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.