.g., cardiovascular risk, sleep apnea), desire for fertility, cost, and preference for daily versus infrequent dosing.
- Some people prefer injections for lower cost or less frequent dosing; others prefer gels or patches to avoid injections; others like pellets for long gaps between treatments.
- Important: testosterone therapy can affect fertility and may have risks for prostate health and cardiovascular status. Monitoring is essential.
Monitoring while on TRT
- Check testosterone levels after starting or adjusting therapy (often 4–12 weeks after the start, then periodically).
- Monitor hematocrit/hemoglobin (risk of thick blood), PSA and digital rectal exam as advised, lipid panel, liver function tests (especially with oral forms), and blood pressure.
- Watch for side effects like acne, breast tenderness, swelling, sleep disturbances, or mood changes.
If you tell me your location and whether you’re looking for a specific route (e.g., least injections, skin-friendly, or a pill you can take), I can tailor the list with commonly used products in your area and give more detail on dosing schedules and monitoring.