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 testosterone levels, 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 find more information about how test your testosterone levels in another post.
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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
Thanks so much for the article Mark – this is a great site, but we definitely need to get more people to sign up at the mehacker.com forum so that we can all start helping each other as a community. I registered there, and I have lots of experience with this area, but I am just waiting to have some other people post so I can answer any questions. Thanks again though Mark, I’m glad that somebody is actually talking about this. My experience with Testim has been mixed at best – I was on it for 18 months (53 y/o), and I have since moved on to try other things. All the best and good health. James.
i have e d problem plus i would like to know what kind of doctor i would have to go to find out more about it my doctor gave me a blood test and said i was fine but i did not think he wanted to bother i like to see a doctor who will give me more information and tell me what i must do thank you
Rayfind – I would suggest that you don’t accept the ‘you are fine’ answer. Ask for the specific numbers (total T and free T) and do your own research. Remember, your doctor just ‘sort of’ knows a bit of everything – he’s likely not an expert in this area. Sometimes we give them too much credit – your healthcare is your responsibility.
Joseph – 255 is low. Honestly my friend, go see another doctor. This one sounds nuts!
Take control of your health care. You only get one life, etc. Make the most of it. Best of luck.
I’m 55 years old and have diabetes my doctor told me that i had lowT i have tried viagra and it did’nt do very much.i need more info on what to do about my problem.
I need more info about lowT,
Not sure where I stand regarding T. 40 up, Total T was 456, Free T 65, Free percent testosterone was low 1.6 and FSH was low at 1.4. My doctor thinks its all in my head. Ive gotten my T levels checked before and they were low-normal. Why will they prescribe adderall so quickly but not testosterone? Btw, my doc said its normal to have low testosterone and fsh at my age.
Thanks
Typo 40 years old.
I;m 47, been dealing with this low t for a few years, after a bad accident with a head injury my t level crashed, seems the pituitary glad was dammaged from one to many concussions.. Didnt have much help at the time from local doctors so I found myself using a Florida based anti aging Doc shop! They over prescriped and overcharged me,, my T level went to 2300….Since then the Low T level campain started, opening the eyes of many more Dr’s .. I started a more reasonable treatment with a local Dr ..I closely monitored the levels,, but we found I developed a high red blood cell count (High Hemoglobin) .. which is diagnosed as Polycythemia! great! so I’ve since terminated the injections awaiting the visit to a blood specialist!! Just giving a heads up to you guys! be careful who and how your being treated! Good luck
Hello Everyone.
This is a very interesting article , especially about the part where it says “Androgel are actually paying other companies to not make a generic version of testosterone gel”. You know this does not surprise me one bit at all, PURE SELFISHNESS. I guess this is why many scientist/researchers don’t want to do any research on Men who have had Bilateral Orchiectomy?(Testicles Removed). I mean i totally understand that Testosterone Replacement Therapy is a great thing to maintain hormone levels in men who have low t levels, but don’t you all think its time Urologist/Endo work on a better procedure for men who have been diagnosed with Testicular cancer, chronic orch/epidid/prostastis or Hypogandism ( sorry if i misspelled it). Its 2011, the medical field has advanced so much there is a face transplant that was done, a tongue transplant, a penile transplant, a hand transplant and many other ones but why has not there been any allogeneic Testicular Transplant done? Is it because of selfish greedy money hungry companies like Andorgel who know for a fact that if Testicular Transplants are done more They (Androgel) will lose billions of dollars????!!!!
Good day.
Read, laughed, learned.
Thanks for the imfo.
I plan to see my DR. and see where that gors.
MS sufferer. I believe the injectable medication got me.
Maybe low T has caused my ED, gotta find out.
54 years of age, really? You got to be kidding me…
I have always been and am healthy.
OK, I have been diag. with MS.
So far so good.
The pills do not work to make my #$%^ hard.
Well, sorta…
But, not good for me or my wife…
And I am concerned for her well-being as well.
Thanks for all the info and the chance to learn.
Best,
dww
Hi my name is Daniel Rodrigues. I am 21 years old. For the past few months, I have been suffering from what I believe is low t (ED, chronic fatigue,no sex drive, terrible brain fog, and what seems to be a lack of emotion) I’ve been seeing a urologist for the past 6 months, at first when I presented the symptoms to him, he said it was all in my head and I was just depressed, then we got bioavailable t checked and I’m not sure what my free t was but my total t was only about 380, and from what I am understanding, that is very low for my age. At first he tried telling me it was normal, it took me two months to convince him to put me in trt. He has me using this 2.5% gel and I’ve been using it for about 3 and a half months and my level has barely gone up but symptoms are definetly eased. I was told that I should have felt the full effect after 6 to 8 weeks, and was told that this dose could be too low or I have absorbtion issues. What should I do, need advice I’m going insane, thank you!
