The first thing to understand about testosterone replacement is that oral testosterone (pills taken by mouth) doesn’t really work because it is broken down so quickly by the liver. The solution to this problem involves patches, gels and shots. Here are your options, with some new players in the game:
1. Testosterone patches: Androderm patches are meant to be worn on the arm or torso. Androderm patches deliver approximately 5 mg of testosterone per 24 hours and results in normal testosterone levels in the majority of hypogonadal men. These have been around for a while.
AndroGel is supplied in both 1 percent and 1.62 percent concentrations. The 1 percent concentration was the first to become available. This will be your cheapest option for a testosterone gel.
Testim (1 percent testosterone gel) is supplied in tubes and applied once daily. Anecdotal reports suggest that this preparation gives off an odor.
Axiron (2 percent testosterone solution) is a solution of testosterone that comes in a metered-dose pump with applicator. This is a gel applied to the underarm and it is quite expensive so be prepared.
Fortesta is a new 2 percent testosterone gel applied to the front and inner thighs. Also pricey.
Are testosterone shots the way to go? The option of intramuscular injections is a good one, though it requires office visits. Injections are usually given one shot of 100 mg, once a week for 12 weeks. Regimens of 300 mg every three weeks and 400 mg every four weeks can also be used. An advantage of the shots for men is the freedom from daily administration of a gel or patch, while the disadvantages are the need for a shot of an oily solution every one to three weeks.
Most options for testosterone replacement are considered Tier 2 drugs by many insurance plans, though they may fall under higher copays or may not be covered with some plans. Androderm patches and all gel options run about $300 – $350 per month or per prescription (for 30 patches or one container of gel). Testosterone shots are significantly less expensive, with generic versions sometimes available for as little as $20 per dose.
Update March 2013:
The FDA has just approved a new option for AndroGel 1.62%. Now in addition to the metered-dose pump packaging, AndroGel 1.62% will also be available in two separate strength packets. Each packet will contain either 20.25mg of testosterone in 1.25 g of gel or 40.5mg of testosterone in 2.5 g of gel (note that the starting dose of AndroGel 1.62% is 40.5mg of testosterone). Separate packets should make dosing a little easier than a metered-dose pump.