Testosterone Delivery Systems

In deciding on the initial approach to Testosterone Replacement Therapy (TRT), it's crucial to collaborate with the patient. There are two primary TRT delivery systems: transdermal and injectable. Let's explore the options:

Transdermal Testosterone (Gels and Creams):

• These are a preferred choice if both physician and patient opt for a transdermal method.

• Transdermal methods, particularly gels, are highly recommended due to their convenience and rapid establishment of stable testosterone levels within three days.

• The gels are generally better than creams, as they offer faster absorption into the skin, maintaining steady levels throughout the day.

• Transdermal TRT can mimic the hormonal fluctuations of a young man, offering benefits in treating sexual dysfunction.

Testosterone Patches:

• While effective, some patients may find patches inconvenient.

• Approximately two-thirds of patients may develop skin irritations due to patches.

• The patches can be noticeable and uncomfortable in certain public settings, like locker rooms.

Testosterone Pellets:

• Pellet insertion is considered outdated and poses surgical risks.

• The dosing with pellets can be problematic, as there's no upfront prediction of how patients will respond, leading to potential over or underdosing.

• Patients may not yet experience the benefits of TRT when considering further surgical procedures.

Testosterone Injections:

• Intramuscular injections can be inconvenient for patients who prefer not to self-administer and need weekly office visits.

• It involves the risk of infections and discomfort.

• Injections must be administered weekly for various reasons explained in another section.

Human Chorionic Gonadotropin (HCG):

• While often considered an excellent treatment for secondary hypogonadism, some patients may not experience the expected benefits when HCG is used as sole TRT.

• Higher HCG doses can lead to LH insensitivity, even causing primary hypogonadism.

• HCG may increase aromatase activity and estrogen levels at higher doses.

• It's advisable to start with a modest 100IU of HCG per day to prevent testicular atrophy and avoid higher doses.

In summary, transdermal methods, especially gels, are recommended for TRT, offering convenience and effective testosterone level stability. Pellets are considered outdated, and HCG should be used with caution to avoid unwanted side effects. Injections are an option, but they come with their own set of inconveniences and risks. Collaborating with patients and regular monitoring is essential for successful TRT.