Also I used to get morning wood every morning and numerous spontaneous erections, which have all completly disappeared.
Somebody please help! Lol do you guys thnk since I saw minor improvements with that dose that if they bump it up it can be alot more effective?
i’m 42 and just found out that my t levels are in the toilet,,,total t 120 and free t is at a 2…i just started injectible therapy. from what i’m reading it should not be normal for the rolar coaster feeling. i felt great the first week or so then my mood and sex drive started drop again. i go back to the doc at the end of the week for my next shot,,,i guess what i want to know is how often is too often to get the shots? i really hated the depressed feeling at the end of the “cycle” (for lack of a better term)
I am 80 now my problem was statins for CHOL. statins age my muscles where they just hung under arms & legs. leg spasums cramps etc
normal worning on tv adds for use of statins for CHOL.
RESEARCH U of Cal about 40 male subjects 600 units a week for 10 weeks injected Muscle Mass Gain prox 13 lbs average and more for those who worked out. My doctor wont do the short term hi dose. My dose is now 100 units in 200 oil each 2 weeks for past months
1-1/2 deep muscle injections, I do not feel the injection 22 needle which is drawn from 200 vial by 18 needle.
I have been at around 100-( HI -T is shown on lab print out 1,138) for years and muscle mass was low not gaining, tired quickly after 1 hour of hard work, exercise eliminated desire to do natural hard work. Latest test print out is July 19 2011. I am only concerned about
being able to do hard work on farm alone my weight is 180 for past many years. U of Cal, Drew Research wat year 2006.
I goofed my T is now at 853 and I feel good like it is working.
I have used Testim in the past and its OK. After I finished the Testim – I have been using the Dr Max Powers Testosterone Boost for 4+ years. I absorbing it and the body regulating to the introduction of the hormone takes awhile, at least it did for me. Its also better than taking Testim again.
You seem kind of young for low T levels. I do not want anymore kids, but a sexy wife that’s needs regular servicing. My Doctor did a full blood work up and said my levels are back to normal now. I think its mainly because I took the Testosterone Boost from Dr Max Powers to help maintain the levels. And did so in a healthy way. I know he checked my pituitary, and the results came back OK.
Hello everyone I am a 40yrs young male and my Dr. told me that my T levels are at 257. Based on my own research, I am supposed to be at the 600 + level. My Dr. put me on Testim which I’ve used for 2 days then stopped and had to start again after 2 days. Today is my second day. I know it takes some time before this starts working, but can anyone give me some advice? I feel horrible (anxious, depressed, no energy, no stamina, fatigued, irritable, moody, etc) and I was not like this until 6 weeks ago. I am waiting for an appointment from a Dr. (Endo) here in RI who is an specialist on Bioidentical hormones and I hope he will be the answer to my unfortunate situation. I was also diagnosed with Thypoperoxidase Antibody (Thyrod issue) and my Dr. told me that they cannot prescribe anything yet until my Thyrod goes empty!! which sounds stupid. Anyways, my Dr. is trying to get me in sooner to see the specialist and hopefully he will give me some Bioidentical hormones for my T and Thyroid.
God bless you all :0)
Hi, Iam 21 years old, and i think i suffer from low t, becuase of the symptoms i have.
I often feel depressed, brain fogged, cant really concentrate long, clumsy and not having much control
of my body. My erections arent too strong too. I feel extremely week for a 6’5 young man. Iam going to get my blood test
and i want to kno how much would the price be ( I Have insurance)
Hello, I am a 37 year old male and have been dealing with depression, fatigue, no sex drive, ect. I have been on antidepressents for 3 years now, but just recently 3 months ago I had blood work done and what do know my T level was 154 and that was before 9am. I have had my blood drawn 3 times now and it’s always low. I seems like I keep getting the run around, stay on your medication, exersize , blah, blah, blah. Why is it so hard to get a script for Testosterone replacement therapy.
Hello, I am a 47 year old with hypogonadism and I started out on androderm patches and by the end of the 4th week alot of my symptoms were way better. My symptoms were pretty extreme, energy crashes where I needed to eat lots of food, brain fog was quite extreme, and I had horrible anxiety and depression issues and the usual low energy and weakness that low t gives you. I did quite well with the patches until I got a bad rash from them. Now the endo has switched me to androgel and I still have energy. increased sex drive and ok strength, but I get dizzy and feel a little more brain fog again. I guess what I am saying is I dont know if the gel is as good as the patch or if anyone has had expierence with this and feels injections are better to try or maybe 5 to 6 weeks of treatment just isnt enough time yet to be back to normal. It hard to be patient with this. Please help if you can!!!
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