Table 2. Testosterone replacement therapy (TRT) options.
| Formulation | Preparation (US tradename) | Dosage forms | Usual dosing | Site of application | Advantages | Disadvantages and risks |
|---|---|---|---|---|---|---|
| Intramuscular | ||||||
| Long-acting | Testosterone cypionate (Depo-Testosterone) | 100 or 200 mg/mL | 100–200 mg every 2 w or 50–100 mg every 1 w |
Thigh or buttock | Home IM injection, infrequent treatment, low cost, high efficacy | Peak effects or fluctuating testosterone levels, pain or irritation at injection site |
| Testosterone enanthate (Delatestryl) | 200 mg/mL | |||||
| Extra-long-acting | Testosterone undecanoate (Aveed) | 250 mg/mL | 750 mg initially, then 750 mg at 4 w, then 750 mg every 10 w ongoing |
Buttock | Long-acting | Administered in office or hospital by REMS-certified provider, risk of pulmonary oil microembolism and anaphylaxis |
| Transdermal | ||||||
| Gels | Androgel (1% gel) | 25 mg in 2.5 g packet or 50 mg in 5 g packet | 50–100 mg daily | Dry intact skin or back, abdomen, upper thighs or arm | Steady serum testosterone concentration | Risk of transfer, requires daily application, may not achieve normal testosterone levels in all men, occasional skin irritation |
| Testim (1% gel) | 50 mg in 5 g packet | |||||
| Androgel (1.62% gel) | 20.25 mg in 1.25 g packet, 40.5 mg in 2.5 g packet, 20.25 mg per actuation, metered-dose pump |
20.25–81 mg daily | ||||
| Fortesta (2% gel) | 10 mg per actuation, metered-dose pump | 10–70 mg daily | Dry intact skin of front and inner thighs | Ease of application | ||
| Axiron (2% solution) | 30 mg per actuation, metered-dose pump | 30–120 mg daily | Dry, intact skin of axilla | Ease of application, reduced risk for transfer | ||
| Patch | Androderm | 2 mg/24 h patch, 4 mg/24 h patch | 2–6 mg daily | Dry intact skin of arm or torso | Limited risk of transfer, no injection | Skin irritation or rash (about 1/3 of men), daily application |
| Other | ||||||
| Implanted subcutaneous pellet | Testopel | 75 mg pellets | 150–450 mg every 3–6 mo | Implanted into subcutaneous fat of buttock, lower abdominal wall or thigh | No risk of transfer, no daily treatment | Extrusion, infection, fibrosis at pellet sites Placed in clinic or hospital by trained provider under sterile conditions |
| Nasal | Natesto | 5.5 mg per actuation, metered-dose pump applicator | 11 mg (2 pumps, 1 in each nostril) 3 times daily | Intranasal | Minimal risk of transfer | Frequent administration, rhinorrhea, epistaxis, sinusitis, nasal scab |
| Buccal | Striant SR | 30 mg buccal system | 30 mg twice daily | Adhere to depression in the gingiva superior to upper incisors | No injection | Frequent administration, gingival irritation |
| Oral | Not recommended | |||||
Adapted from reference (19) with permission.