The Different Types Of Testosterone Replacement Therapy
This article is about Testosterone Replacement Therapy, it tells you about the reason why you might need it, how the problem of low testosterone is diagnosed and the various treatment options
Testosterone is the key male sex hormone.
Responsible for almost everything ‘manly’ it controls our muscularity and strength, our body and facial hair, our deep voices, and body fat distribution.
Its main purpose however is to develop and maintain our sexual responses, erections, and fertility.
At its peak through puberty and our 20’s, as we start to get older and go into and through our 30’s our natural testosterone production starts to diminish.
Research estimates this reduction at about 1-2% per year.
At first the effects are generally unnoticeable.
However by the time we reach our mid 40’s our testosterone production can be up to 40% lower than it was when we were in our youthful prime.
As the reduction starts to take hold, we will usually begin to experience some of the many symptoms and side effects linked to reduced testosterone production.
These can include:
- Poor sleep quality
- Increased irritability and poor moods
- Erection problems
- Reduced libido/lack of performance
- Poor muscle tone
- Decreased strength
- Increased body fat
- Development of gynecomastia (aka man boobs)
Testosterone levels can easily be diagnosed.
A simple morning blood test can reveal the amount of testosterone in your blood. In young healthy men normal testosterone levels should be between 300ng.dl and 1000ng.dl.
When your testosterone levels drop below 300ng.dl, you are technically classed as having low testosterone. (medical name hypogonadism).
If this is the case your doctor has a number of options for you.
They will quite probably prescribe a course of Testosterone Replacement Therapy (TRT).
This basically means a drug based medicine that delivers either man made or synthetic testosterone into the blood to make up the shortfall.
Types Of Testosterone Replacement Therapy
Your doctor has a number of treatment options available to them.
They are as follows:
#1. Testosterone Creams
Testosterone creams are a topical cream that has been impregnated with synthetic testosterone.
They are very easy to use, simply apply the cream as directed to a clean and preferably hairless part of the body.
This normally means the abdomen, upper arms or shoulders.
One area that you should NEVER apply testosterone cream too is the genitals.
It is also recommended to vary the application site to avoid any skin problems.
The testosterone is passed transdermally through the skin and into the blood stream.
Here it goes to work to increase the levels of testosterone in the blood and reverse the symptoms of low testosterone.
Benefits and Side Effects Of Testosterone Creams
These types of testosterone creams can be very effective as testosterone replacement therapy.
They have however, been linked to some side effects, some relatively minor and some more serious.
One of the most common is urinary tract infections, users of testosterone creams report frequent urges to urinate, even when there is no urine to actually pass.
There have also been reports of blood in the urine in some users.
Some of the other minor side effects include:
- Burning and itching of the treatment area
- Skin blisters
- Redness and acne breakouts.
- Dry skin
More seriously, there have been reports that blame testosterone creams for the increased risk of heart attacks, strokes and even the onset of prostate cancers
The other downside to testosterone creams is the risk of secondary exposure, particularly to female partners and young children.
If the application area is left uncovered for any reason, it’s possible to pass or transfer the testosterone by skin to skin contact onto your partners or child’s skin.
If a woman is exposed to testosterone it could see them develop deeper voices, increased body hair growth, changes in their genitals and reduced breast size.
Children, can if exposed develop other problems such as:
- Premature puberty
- Increased hair growth
- Increase aggression
With this in mind, its crucial to ensure that hands are washed immediately after application and that the area of application is kept covered at all times.
Popular brands of testosterone creams include: Androfil, Aquaviron, Androl, Testim, and Cernos
Are Testosterone Creams Safe ?
These creams are very strong medications that do work for many men.
That said the very real risk of side effects both to the man himself and those closest to him do raise some serious concerns about their viability and safety.
Great care needs to be taken when using testosterone creams.
The facts are that they do actually lack a lot of clinical testing, especially when using them in the long term.
Personally I would steer well clear until more studies have been carried out to balance the benefits that they could deliver against real risks to your health.
#2. Testosterone Injections
Another common Testosterone Replacement Therapy method, testosterone injections are just that.
Synthetic testosterone is injected directly into the muscles where it passes through into the blood stream.
Here is gets to work, boosting the testosterone in the blood and helping to reverse the detrimental effects caused by low T
The most common site for injections is the upper arms, but the hips can also be used.
Injections are thought to be the fastest way of boosting testosterone, especially in the short term the levels are well below the 300ng.dl point.
Testosterone injections can also help regulate quality of the man’s sleep and help reduce the build up of fat cells.
Cost Of Injections
Costs of testosterone injections does vary, as a guide a months course of injection along with doctors fees etc usually costs in the region of $400-500.
Health insurance does not always cover the full cost.
Make sure you double check with your insurance company before proceeding with treatment as some policies only cover the initial consultation.
