Types of testosterone replacement therapy
Testosterone taken by mouth, also called oral, isn’t often used for treatment of hypogonadism. Oral testosterone can cause serious liver problems. And it doesn’t keep testosterone levels even.
The U.S. Food and Drug Administration has approved one oral testosterone replacement, testosterone undecanoate (Jatenzo, Tlando, Kyzatrex). The lymph system absorbs it, so it might not cause the liver problems seen with other oral forms of testosterone. It’s not used to treat hypogonadism caused by aging.
Other forms you might choose can depend on how easy they are to get and use, how much they cost, and whether insurance covers them. They include:
Gels. There are several available with different ways of applying them. Depending on the brand, you rub the testosterone into your skin on your upper arm or shoulder (AndroGel, Testim, Vogelxo) or apply it to the front and inner thigh (Fortesta).
The body soaks in testosterone through the skin. Don’t shower or bathe for several hours after a using a gel to give it time to soak in.
Side effects include skin irritation and, if someone touches you, having the medicine get on someone else. Don’t let your skin touch anyone until the gel is fully dry. Or cover the area after putting on the gel.
Shot. Testosterone cypionate (Depo-Testosterone) and testosterone enanthate (Xyosted) are given in a muscle or under the skin. Symptoms might vary between doses depending on how often you get the shots.
You or a family member can learn to give testosterone shots at home. If you’re not OK with giving yourself shots, a member of your care team can do it for you.
The shot form of testosterone undecanoate (Aveed) goes deep into a muscle, typically every 10 weeks. A member of your medical team must give it. It can have serious side effects.
- Patch. A patch containing testosterone is put on an arm or the torso each night. Possible side effects are mild or severe skin problems.
Gum and cheek, also called buccal cavity. Small and puttylike, gum-and-cheek testosterone replacement sends testosterone through the area above the top teeth where the gum meets the upper lip, called the buccal cavity.
This product, taken three times a day, sticks to the gumline and sends testosterone into the bloodstream. It can irritate the gum.
- Nasal. This testosterone gel (Natesto) can be pumped into the nostrils. This option reduces the risk that medicine will get on someone else through skin contact. This type of testosterone is put into each nostril three times a day. This might make it less easy to use than other methods.
- Pellets put under the skin, called implants. Testosterone-containing pellets (Testopel) are surgically put under the skin every 3 to 6 months.
Testosterone therapy carries risks, including:
- Making too many red blood cells.
- Acne.
- Bigger breasts.
- Sleep problems.
- Growth of the prostate.
- Not making as much sperm.
Risks from testosterone therapy are most often due to doses that are too high. Many of these side effects go away when the dose is lowered. That’s why it’s so important to have regular follow-up visits with a health care professional, who will monitor the testosterone levels in your blood.
