Table 3: Different formulations of testosterone replacement therapy.
| Route of administration (brand name) | Dosing | Advantages | Disadvantages |
|---|---|---|---|
| Buccal tablets (Striant®; Columbia Laboratories, Portland, OR, USA) | Twice daily, lymphatic absorption from buccal mucosa | Easy to use, discreet, easy to reverse | Twice daily dosing, gingival-related side effects, effects on taste, expensive |
| IM injection | Testosterone enanthate, tesosterone cypionate: 1–2 weeks; Testosterone undecanoate (AVEED®; Endo Pharmaceuticals Inc, Malvern, PA, USA): 10–12 weeks | Inexpensive generic, reduced dosing frequency, adjustable dosing, no transmissibility | Testosterone enanthate, tesosterone cypionate: Peak and trough levels leading to fluctuations in mood and libido, needle phobia, painful, skin irritation, higher risk of polycythaemia, need for dose adjustment, anaphylaxis. Testosterone undecanoate: POME and high cost (ultra-long acting) |
| Intranasal gel | Thrice daily | No transmissibility, not painful, easy reversibility, less impact on fertility? | Thrice daily dosing, nasal side effects (nasopharyngitis, sinusitis, epistaxis, parosmia) |
| Oral capsules: Andriol® (Merck Pharmaceuticals, Darmstadt, Germany), JATENZO® (Clarus Therapeutics Inc., Northbrook, IL, US), TLANDO® (Lipocine Inc., Salt Lake City, UT, USA) | Twice daily | Convenient, easy intake, no transmissibility, easy reversibility | Expensive, food-dependent absorption, gastrointestinal side effects (nausea, diarrhoea), elevated blood pressure |
| Subcutaneous implant/pellet (TESTOPEL®; Endo Pharmaceuticals Inc, Malvern, PA, USA) | Long acting (3–6 months) | Compliance, long-acting, no transmissibility | Invasive procedure, infection, skin allergies |
| Subcutaneous injection (XYOSTED™; Antares Pharma, Ewing, NJ, US) | Once weekly | Less painful than IM, no transmissibility, fewer fluctuations compared with IM | Expensive, elevated blood pressure |
| Transdermal patches | Once daily | Ease of use | Skin irritation, variable plasma concentration in some patients |
| Transdermal gels | Once daily | Ease of use | Skin irritation, transmissibility, daily dosing, variable plasma concentration in some patients |
IM = intramuscular; POME = pulmonary oil micro embolism.