Testosterone replacement therapy is the standard approach to treat low testosterone that’s due to medical reasons, not typical aging. It comes in a variety of forms, some which may work better for your lifestyle than others.
Testosterone Skin Gels
You apply testosterone gel (AndroGel, Fortesta, Testim) directly to your skin at the same time daily. Clean and dry the skin before applying the gel, and let the area air-dry after use. Then cover it with clothing to make sure that no one else comes into contact with the medication, including pets.
It’s important to avoid other people having skin contact with this medication because of the risk of side effects. For example, people who are pregnant or trying to become pregnant are at risk of birth defects from this medication. If others do come in contact with your medication, have them wash the area with soap and water as soon as possible.
Testosterone Skin Patches
Testosterone skin patches (Androderm, Testoderm) deliver testosterone through the skin. You apply these once daily, at the same time each evening, to the abdomen, back, upper arms, or thighs. Avoid putting a patch in the same place more than once in seven days. These stay attached during showering, sex, and swimming, but sweating too much and intense exercise may cause the patch to come loose or fall off.
Testosterone Injections
Testosterone comes in an injectable form, but you may need to go to a clinic for injections (Andro LA, Aveed, Delatestryl) into your muscle every week or every two weeks. Some testosterone injections are available to self-inject under the skin. Long-acting injections, which last for 10 weeks, are also available.
Testosterone Buccal Systems
Testosterone buccal systems (Striant) are tablet-shaped patches that you apply to the upper gum (just above the left and right incisors) every 12 hours. They don’t completely dissolve, so you’ll need to remove buccal systems when you replace them. You can do normal things like eating, drinking, chewing gum, and brushing your teeth, but the buccal system can fall out, so be sure to check after finishing these activities.
Buccal systems may irritate the gums, leave a bitter taste in your mouth, and make food difficult to taste.
Testosterone Pellets
Testosterone pellets (Testopel) are a newer form of treatment. A medical professional inserts the pellets under the skin every three to six months to provide ongoing, consistent doses of testosterone.
Oral Testosterone
A pill called oral testosterone undecanoate (Andriol, Jatenzo, Tlando) can help restore testosterone levels for people with specific health problems, such as pituitary damage due to tumors and Klinefelter syndrome. You might need to take this medication with food, as fats are sometimes necessary for the bloodstream to absorb the testosterone.
Liver damage is a possible risk of taking testosterone pills.
Testosterone Nasal Gel
Testosterone nasal gel (Natesto) is a gel you put up your nose to supplement testosterone. Be sure to blow your nose before using the gel and wash your hands afterward. Side effects may include a runny, stuffy nose and nosebleeds.
Dehydroepiandrosterone Supplements
Dehydroepiandrosterone (DHEA) is a building block of testosterone. Your body already makes DHEA, but a lab-made version is available as an over-the-counter capsule, tablet, gel, powder, and topical cream.
Some people try these supplements to improve testosterone levels or reduce symptoms like erectile dysfunction, but the U.S. Food and Drug Administration (FDA) doesn’t regulate DHEA supplements in the same way it does medications. The Mayo Clinic suggests avoiding them, finding the quality of most DHEA supplements to be low.
DHEA may also have several side effects, including increasing the risk of hormone-sensitive cancers like prostate, ovarian, and breast cancers. It may make psychiatric disorders worse and cause acne, oily skin, or male-pattern hair growth in women. It may also interact with testosterone if you’re taking other testosterone treatments.
Medication Side Effects, Safety, and Precautions
As of 2018, the FDA advised that using TRT to manage low testosterone due to aging is unsafe, with links to a possible risk of stroke or heart attack.
However, your doctor may still prescribe TRT for off-label use. Several newer studies suggest that TRT is safe and helpful for many men older than 65 who have low testosterone.
Before you start TRT, your doctor will do several blood tests to check for potential low T causes to help avoid risks. While you are receiving TRT, you will get follow-up blood tests for the doctor to monitor you.
Side effects of TRT are similar regardless of which form you use. These are some of the possibilities:
- Acne
- Altered performance or drive during sex
- Irritated skin at the site of application
- Unexpected breast tissue growth
More serious side effects are sometimes possible. Immediately tell a doctor if you notice these signs:
- Blood clot
- Heart attack
- Liver injury
- Stroke
- Increased blood pressure
- Sleep apnea
- Limb swelling
- Allergic reactions
- Extreme mood changes
- Constant, painful erection
Let a doctor know if you have certain medical conditions, like cancer, diabetes, or diseases of the heart, kidney, liver, lungs, or prostate, as well as any allergies, or if a partner is currently pregnant or trying to conceive, as this medication can cause complications with a pregnancy.
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