Table 3. Testosterone (T) formulations and commercial names (in parentheses).
| Formulation | Dosage | Advantages | Disadvantages |
|---|---|---|---|
| Injectable long-acting T undecanoate in oil (Nebido, Hormus) |
1000 mg IM, followed by 1000 mg at 6 weeks; then, 1000 mg every 10–14 weeks | Convenient drug regimen (once every 10-14 weeks); stable T levels | Requires IM injection of a large volume (3 or 4 mL); coughing (rarely); coughing episode immediately after injection (rarely); high cost |
| T enanthate (Delatestryl)* | 100–200 mg IM every 2–4 weeks or 100 mg/week | Flexibility of dosing; low cost | Requires IM injection; peaks and valleys in serum T concentrations that may be associated with fluctuations in symptoms; coughing immediately after injection (very rarely) |
| T cypionate (Deposteron) | 100–200 mg IM every 2–4 weeks or 100 mg/week | ||
| T proprionate + isocaproate + decanoate + phenylpropionate (Durateston) | 125–250 mg IM every 2–4 weeks or 125 mg/week | ||
| Subcutaneous T enanthate (Xyosted)* | Starting dose: 75 mg subcutaneously once a week. The dose can be titrated to 50 mg or 100 mg weekly | Convenient drug regimen (once weekly); stable T levels | Increases in hematocrit, PSA, and blood pressure are the most frequent side effects |
| Transdermal T gel(Androgel) | 50–100 mg of 1% transdermal gel once daily | Provides flexibility of dosing, ease of application, good skin tolerability; less erythrocytosis than injectable T | Potential of transfer to a female partner or child by direct skin-to-skin contact; T concentrations may be variable from application to application; skin irritation in a small proportion of patients |
| Axillary T solution (Axeron) | 60 mg of T solution applied in the axillae | Provides good skin tolerability | Similar to 1% testosterone gel |
| Transdermal T patch (Androderm)* | One or two patches, designed to deliver 2–4 mg of T during 24 hours applied on a clean, dry area of skin on the arm, back, abdomen, or upper buttocks (once daily for most patients) | Ease of application; stable T levels | Serum T concentrations in some T-deficient men may be in the low-normal range; these men may need applications of two patches daily; skin irritation at the application site occurs frequently |
| Buccal, bioadhesive, T tablets (Striant)* | 30 mg controlled release, bioadhesive tablets BID | Convenience and discreet | Twice daily applications are required. Gum-related adverse eventsin 16% of treated men; alterations in taste |
| T pellets (Testopel)* | T Pellets containing 600–1200 mg T implanted SC; the number of pellets and the regimen may vary with formulation | Requires infrequent administration | Surgical incision for insertions is required; occasional spontaneous pellets extrusion; local hematoma and infection rarely seen |
| Nasal T gel (Natesto) | 11 mg two or three times daily | Rapid absorption and avoidance of first pass metabolism | Multiple daily intranasal dosing required; local nasal side-effects (rhinorrhea, epistaxis, nasal discomfort, nasal congestion, parosmia); not appropriate for men with nasal disorders |
| Oral T undecanoate (Jatenzo)* | Starting dose: 237 mg orally once in the morning and once in the evening (with meals). If needed, adjust the dose to a minimum of 158 mg BID and a maximum of 396 mg BID | Convenience of oral administration | Variable clinical responses; administration with fatty meal is required; fat content of meals affects bioavailability; variable serum T concentrations |
*
Not available in Brazil. IM: intramuscular; BID: twice daily; PSA: prostate-specific antigen. Adapted from Bhasin et al. Testosterone therapy in men with hypogonadism: an Endocrine Society Clinical practice guideline. J Clin Endocrinol Metab. 2018,103:1715-44.