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Testosterone Replacement Therapy


Low testosterone which is called hypogonadism is a problem primarily faced by men. But actually, which men do most often fall victims to testosterone deficiency? In fact, numerous researches have shown that the older men get the more susceptible to hypogonadism they become.

Thus, one study conducted in 2006 has demonstrated that 39% of the male participants over 45 years old had testosterone deficiency.1 One more study proved that 13 million American men have low testosterone levels.2 And only a small number of these men treat this disorder. Another research has also indicated a clear interrelation between the process of aging and low T levels. Thus, 20% of American men over 60 years old suffer from low testosterone side effects. As for the men over 70 and 80 years old, 30% and 50% of the men respectively have the mentioned problem.3


Low Testosterone Symptoms

How is it possible to get to know that a man has low T levels? Well, you can suspect that you have hypogonadism if you have noticed low testosterone symptoms. They are as follows:

  • Unexplainable Fat Gain. The body starts storing fat suddenly. This results in substantial weight gain in men. And it’s difficult to lose the stored fat. Moreover, in this case, excess weight is often accompanied with breast tissue enlargement.
  • Drop in Energy Levels. The men who lack testosterone typically complain of increased fatigue, both mental and physical. Chronic fatigue worsens the quality of the men’s lives.
  • Muscle Weakness. Low T levels have a negative influence on muscle mass and, consequently, on muscle strength. And the men note that even high intensity workouts don’t help promote a desirable improvement.
  • Muscle Atrophy. Loss of muscle strength is not the worst thing that may happen with the man’s muscles when his T levels have dropped dramatically. In this case, muscle atrophy develops. Consequently, the man is unable not only to lift heavy weights and go the grunt work, but also cannot move normally. Moreover, the man can even fall without reason.
  • Low Bone Density. Insufficient hormone production may result in osteoporosis which makes the bones very fragile and, hence, destroys them step by step. Those people who have osteoporosis suffer from bone fractures very frequently.
  • Erectile Dysfunction. Decreased T levels can be a cause of impairment of erectile function. Thus, if testosterone production in the body is not enough, the men experience a significant decrease in sexual desire. Moreover, the number of erections reduces, while the quality of erections worsens. Consequently, overall sexual performance is unsatisfactory.
  • Emotional Instability. Testosterone deficiency affects a sense of overall well-being. In addition, it can lead to mood swings. Increased nervousness, uncontrollable anger, sadness, depression, and irritation follow in quick succession many times per day. Therefore, the man loses control over his life.
  • Diabetes Risk. It’s scientifically proven that low T levels contribute to the development of type 2 diabetes. Firstly, excessive weight which the man with testosterone deficiency gains can be an indirect cause of diabetes. Secondly, if the man’s body doesn’t synthesize enough testosterone, this leads to insulin resistance which, in turn, leads to diabetes.

Diagnostic Approach

Once you have noticed the testosterone deficiency symptoms and believe that the reason is hypogonadism, you shouldn’t practice self-treatment. Instead, you have to consult your healthcare practitioner who should make a diagnosis.

The most widespread and the simplest way to find out whether your T levels are really below the normal ones is to undergo serum testosterone test which is a blood test. This test will help the doctor measure total serum testosterone available in your blood. If the hormone level is lower than 300 ng/dL, the doctor has every reason to reveal a disorder.

Furthermore, the healthcare professionals rely on the tests of male comprehensive hormone panel to get to know whether T levels are below the normal range. Thus, it’s necessary to measure free testosterone, total testosterone, sex hormone-binding globulin, complete blood count, and female hormones. These measurements will allow the doctor not only see whether you have testosterone deficiency, but also understand its underlying condition. To ensure the measurements’ reliability, you have to undergo tests no later than 2 hours after you woke up. However, note that you should do testosterone testing again in 2-6 weeks. This is a proven way to obtain the trustworthy results. The matter is that concentration of testosterone in blood plasma is not the same during the day. Besides, the test results may be mistaken. Only if the diagnosis is confirmed, the healthcare professional prescribes testosterone replacement therapy.

Implantable Testosterone

Implantable pellets are an effective mode therapy to treat low testosterone. There is evidence that they provide a variety of advantages to men, who need to raise their male sex hormone level. The implants have been developed and used since 1940s.

In fact, it has been proven that one pellet typically delivers testosterone release for about 3 to 4 months, but for some men, up to 6 months. People usually require a dose of 2 to 6 pellets. It all depends on the age, weight, as well as some other factors.
Doctors need to make an incision about 1 cm in order to perform the insertion. It’s usually the lower back area. It’s worth noting, that they use topical anesthesia, so that the procedure would be quite painless and quick.

Once a person decides to get implantable pellets, he will forget about taking pills, applying gels, creams, or making injections. If you are tired of all of them, or become frustrated about the fact, the implants will take care of everything. There won’t be any need to remember about these procedures on a regular basis. That’s why they are really convenient.

