Testosterone
Testosterone levels decline naturally in men with age and certain medical conditions.

Testosterone is a male sex hormone produced in the testes and adrenal glands and is responsible for the development of male sexual characteristics, such as a deep voice, body hair, muscle growth, and libido.

Testosterone levels increase during puberty and gradually decline after the age of about 40 years. This may cause reduced sex drive and erectile dysfunction in some men.

Testosterone replacement therapy helps increase testosterone levels in the body. Testosterone replacement is available in several forms including patches, gels, injections, creams, nasal gels, capsules, and tablets.

Although the best and most effective form of testosterone depends on the reason for supplementation, personal preferences, and financial picture, testosterone injectables are the ones that are most often and commonly used in clinical practice.

What are the different forms of testosterone supplements?

Testosterone replacement therapy (TRT) is recommended to balance or boost the amount of testosterone in the body when the levels fall below 300 ng/dL.

Six forms of TRT include:

  1. A transdermal patch (skin patch)
    • Applied on the arm or upper body one time a day.
    • FDA-approved two testosterone transdermal patches include:
  2. Gels
    • Clear synthetic testosterone gels that are absorbed directly through the skin. They are typically applied once daily.
    • FDA-approved testosterone gels include:
  3. Nasal gel
    • An applicator is used to pump the medication into each nostril, which is absorbed by the body quickly, but it needs to be applied at least three times a day.
      • Natesto
  4. Injections
    • Testosterone injections are one of the first forms of TRT that were approved for use. 
    • Testosterone is injected directly into the muscles or under the skin.
    • Popular brands of testosterone injections include:
    • Four types of injectables include:
      • Enanthate: A derivative of the primary endogenous androgen testosterone for intramuscular administration.
      • Cypionate: A long-acting eight-carbon ester form of testosterone, which is metabolized in approximately seven to eight days.
      • Propionate: A slow-releasing anabolic steroid, which peaks in the blood within hours of being administered and is metabolized over three days.
      • Testosterone suspension: Water-based testosterone without ester, which is the most powerful injectable steroid available, encouraging quick muscle mass and strength.
  5. Implants
    • Implanted as pellets in the soft tissues, which slowly release testosterone into the body over time.
      • Testopel (a long-acting implant that can last three to six months)
  6. Oral pills
    • Less common compared with other forms because they have been linked with possible liver harm.
      • Jatenzo (testosterone undecanoate)
      • Methitest (methyltestosterone) and Tlando (testosterone)

QUESTION

Testosterone is a chemical found only in men. See Answer

Why is testosterone therapy required?

Certain factors including age, health status, and sex can all affect the natural ability to make testosterone. 

  • Men with hypogonadism (low testosterone levels) due to aging
  • To stimulate puberty in young men 
  • Some types of breast cancer (in women)
  • Certain health conditions that result in low testosterone production, including autoimmune disorders, HIV, and diabetes
  • Primary hypogonadism (low testosterone levels due to a condition that originates in the testes)
  • Secondary/hypogonadotropic hypogonadism (low testosterone levels due to a disease of the hypothalamus or pituitary gland)

What are the symptoms of low testosterone levels?

Testosterone levels decline naturally in men with age, but certain conditions might lead to an abnormally low level. 

Symptoms of low testosterone levels include:

What are the benefits of testosterone therapy?

Many men report the following benefits of testosterone therapy:

  • Improvement in:
    • Energy level
    • Sex drive
    • Quality of erections
    • Mood
    • Cognitive function
  • Increase in:

What are the risks involved in testosterone therapy?

Experts emphasize that oral testosterone can have negative effects on the liver. Using other methods, such as skin patches, gels, orally disintegrating tablets, or injections, provides testosterone directly to the blood.

Some of the side effects of testosterone therapy include:

Men with breast cancer and prostate cancer and pregnant or breastfeeding women should avoid the use of testosterone patches. 

People with certain health conditions should inform their healthcare provider before considering testosterone therapy:

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Medically Reviewed on 11/2/2022
References
Image Source: iStock image

Is Testosterone Replacement Therapy Right for You? WebMD https://www.webmd.com/men/guide/testosterone-replacement-therapy-is-it-right-for-you

Pharmacology of testosterone replacement therapy preparations NIH https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182226/