Side Effects Of Testosterone Injections
This type of Testosterone Replacement Therapy is very potent and it can be very effective in some cases.
Injections are not however suitable for all men.
They do carry a risk of some quite nasty side effects the can include:
- Cardiac Problems
- Increased Red Blood Cell Count
- Sleep Apnea
- Possible Increased Risk of Developing Breast and/or Prostate Cancer
Testosterone injections can in some cases offer a fast ‘fix’ to the problem.
They should only be used by men who have medically diagnosed with extremely low testosterone levels.
They should ideally only be used until levels have returned to baseline normal readings.
You have to remember and consider the chance of some nasty side effects, that could cause some life changing side effects.
Although not so common in Australia, In the US there has been a surge in pop up clinics who offer these types of injections at cheaper cost without the necessary medical diagnosis or guidance.
Naturally these are very risky and I strongly avoid having any testosterone injections unless prescribed by and administered by a medically trained professional doctor.
One of the most common forms of Testosterone Replacement Therapy.
A testosterone patch is basically a sticking plaster that has been impregnated with a slow release form of synthetic testosterone.
They are applied to a clean, hairless part of your skin.
Where the testosterone is slowly passed through the skin, into the muscle and then ending up in the bloodstream.
The most common places of application are the stomach, upper arms, shoulders, back or thighs. They should never be attached to the scrotum.
Your doctor will advise the best places to apply a patch.
It’s not uncommon to have to change the application site every 7 days to stop any skin irritation.
Working very much like a women’s HRT patch that helps them with the menopause.
Do Testosterone Patches Work?
Testosterone Replacement Therapy patches can make some very noticeable improvements to a man’s general health and well being.
Depending on the diagnosis and the actual testosterone readings from the blood test, patches come in various sizes and doses.
Some patches are designed to be changed every day, others can also for up to a week
Please Note – Testosterone patches have been known to interact and conflict with other medications and health conditions.
Its important to never apply one to your skin unless you have been expressively told to by a doctor.
Testosterone patches can aggravate certain health conditions such as:
- High Cholesterol
- Cardiovascular Disease
- Kidney and Liver Problems
- Sleep Apnea
You should not use patches Or any form of drug based TRT if you are :
- Under 18 years old
- Have been diagnosed with, or are at risk of breast or prostate cancers.
If you fail to change a patch or miss a dose, do not double up, simply start again with the correct dose.
Popular Brands of patches include: Evorel, Intrinsa and Androderm
Do Testosterone Replacement Therapy Patches Carry Any Risks?
Side Effects are not widely recorded, but some men have reported:
- Mouth and Gum Pain
- Loss Of Libido
You do need to consider the wider scope of side effects reported by users of TRT generally.
As mentioned above it has been reported that Testosterone Replacement Therapy in general can be blamed for the following:
- Enlarged breasts (man boobs)
- Chest pain
- Heart arrhythmia
- Shrunken testicles
- Breathing issues
Popular website drugs.com details a comprehensive list of potential side effects caused by Testosterone Replacement Therapy patches
Although a lesser risk than with creams or gels, there is still a slight risk of secondary transfer of testosterone onto children and your wife or partner.
In case some of the synthetic testosterone remains on the skins surface after the patch has been removed, you must always ensure that the application areas are kept clean and covered.
Are Testosterone Patches Safe?
Its hard to be exact, for many men they remain the most effective and generally safe method of Testosterone Replacement Therapy.
But their use does carry some risk.
The worse thing is that you will not know if you will experience any side effects until you actually try them.
In the light of recent legal actions in the US (details further down the page).
The FDA is investigating the use of all TRT methods and as such, until their use has been fully studied and understood, its probably wise to avoid them.
#4. Testosterone Gels
The most common of all Testosterone Replacement Therapy methods available, but possibly the most controversial.
Testosterone gels are usually a clear topical gel that has been impregnated with varying strengths of man made testosterone.
When applied to and rubbed into the skin, the testosterone is passed transdermally through the skin and into the blood stream ( in the same way that creams and patches work).
You doctor will tell you the best pace to apply, but as with creams, it’s usually the upper arms, shoulders and stomach – NEVER the groin area
Some popular brands of Testosterone gels include: Testim, Cernox, HI T ultra and Androgel
Most types of TRT will provide improvements in sex drive, muscle tone and energy
Risks And Side Effects
Despite their benefits, sadly gels, just like other forms of TRT do carry some inherent risks. They have been linked to:
- Muscle Pain
- Dry Skin
- Redness and Soreness at the application site
- Reduced semen production.
More serious health issues such as:
- Breathing problems
- Increased risk of heart problems and strokes
- Possibility developing certain cancers, particularly breast and prostate.
Just as the use of creams and to a lesser degree patches, testosterone gels carry a very real risk of secondary exposure to female partners and young children (detailed further up this article).
