The word Testosterone has become synonymous with the title Men’s Clinic. But at Apex we are so much more than just the typical Testosterone factory. We offer our patients the ability to have their hormones optimized as well as take care of their other medical problems. I wanted to write this post to educate patients on the different types of Testosterone replacement therapy (TRT) options. I always believe it best to educate a patient and let them make the best decision for them. Each formulation has its own set of advantages and disadvantages which will be discussed below. This is meant to be a brief overview and of course, everyone should do their own research prior to deciding if TRT is right for you. So here goes.
This is probably the most common form of TRT in the market. The testosterone injections last for about 8 days in the body after injection. So with this type, weekly injections are needed to keep the hormone level at the optimal range. Weekly injections can be beneficial because it allows the dose to be adjusted quickly. The Testosterone can be titrated to improve low T symptoms and during times of increased need, like periods of heavy exercise. The weekly injection schedule is also the biggest disadvantage. Patients either have to come to the clinic to be given the injection or do it themselves at home. Another disadvantage is that in the body, testosterone is converted to estrogen. Testosterone is the main Male hormone and estrogen is the main Female hormone, but men do need some estrogen just like women need some Testosterone. If a patient is getting TRT their body will try to convert it into estrogen and thus medication needs to be taken to keep the estrogen at a reasonable level.
Topical Testosterone usually comes as a gel or cream and is applied on a daily basis. The skin is an excellent barrier and is designed to keep stuff out, whether it is bacteria, viruses, or medication. This is usually a popular option for older patients because the absorption is usually a little better when the skin is thinner which happens as we age. Topical Testosterone response is difficult to measure because they rarely cause an increase in your Testosterone blood level even though patients may feel better. Another drawback of topical therapy is that if anyone else such as a child or spouse comes in contact with the gel or cream before it dries they will then be exposed to the medication. The biggest advantage for topical therapy is that it is very non-invasive, which makes it a good option for guys with a needle phobia.
Testosterone Pellets are approximately the size of a grain of rice. They are inserted under the skin in a simple in-office procedure. They then dissolve over a period of 3-6 months releasing a steady amount of Testosterone into the body. The main advantage of this is that patients don’t have to give themselves weekly injections and avoid medication level peaks and troughs associated with injections. Pellets also have a lower risk of side effects of increased Estrogen and red blood cell counts in the blood. The largest drawbacks are that it is a procedure to get them to put in and dosing can be a challenge. To get the patient’s Testosterone level to the therapeutic level the right number of pellets have to be inserted.
Taking a pill is by far the most common way any medication is dosed. We have pills to treat just about everything, however, Testosterone is different. A specific formulation of Testosterone (Testosterone Undecanoate) is required to be absorbed orally. Testosterone, in general, is metabolized by the liver and anything we absorb through the GI tract has to pass through the liver before going into the rest of the body. If the wrong formulation of Testosterone is taken it can cause liver damage. Another limitation is that even Testosterone Undecanoate has a low absorption rate and its effect doesn’t last for long in the body and requires taking a pill multiple times daily.