Testosterone Replacement Therapy (TRT)

1. Testosterone Injections

• Intramuscular (IM) Injections:
  • Testosterone Enanthate: A common long-acting form of testosterone, usually injected every one to two weeks.
  • Testosterone Cypionate: Similar to enanthate, it’s another long-acting form, with a typical injection schedule every one to two weeks.
  • Testosterone Undecanoate: A long-acting form, typically injected every 10-14 weeks (less frequent dosing).
• Subcutaneous (SubQ) Injections:
  • Similar to IM, it is injected under the skin rather than into the muscle, offering less pain and more convenience for some patients. Some men use enanthate or cypionate for SubQ injections.

2. Testosterone Gels and Creams

• Topical Gels: These are absorbed through the skin and applied daily. Common brands include AndroGel, Testim, and Fortesta.
  • AndroGel: Typically applied to the shoulders, upper arms, or abdomen.
  • Testim: Applied to the upper arms or shoulders.
  • Fortesta: Applied to the thighs, and it typically uses a lower dose.
• Testosterone Creams: Similar to gels, but the formulation is thicker. These may be custom-made at a pharmacy based on a doctor’s prescription.
• Gels and creams are typically applied once every day, and care must be taken to avoid transferring the hormone to others (through skin contact).

3. Testosterone Patches

• Testosterone Transdermal Patches: These are applied to the skin, typically on the back, stomach, or thighs, and provide a slow release of testosterone over 24 hours. A brand example is Androderm.
• Patches are worn for a full day and replaced daily, but skin irritation may occur in some people.

4. Testosterone Pellets

• Testosterone Implants (Pellets): Small pellets of testosterone are surgically implanted under the skin (usually in the hip or buttock area) by a healthcare provider. They slowly release testosterone over 3 to 6 months.
• These provide a long-term solution with relatively stable blood levels, but the procedure can be invasive and require minor surgery.

6. Testosterone Oral Tablets and Capsules

• Oral Testosterone (e.g., Testosterone Undecanoate): There are some oral forms of testosterone available, but they are less common in the U.S. due to potential liver side effects. Andriol is one example, though it’s more commonly prescribed in other countries.
• Oral forms of testosterone are typically less effective than injections or topical treatments because testosterone is metabolized by the liver before entering the bloodstream.

7. Testosterone Nasal Gel

• Natesto: A nasal gel that is applied inside the nostrils 2-3 times a day. This option is less common but provides a way for people who can’t or prefer not to use injections or topical therapies.

9. Combination Hormone Therapies

• In some cases, testosterone therapy may be combined with other hormones (like human chorionic gonadotropin or hCG) to support testicular function, and fertility, or to address other hormonal imbalances.

How to Choose the Right Form:

• Injections offer high efficacy and are often the first choice for those seeking long-lasting results. However, they require needle use and can be inconvenient for some people.
• Gels, creams, and patches provide convenience, but they require daily application and can have issues with transfer or skin irritation.
• Pellets offer the most convenience once implanted, but they do involve a minor surgical procedure.
• Oral forms are less common due to liver metabolism concerns, though they may be a preferred option for some men who prefer non-injection methods.

The choice of testosterone therapy depends on individual preferences, lifestyle, and how the body responds to the treatment, so it’s essential to work closely with a healthcare provider to find the best solution.