Testosterone Treatment Options
Testosterone has been used for many decades for the treatment of testosterone deficient males.
Today options for treatment include topical testosterone gels and creams, short and long acting injections of testosterone esters, application of testosterone via transdermal skin patches, subcutaneous testosterone implants and oral testosterone capsules.
Injections: Testosterone esters (Sustanon®) must be injected every 2-4 weeks, customarily in doses of 250mg. The injection must be deep intramuscular and is quite often painful. The injection results in very high circulating concentrations of testosterone for several days after administration, with a progressive fall to normal or sub-normal concentrations over the succeeding 2-3 weeks.
The rise and fall in concentration may be accompanied by fluctuations in the symptoms of androgen excess and deficiency.
Recently longer acting injections (Nebido®/Reandron®) have become available and last for up to three months. They, like the shorter acting injections, are often associated with pain and their effects are irreversible if unwanted side effects occur.
Testosterone skin patches (Androderm®) provide physiological testosterone replacement, with night-time applications leading to a pattern of circulating concentrations similar to that normally seen in healthy males. Patches must be applied daily, and there is a relatively high incidence of adverse skin reactions, which may be sufficiently severe to lead to discontinuation of use. The patches are readily visible and may discourage users from participation in sporting activities, including swimming and other sports requiring the use of change rooms.
Testosterone pellets (implants) in doses of 600-1200 mg, are inserted subcutaneously under local anaesthetic. They produce physiological testosterone concentrations which may be sustained for 4-6 months. Problems include the need for repeated local surgical procedures, and expulsion of the implants which may occur in 5-10% of procedures, often several weeks later. The site of implantation may occasionally become infected which may require antibiotic treatment.
Oral testosterone capsules (Andriol®) provides only moderately effective testosterone replacement, with wide fluctuations in circulating concentrations, due to highly erratic absorption and sometimes gastro-intestinal intolerance. Up to eight 40mg oily capsules daily are required and the use of oral testosterone is generally confined to patients who are intolerant of other preparations.
Topical transdermal testosterone gels (AndroGel®/Testogel®, Testim® 1% testosterone gels) and testosterone creams (AndroForte® 5% & AndroForte®2% Testosterone Cream) require daily application, and provide physiological replacement with few problems and satisfactory efficacy. Well designed studies show the efficacy and safety of this mode of administration to be high when given for an average of 36 months follow-up. Gels and creams have to a large extent replaced the previously mentioned forms of testosterone due to their patient friendly mode of application and flexibility with regards to dose.
In practical terms, the gels need to be applied over a very large skin surface area (back, chest, shoulders and arms) compared to the higher concentration creams which require smaller surface areas for application (fore and upper arms, scrotum torso and thigh).
Scrotal application of the cream does not meet with discomfort in patients, whereas the alcohol-based gel creates a burning sensation when applied to the genitalia. Scrotal use is the optimal site of application to achieve highest serum testosterone.
A recent medical paper established which compared the cost effectiveness versus efficacy of currently available testosterone treatments determined that the testosterone cream, AndroForte® 5% (Lawley Pharmaceuticals, Australia) was the most affordable and effective testosterone therapy currently available. To view this paper click here. (PDF)
For Prescribing Information on AndroForte® 5% Testosterone Cream for men please click here.
For Consumer Medicine Information on AndroForte® 5% Testosterone Cream for men please click here.
To view images of AndroForte® 5% Testosterone Cream please click here.