Last year we heard the warnings about testosterone therapy in men after studies found an increase in cardiovascular risk. Well, a new study has shown that the delivery method of testosterone matters: injections, gel, or patch. Use of testosterone injections is associated with the greater risk of heart attack compared to gels.
Why? Injectable testosterone preparations result in intermittent spikes in the blood level of testosterone—higher than is needed, or at “supratherapeutic” levels. This recent large study found injectable testosterone was associated with a greater risk of heart attack and stroke, but not blood clots in the leg compared to testosterone gel.
Why are testosterone injections tempting? Because they are lower cost, given in the doctor’s office, and you only need them every few months—they are convenient.
So if testosterone gels are preferred, what are your choices?
- One percent transdermal gels like Testim 1% and Androgel 1% gel. These come in packets, with a 25 or 50 mg dose per packet and are placed on the back, abdomen, upper thighs or arms.
- Androgel 1.62% gel also comes in packets or a metered dose pump, and is used on the back, abdomen, upper thighs or arms.
- Fortesta 2% gel. This is a metered dose pump, with 10 mg per pump. You use 10 to 70 mg per day on the skin of front and inner thighs.
- Axiron 2% solution also comes in a metered dose and is applied to your underarms, similar to deodorant.
Are there downsides to the gels?
The potential for skin transfer, meaning if someone touches your skin the testosterone gel can be transferred to that person.
Oh, and cost. Most of the testosterone gels are brand-name only and expensive.
Update 1/9/2016: The information for the study referenced in this article is as follows:
Comparative Safety of Testosterone Dosage Forms
J. Bradley Layton, PhD1; Christoph R. Meier, PhD, MSc2; Julie L. Sharpless, MD3; Til Stürmer, MD, PhD1; Susan S. Jick, DSc, MPH4; M. Alan Brookhart, PhD1
JAMA Intern Med. 2015;175(7):1187-1196. doi:10.1001/jamainternmed.