Low Testosterone: What Are Your Options?

Levels of testosterone decrease as men age. In some men, this leads to symptoms that can be improved with available medications. Know the signs and symptoms of low testosterone and your treatment options.

Key takeaways:
  • arrow-right
    Low testosterone can result in decreased libido and erectile dysfunction, as well as depression and feelings of fatigue.
  • arrow-right
    Treatment options include injections, gels, transdermal/buccal patches, and intranasal gels.
  • arrow-right
    All replacement therapies are associated with side effects including acne, breast tenderness, increased red blood cell counts, and mood swings.
  • arrow-right
    Androderm is considered to have the highest efficacy in returning testosterone levels to normal.

What is male hypogonadism?

Male hypogonadism is a condition in which the testicles do not produce adequate amounts of testosterone. This can occur from issues directly attributed to the testicle (injury, removal, or chronic infections). However, it can also be caused by dysfunction of the pituitary or hypothalamus, two areas of the brain responsible for stimulating the production of testosterone.

The diagnosis of hypogonadism (low testosterone) has dramatically increased over the past decade and is estimated to affect around 87 million men in the US by 2050.

Symptoms of testosterone deficiency

The symptoms of low testosterone (low T) can have negative effects on a man’s sex life. Men can experience reduced libido and erectile dysfunction (ED) when testosterone levels are lower than normal.

Low testosterone can also have effects on physical appearance such as reduced muscle mass and reduced facial/body hair. In addition, psychological symptoms such as depression, difficulty concentrating, and feelings of fatigue or reduced energy levels.

Overall, these symptoms can lead to an overall reduced sense of well-being and poor self-esteem. Talk to our doctor if you experience any of these symptoms as there are treatment options available.

Options for testosterone replacement

Replacement options are available in multiple forms from patches, gels, injections, and slow-release pellets.

Injections

Depo-testosterone: Injected into a muscle (intramuscularly) every 2 weeks. Slowly releases testosterone over the 2 weeks.

Delatestryl: Injected into a muscle (intramuscularly) every 2 weeks. Slowly releases testosterone over the 2 weeks.

Xyosted: Injected under the skin (subcutaneously) once a week. Comes in an easy-to-use auto-injector.

Transdermal (skin) patches

Androderm: Applied to the skin every 24 hours. Can cause local skin reactions and irritation.

Testoderm: Applied to the skin every 24 hours. Has an option for patches applied to scrotal skin. Can cause local skin reactions and irritation.

Buccal (gums) patches

Striant: Applied to gums just above incisor teeth (tooth next to two front teeth) every 12 hours. Can cause gum irritation, redness, swelling, and a bad taste in the mouth.

Transdermal gels

Androgel: Available in packets and a pump system and is applied every 24 hours. The most common side effect is acne. Risk of transfer to partner or others.

Axiron: Available in a pump system and is applied every 24 hours. The most common side effect is skin irritation. Risk of transfer to partner or others.

Testim: Available in tubes and is applied every 24 hours. Fewest side effects of replacement options. The most common side effect is skin irritation. Risk of transfer to partner or others.

Vogelxo: Available in packets and a pump system and is applied every 24 hours. Similar to Testim in terms of side effects. The most common side effect is skin irritation. Risk of transfer to partner or others.

Fortesta: Available in a pump system and is applied every 24 hours. The most common side effect is skin irritation. Risk of transfer to partner or others.

Nasal gel

Natesto: Applied intra-nasally three times a day. Can cause a runny nose, nasal irritation, and an abnormal sense of smell.

Side effects of testosterone replacement

Overall, all forms of testosterone replacement can cause the following side effects:

  • Acne
  • Worsening of sleep apnea
  • Increased red blood cell production
  • Breast tenderness and swelling
  • Increased aggression and mood swings

What form of testosterone replacement is best?

All forms have been shown to be effective in restoring testosterone levels. However, medications applied daily tend to maintain testosterone levels within the normal range better than those administered less frequently.

Androderm has been shown to be the most effective replacement therapy but has a high frequency of side effects (skin irritation).

Injectable forms are effective in restoring testosterone levels but often result in lower-than-normal levels towards the end of the two-week interval. The less frequent dosing improves compliance.

Natesto and Striant require multiple doses in a 24-hour period, which makes it more likely to forget a dose.

When deciding on the most appropriate therapy, one must consider the frequency of dosing, side effects, and ability to administer the medication. If one method proves to be ineffective or intolerable, consider trying a different method.

Low testosterone can significantly affect a man’s quality of life. However, there are multiple options available with different administration methods and frequencies. Therefore, discuss with your doctor the pros and cons of all treatment methods to determine what method is best for you.