Testosterone

Testosterone is available in a number of formulations in the US.

1. Topical gels-This is the most commonly prescribed testosterone treatment. Five FDA-approved gels are available, AndroGel, Axiron, Fortesta and Testim, plus a generic Testim. Both are applied daily to the upper arms, shoulders, and chest. The usual dose is 5-10gm. Blood tests should be obtained at 2-4 weeks to determine blood levels of testosterone. Caution must be exercised within the first 2 hrs to avoid skin-to-skin contact with women and children.
2. Pellets-Pellets are placed subcutaneously, usually in the buttock region. These pellets dissolve over time, providing normal testosterone concentrations for 3-6 months. There is one FDA-approved pellet, called Testopel. Each pellet contains 75 mg of testosterone. The usual number of pellets implanted is 8-12 at a time.
3. Injections-Injections of testosterone enanthate or testosterone cypionate are FDA-approved, and provide good blood levels of testosterone. Injections are made into the gluteus muscle, but can also be delivered subcutaneously. A common dose is 100 mg each week, or 200 mg every two weeks. A different kind of injection is Aveed.
4. Patches-Testosterone patches are applied daily to the skin. There is one FDA-approved brand, Androderm. The dose is 5 mg. Patches are convenient, but are associated with a high rate of skin reactions. Blood levels of testosterone tend to be lower with patches than with other forms of treatment.
5. Buccal tablets-A testosterone pellet is available that is placed on the gumline above the incisors. It requires replacement every 12 hours. The trade name is Striant, and it is FDA-approved. It provides good testosterone levels.
6. Oral forms of testosterone-Testosterone is available in pill-form, but is only rarely used, since all the oral forms available in the US are associated with significant risk of liver damage. A safe form of oral testosterone is available in other countries under the name Andriol. It is taken twice daily.