Testosterone replacement therapy: Effective treatments are available
In men whose testicles fail to produce sufficient amounts of the hormone testosterone (hypogonadism), testosterone replacement therapy (TRT) may restore sexual function, improve protein metabolism and prevent bone loss. In addition, men receiving TRT often experience an increase in energy and libido and an improved sense of well-being.
In the past, men requiring testosterone replacement had one option — injections. But new therapies developed in the last decade give men with significantly low testosterone more options.
Testosterone delivery methods
The safest testosterone delivery methods for adult men are intramuscular injections and absorption through the skin using patches and gels. Taking testosterone orally is now rare because it may worsen your blood cholesterol levels and increase your risk of blood clots, heart disease and liver disease.
Intramuscular testosterone injections (testosterone cypionate and testosterone enanthate) are effective, safe and inexpensive. The shots are given about every 2 weeks. You may experience fluctuations in symptom relief because the level of testosterone varies between doses.
- Scrotal patch (Testoderm).
Thin scrotal skin is much more absorbent than other skin sites. Apply the scrotal patch in the morning and remove it for bathing and intercourse. Itching and skin irritation, which can occur in a small percentage of people, are usually very mild and diminish with continued use.
- Nonscrotal patch (Androderm, Testoderm TTS).Apply the nonscrotal patch as directed to such areas as your back, abdomen, arm or thigh. You might experience a skin reaction to this product.
The most recent advance on the market is testosterone gel. You rub the gel onto your upper arm, shoulder or lower abdomen. It’s possible to transfer the testosterone from your skin to your partner’s since there is no barrier, as there is with patches. To avoid this, cover the area and avoid skin-to-skin contact for approximately 5 hours after application.
Choosing a preparation
You and your doctor have many options for TRT. Choosing a therapy depends on your acceptance of a particular delivery system, its side effects and its cost.
If you or a family member learns how to administer the injections, the intramuscular testosterone shot is the least expensive and perhaps safest therapy. The cost is higher if a nurse or doctor gives the injections.
The scrotal patch has a low rate of skin irritation but must be removed for bathing and intercourse. Nonscrotal patches are more expensive.
Gels offer a convenient option, but they’re also the most expensive. Skin reactions are uncommon.
All of these preparations are effective, so choosing one over another often comes down to your individual preference, convenience and cost.
Hypogonadism and aging
Studies evaluating testosterone treatment in hypogonadal men suggest improvement in muscle mass, bone mass, strength and sense of well-being. But should TRT be considered for testosterone loss from normal aging?
"There are a lot of good data that define the risks and benefits of estrogen replacement for women," says Todd Nippoldt, M.D., an endocrinologist at Mayo Clinic, Rochester, Minn. "We’re just getting that sort of data on men now (regarding testosterone). It’s unclear if it’s beneficial to raise testosterone levels that have declined because of normal aging."
Many questions remain unanswered, particularly the extent and the duration of beneficial effects, the number of men who will benefit and the long-term risks. Risks may include an increase in cardiovascular disease, benign and malignant prostate disease, and sleep apnea. If a disease is the cause of low testosterone, TRT may be right for you. At this point, there is not enough evidence to recommend using TRT to compensate for the gradual decline of testosterone due to normal aging. See your doctor for advice about your specific situation.