Testosterone Replacement Therapy: Understanding Options in 2018

At EveresT Men's Health clinic, many men come to us for our expertise in testing and treating men determined to have low testosterone.  Our primary focus is to be a knowledgeable resource for men who question whether changes in energy may be related to deficient testosterone levels. If we identify low levels, we will explore hormonal correction through testosterone replacement therapy. Currently, available methods include injectable testosterone, topical applications, and implantable hormonal pellets. 

While all of these options can be valuable, our men’s health doctors prefer the more traditional approach of injectable Testosterone Cypionate, as we find that it provides more individualized treatment. Each individual will metabolize medications differently, and through blood retesting we examine how slowly or quickly a man is metabolizing the medication. Then, we can make focused and personalized dosing adjustments that can be more precisely achieved using the injectable form. A short acting injectable also provides the opportunity to medically correct deficient testosterone levels to achieve circulating levels that run at the upper end of a normal physiological range. 

Comparatively, topical applications may provide good clinical benefit, but there are a few important things to understand. Topical applications require daily applications that many come to experience as a chore. Additionally, the skin acts as a significant barrier to absorption, where the therapeutic levels may run lower and subsequently may stimulate a milder clinical response. Additionally, a man using a topical application needs to be cautious about coming into skin-to-skin contact and accidentally transferring testosterone to a woman or child.

Subdermal pellets provide a convenience to patients, as a new pellet is only needed every four to five months. However, some men do not enjoy the experience of surgical insertion that may result in local inflammation and swelling. Additionally, the testosterone levels will run at the upper end of a normal range shortly after pellet insertion, but will naturally metabolize down to low to mid normal ranges. Often, patients report diminishing benefit long before the next pellet insertion.

While we hold a preference for using injectable testosterone replacement therapy, all options provide value and it is left to the individual which method that he may prefer. Central to this decision and of paramount importance is an evaluation for low testosterone to identify if testosterone replacement is appropriate treatment.

EveresT Men’s Health clinic is an expert and convenient resource for men who want to learn more. Our larger mission is to help empower men to achieve their best energy and long-term health so that they can get the most out of life's many adventures. Testosterone is only one aspect to achieving this end.