The results can be very detrimental to their health and development.
ALWAYS keep hands clean and cover the application area at all times.
Lawsuits involving TRT
In the US there have been a large number of lawsuits brought to the courts by men who ( they claim) have suffered heart attacks after using testosterone gels and other forms of TRT.
They have claimed that the manufacturers of these products knew about the health risks and failed to advise both the prescribing doctors and the public about them.
The governing body – the FDA are monitoring these cases, and may, depending on the outcome, restrict or even ban the use of these products.
UPDATE – The lawsuits involving one gel manufacturer (Testim) have settled all of their claims Read More Here
Are Testosterone Gels Safe To Use
The fact is that they do have their benefits (just like all forms of Testosterone Replacement Therapy).
But with the inherent risks linked to testosterone gels, its difficult to recommend their use until the full results of the lawsuits and subsequent investigations are completed.
If you do decide to use them, ensure that it’s strictly under medical supervision.
#5. Testosterone Pellets
Testosterone pellets are generally the least used and most invasive form of TRT.
They are small cylindrical hard pills that are impregnated with various doses of slow release synthetic testosterone.
During a surgical procedure, pellets are placed under the skin where they break down over a preset amount of time, releasing testosterone into the blood stream.
The procedure is relatively simple.
Under a local anaesthetic a small incision is made, then using a special device called a Trocar, the pellets (up to 10) are placed under the skin.
Most commonly they are placed in the hip or thigh area.
Most pellets last from between 3 and 6 months depending on dosage.
Risks and Benefits
They offer the same benefits as other forms of TRT in that they can enhance energy levels, muscle tone and libido.
They also do not carry the same risk of secondary exposure to women and children.
The recipient does not have to remember to take pills or apply gel or cream, each day.
If however, something goes wrong, or the dosage needs altering the pellets need to be surgically removed.
Naturally any surgical procedure, however minor carries some risks of infection and rejection.
In fact it is revealed that around 9% of men reject the implants, their bodies forcing the pellets back out of the skin
Just as with all other forms of Testosterone Replacement Therapy, Testosterone pellets carry the same very real health risks.
Also because of the need for more surgery to remove them, they are not as simple to just stop using if you suffer any health problems or reactions.
For this reason, most doctors avoid the use of implanted pellets, certainly at first.
Not the most popular form of Testosterone Replacement Therapy.
Testosterone pills are drug based products containing man made synthetic testosterone.
The dosage will be dependant on the severity of the testosterone shortfall.
Testosterone pills are usually taken twice or three times a day.
Usually first thing in the morning and spread throughout the day.
Benefits and Risks
Testosterone pills can deliver the same benefits and other forms of Testosterone Replacement Therapy.
Improvements in energy, better muscle tone and strength along with an invigorated sex drive can all be enjoyed.
However, they are also prone to the same side effects and health risks linked to all other forms of Testosterone Replacement Therapy
One good point is however that they do not carry any risks of secondary exposure.
Care must be taken though to ensure that the pills are kept locked away from young children.
If swallowed accidently the results could be seriously detrimental to their growth and development.
#7. Natural Testosterone Boosters
With the very real risks to life and limb associated with drug based testosterone treatments more and more men are turning to natural supplements to boost their flagging testosterone levels.
Unlike these drug based forms of Testosterone Replacement Therapy, a good natural T-boosting supplement is different.
It contains clinically proven natural ingredients that instead of forcing a foreign, man made hormone into the body.
These work to trigger and promote the increase production of your bodies own natural hormone.
As the increased testosterone is your own genetic hormone, it will not cause your body to react in a bad way, they do not cause any adverse side effects.
Instead it will naturally help increase the levels in the blood, bringing with it all the benefits associated with optimum testosterone levels.
Natural Ingredients To Look Out For:
There are many different ingredients out there. There are however very few that have been clinically proven to increase testosterone production.
These are as follows:
- D-Aspartic Acid
- Vitamin D3
- Vitamin B6
These offer a range of benefits to the body.
Some directly trigger the natural release of more testosterone, while others help reduce the effect of aromatase.
This is a hormonal process where testosterone is turned into the female hormone estrogen.
This frees up more testosterone in the blood where it can get to work, enhancing muscle mass, boosting energy and improving both erections and sexual performance.
MEET THE AUTHOR – My name is Paul Gardner and I am the guy behind testocentral.com
I am 60, and come from Strathpine just outside Brisbane. I live with my wife Donna. I also have a 35 year old daughter who is married.
I have always been into sports in big way, I used to swim competitively in my youth, and have always loved anything to do with the water. In addition, I play tennis, cycle and spend many hours in the gym each week.
I have a CPD accreditation in Sports Nutrition and am a published author. Over the past 12 years I have had many articles featured in media publications. I have a deep interest in androgen hormones and the roles they play in our body.