Testosterone Replacement: Options for Treatment Have Gotten Better

four types of medication routes - pad, cream, injection and bottle
Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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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, shots, and even nasal sprays. Here are your options, with some new players in the game.

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 result in normal testosterone levels in the majority of hypogonadal men. These have been around for a while.

Show me the gels!

Four testosterone gels are available: AndroGel, Testim, Fortesta, and Axiron.

Testosterone shots

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.

Nasal sprays

Natesto is the first nasal testosterone gel approved in the United States for the treatment of male hypogonadism and testosterone deficiency. Natesto is a metered-dose pump applicator that places the gel into the nostrils.

The good thing? Because this gel is applied inside of the nostril, there is little chance of transferring testosterone to women or children who come into close physical contact with the person using the intranasal gel. That can occur with the gels and patches used on the skin.

There are some disadvantages. Some men won’t like that it needs to be used three times daily. People with allergies or underlying nasal or sinus problems also may not like Natesto as a runny nose, sore throat and sinusitis are among the most common side effects.

Thoughts?

Dr. O.

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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 $550-$600 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.

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