Testosterone therapy has been around for more than sixty years. It is well understood, generally well tolerated and available in a surprisingly wide range of treatment options. Which one is for you?
Testosterone Creams and Gels
This is the most common form of testosterone therapy in the US, with just two FDA approved formulations (Androgel and Testim) controlling more than 60% of the market for testosterone therapy. Under guidance from a medical practitioner, the gel is applied once a day to the skin, usually on the upper arms and shoulders.
If your doctor diagnoses you with low T, you will most likely be started on the gel. It’s reasonably convenient, reasonably well tolerated, and it can get your T levels back up very quickly. It is also very heavily marketed – both to consumers and to doctors.
Personally, I am not big fan of this type of therapy. I hate having to be careful not to get it on my wife and kids (nobody wants a bearded five year old), I hate the smell, I hate having to let it dry and being unable to shower for a few hours after applying it. It’s a nice introduction to testosterone therapy, but many guys switch to injections for the long term. The cost can also be prohibitive without insurance – as much as $500 per month.
Interestingly, you can also get non-FDA approved compounded testosterone creams from many compounding pharmacies that do a similar job for much less money. As a reminder of just how crazy the world of big pharma is, it’s also worth noting that the makers of Androgel are actually paying other companies to not make a generic version of testosterone gel. The FTC recently filed a complaint about this – read about it here.
Testosterone Pills
Amazingly, there is no good ‘1 pill a day’ treatment for low testosterone. I predict that someone will produce one within the next couple of years, and that it will be a billion dollar drug. The makers of Androgel actually appear to be working on this right now.
Most testosterone pills that have been created over the years are extremely liver toxic. The exception to this rule is Andriol, but it is not available in the US. It’s also not generally as effective as most of the other treatments listed here.
Testosterone Pellets
Just like they do with cows! You get a little pellet inserted under your skin, and it releases a steady stream of testosterone over 3 to 6 months.
I have personally never tried this treatment, and I’m not sure that I want to quite honestly. Let me know if you have tried it – it sounds intriguing once you get over the fact that you will have a foreign object buried under your skin for an extended period. Blergh.
Injections
Injectable Testosterone
The grandaddy of testosterone treatment. In 1889 some bright guy called Charles-Edouard Brown-Sequard injected himself with an extract that he had made from the testicles of dogs and guinea pigs. He reported back to the medical community that ‘it was awesome’ (or words to that effect) and thus testosterone therapy was born. Hooray!
These days, you don’t have to grind up any testicles to get your T fix. Your doctor can prescribe you testosterone with an ‘ester’ attached to it that will slow absorption, allowing for less frequent injections. In the US, the most common esters used are called enanthate and cypionate.
The ‘less frequent injections’ is the point to be aware of here. Most doctors will prescribe one injection every two weeks, which has never been ideal for me. I find that after the 10th or 11th day I can really feel that my T levels are low again, and I hate this ‘roller coaster’ effect. Everyone is different, but for me every ten days has worked out to be ideal.
To make this routine less annoying (and less expensive) your doctor can allow you to pick up your own multi-use vial of testosterone from the pharmacy, as well as syringes and needles, and you can administer your own shots at home. As daunting as this sounds, it’s actually very easy and painless – I am almost ashamed to admit that I actually enjoy doing it now!
I am not a doctor, and I cannot give you medical advice, but my personal experience is that the gel can be a good place to start, but that you will probably want to end up on the injections for the longer term. Within the next couple of years a new injectible testosterone ester called undecanoate will be approved by the FDA, and this will provide much less frequent shots – perhaps even once every two months.
So, there you have it – a range of treatment options. As for side effects, well, nobody can pretend that there are none, but my personal opinion is that if you put me in a room with a bottle of tylenol, a bottle of anti-depressants, and a bottle of testosterone and told me I had to take one, I would take the testosterone every time. The media have vilified testosterone as an ‘evil’ substance, but the reality is that it’s just a hormone – nobody balks at taking thyroid medications, and it’s really no different.
In all my years of testosterone therapy, I haven’t killed anyone, I haven’t beaten anyone up, and I haven’t grown horns or hooves (yet). If you think you have low T, you owe it to yourself to get your T level checked and talk with your doctor about the treatment options. You’ll thank me for it later.
You can discuss approaches to testosterone therapy with the community at www.mehacker.com. People there want to help you!
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Help! I am 53 years old and have been on low T therapy for over a year. I started out with Androgel(very expensive even with insurance) and it barley raised my level to about 124. I was the switched to 300 mlg. injection’s every three weeks. After 7 months of this my T level tested 100. What do I do?! I want to have a desire for life again but nothing has helped.
