Testosterone Replacement Therapy
Benefits of TRT
Effectively treating hypogonadism can have significantly improve a patient’s sense of wellbeing and quality of life.

TRT can improve: 1, 2-7
- Sexual function
- Sexual desire and performance
- Muscle strength and mass
- Bone density
- Wellbeing and mood
- Erythropoiesis
- Cognition
- Response to PDE5 inhibitors
Lipid abnormalities
- Dose dependent reduction in HDL, LDL and total cholesterol
Glucose metabolism
- Reduction in glucose level and insulin resistance
- Improved insulin sensitivity
- Decreased leptin levels in T2DM and metabolic syndrome
Adiposity
- Reduced body fat mass and waist circumference
- Appropriate fat distribution
- Improved BMI
- Improved lean body mass
Types of TRT
TRT is available in the form of injections, gels, implants, patches, capsules and tablets; all of which differ in terms of pharmacokinetics and adverse events.
Short-acting preparations such as gels are recommended by the EAU over long acting injections when initiating treatment, as therapy can be adjusted or stopped in response to adverse side-effects.3-13
Gels and injections are more commonly used, but ultimately, selection should be based on safety, tolerability, efficacy and patient preference.
TRT formulation comparisons
Advantages of different methods of administration1, 14-19
Gels
Once daily application
No injection
Rapidly absorbed
Provides reservoir for sustained release
Good tolerability
Patches
Easy to apply
Closest approximation to normal circadian levels
injections
Given at 12 weeks intervals
Low cost
Buccal tablets
Twice daily use
Physiological level reached in 4 hours
Steady state reached in 24 hours
Low adverse event frequency
Implants
Long duration of action
Oral Capsules
Easy to use
Avoids fluctations in plasma testosterone levels seen with injections
Disadvantages of different methods of administration1, 14-19
Gels
Transfer risk to partner and children
Absorption problems (10% of men)
Skin irritation (rare)
High dihydrotestosterone (DHT) levels
Patches
Skin irritation
May fall off with sweat
Dosing adjustment is difficult
Injections
Multiple injections
Pain on injection
Fluctuations in plasma testosterone levels
Polycythemia risk
Injection site reactions
Buccal tablets
In mouth for 12 hours
Risk of gum/ mouth irritation
Headaches
Taste perversion
Implants
Minor surgical procedure
Risk of extrusion
Risk of local
infection / scarring
Oral Capsules
Short duration
Several needed per day
Gastro-intestinal complaints
Liver toxicity (some preparations)
More information on diagnosing and treating
hypogonadism can be found in the European Association
of Urology Guidelines on male hypogonadism.