Testosterone Therapy – What Are The Options?

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!