Hi Tony,
Apologies for the delay in replying. As always, I have to be relatively careful not to appear to be giving medical advice here, but here’s my take.
First, what does your doctor say about this? Has he referred you to a specialist?
Second, upping the does of testosterone will help – it’s not like it will boost your own testosterone, it will actually replace it. I don’t have the chart handy, but it’s physically impossible for weekly injected testosterone to not raise your T levels over 100.
I would strongly advise against a frequency than every 3 weeks for injections. Even every two weeks is too little for me – ten days is my limit.
If your doctor is not helping then ditch him. A doctor is a service professional that you pay to help you, like a gardener or a barber. If your doctor isn’t working out then life is too short to live with it. Ditch him and get a doctor who can help – weekly injections will get your T levels up – it’s impossible for them NOT to.
Let me know how you get on, and best of luck!
Hello, I was just diagnosed with low T levels. I am a bit nervous to the treatment basically because of the unknown. I also, was diagnosed in late 2009 with Grave’s Disease, which attacks the thyroid. I am currently taking synthroid to boost my level and now I have low T. I believe possibly the radiation therapy has harmed more than just my thryroid. I am wondering what you feel is a good idea. Do you think I should ask my Dr for weekly injections rather than starting on the gel?
Thanks,
Murph
Do you know how successful the natural treatments can be you listed under products. Since I am at 338 which is borderline I was hoping to start there. I think I will order some ZMA as my multivitamin is low in magnesium but yeah I would really prefer just to get back to normal and not have to take injections every 10 days. What I have read is once you replace testosterone, your body makes less of it, so if I go that route I can never hope to recover naturally.
i am not diagnost yet,but im pritty sure that my t level is very low.
my question is if i start any treatment,can i ever stop and go back to normal?
is there a treatment that helps to increse my own t production?
Hi Andy,
If you go register at the forum (http://www.mehacker.com) and ask a question, someone there can help you. I know that the forum looks empty right now, but we’re just getting it kicked off and we have a few experts watching it who will be more than happy to help you. As soon as you can post there, you should get an answer as the admins will receive an email. Answering on the blog is really cumbersome – thanks and good luck!
Hi Justin,
If you go register at the forum (http://www.mehacker.com) and ask a question, someone there can help you. I know that the forum looks empty right now, but we’re just getting it kicked off and we have a few experts watching it who will be more than happy to help you. As soon as you can post there, you should get an answer as the admins will receive an email. Answering on the blog is really cumbersome – thanks and good luck!
I use a product called Andromen Forte which is a 5% cream available in Australia from a pharmacy. It costs $100 for a 50 day supply as the tube has 50 daily doses – without insurance.
I’ve been using it for over 4 years now and it has made an incredible difference to my life. I used to be very tired and depressed. Visited doctors and was prescribed anti-depressants – didn’t help. After about 2 years of all this S**T I had my bloods done and – guess what? Low-T.
So now I’m real happy and make sure I dose myself everyday.
They say the product is bioidentical and I know it’s pharmaceutical grade cause I need a script over here to get it but they export worldwide so they say.
Just my 2-cents worth.
I am 64yoa and just had my 5 year post radical prostate surgery exam this month. Still cancer free! I’m still unable to achieve erections since my surgery. My urologist tested my testosterone level and it came back low (290) He wants to put me on replacement therapy, either by injections or cream. He said he would like to see my level above 400 and even higher if possible. What are the good and bad side effects I need to consider. I’m 6′3 and weigh 208 #. Good health and don’t smoke. Thanks in advance – - SkipT (Texas)
My name is Marilynn….
My boyfriend is 22 years old. We have been in a relationship for 3 years. During the first year our sex life was amazing. Then it slowly stopped. For the past 2 years we’ve been hardly having sex at all. I would ask him, he’d push me away. I seduced him. He would reject me. I know he is not cheating on me and i know he’s not gay. He is 6′0 and weighs 175. Whenever we were “together” and he finished… he would have back spasms and his legs would go numb. Also, he finishes very quickly (within 5 minutes). He hates himself for it and wishes he can go longer.
I have read up on Low T and I am concerned he might have it. He is going through therapy, but I can’t take not “being” with him anymore. I am suffering and he knows this. I will not cheat on him but I have no idea what to do. Please help and thank you in advance. – Marilynn
hi my name is Joseph and i have diabetes and i am also have low -T it is 255 and the doctor report states it is mildly low. i had to laugh 255 is not mild to me. Viagra don’t help and i am confused in what to do I am 54 years old exercise very often from age 18 and i don’t drink not even beer or smoke.. I need your advice
thank you Joseph