Skin Patches

testosterone patchTestosterone transdermal patch is a fundamentally new approach to fixing hormonal imbalance in men. It’s indicated for treatment when middle aged men and elderly men experience andropause. During this period of the men’s lives, the lack of testosterone contributes to unpleasant changes in their overall health and the life style. A skin patch helps replenish testosterone levels, thereby normalizing physical, mental, and sexual health. It’s possible to apply a transdermal patch to the shoulders, forearms, hips, back, and abdomen.

Androderm is a well-known anti-hypogonadism remedy that enables the men to safely undergo transdermal hormone replacement therapy. It’s a multi-layer patch consisting of an adhesive layer, pure testosterone itself, and special membrane tissue. The uniqueness of the membrane lies in the fact that it allows the skin to absorb testosterone in different amounts during the day. When using Androderm, the middle aged and elderly men can keep their T levels in a normal range typical for the young men. The application of a skin patch is advantageous because it’s easy to use, non-invasive, completely painless, as well as doesn’t require a doctor’s assistance.


testosterone gelGels are another popular way for men to transdermally get the necessary amount of testosterone. These gels are intended for external use and have to be applied to the arms, shoulders, or abdomen.

This method allows the men to balance and regulate the male hormone without too sharp rise in T levels. In addition, it’s well tolerated, invisible on the skin, convenient to use, doesn’t cause discomfort, and almost doesn’t lead to the development of skin manifestations. Due to the transdermal delivery, testosterone gel doesn’t affect liver and increases T levels quickly. AndroGel is one of the most thought-after testosterone gels nowadays.

Numerous studies have proven the efficacy and safety of this gel for the treatment of hypogonadism in men. In addition to the normalization of T levels, AndroGel restores the male sexual function, as well as helps reduce visceral fat and build muscle mass. Testim gel can replace AndroGel. It has already become a well-recognized medication on the market. Axiron and Fortesta also give topical solutions for men who lack own testosterone. Natesto gel differs from the rest of testosterone gels with its administration method. That is, it’s applied nasally.

Mouth Patches

Mouth patches belong to the latest innovations available for men who need testosterone replacement therapy. They give the men an opportunity to increase T levels by sticking buccal systems in the mouth, between cheek and gum. These transbuccal systems come in the form of tablets which dissolve over time. Testosterone is released from the matrix where it was “packed”. It’s necessary to use 2 mouth patches per day to ensure a long lasting effect during the day. This treatment method is less harmful for the liver than the injections and pills because, in this case, the absorption takes place through the gums and buccal mucosa. The effects of transbuccal systems are similar to those of testosterone gels. The mouth patches offer an effective way to cope with testosterone deficiency since hormone quickly reaches the “goal”. Though the use of the mouth patches is one of the new treatment methods, it hasn’t yet become too popular. The matter is that the placement of a transbuccal system causes a considerable discomfort in a large number of the men with hypogonadism.


testosterone injectionsIntramuscular testosterone injections fight hormone deficiency most successfully. In fact, hormone injections are used to cure hypogonadism for a long time. They have got a scientific proof as the highly trusted medications. By the duration of action, the injectable forms of testosterone are conventionally divided into:

  • Short-acting injections.
  • Medium-acting injections.
  • Long-acting injections.

The short-acting medications are injected intramuscularly every 2-3 days. The major advantage of these medications is their immediate effect. However, the main disadvantages are the frequent use and pain at the injection site. The medium-acting injections are given every 2-3 weeks. And the latest pharmaceutical development is a long-acting injectable testosterone. The interval between these testosterone injections is 2.5-3.5 months, enabling the men to maintain necessary hormone levels throughout the period. At the same time, these medications are quite expensive. Moreover, the testosterone injections have many adverse effects.

These injectable liquids are used in different dosages. But only the doctor can determine the dosage. The patients should never change the dosage by themselves.

Testosterone Pills

Testosterone pills are the simplest and the most widespread method to increase testosterone levels. The high popularity of this method is determined by its convenience. Therefore, because of the ease of use, most men give preference to pills over the rest of testosterone replacement therapy options.
In general, testosterone pills are divided into synthetic and natural ones. Natural pills are made with the use of ingredients of herbal origin. Usually, such medications are able to maintain normal T levels for about a day. As a result, it leads to the increase in energy levels and sexual arousal, as well as to the improvement of bone density. A distinctive feature of synthetic pills is their instant absorption into the blood stream and a more pronounced effect on the body. The use of such drugs causes sharp changes in the hormone levels.

As a rule, it’s necessary to take the pills twice a day after meals. The treatment course lasts from 2 to 4 weeks, depending on the condition severity. It should be mentioned that the use of pills can cause some side effects. The choice of testosterone pills is individual. The doctor prescribes the pills on the basis of physical exam results and patient history.

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Clinical References

1. Crosnoe L, Grober E, Ohl D, Kim E. Exogenous testosterone: a preventable cause of male infertility. 2013;2(2):106–113. PMCID: 4708215
2. Dandona P, Rosenberg M. A practical guide to male hypogonadism in the primary care setting. 2010;64(6):682–696. PMCID: 2948422
3. Osterberg E, Bernie A, Ramasamy R. Risks of testosterone replacement therapy in men. 2014;30(1):2–7. PMCID: 3897047



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