Testosterone replacement therapy is an effective treatment if you're suffering from the uncomfortable health effects of low or imbalanced hormones. This therapy is available as an oral medication, intramuscular injection, or a subcutaneous implantation. One study compares all three options to determine which is the most effective and affordable option for patients who are suffering from low testosterone levels. The results can help inform your own choices for future therapies.

What is testosterone replacement therapy?

Testosterone replacement therapy helps increase testosterone levels for individuals who have low levels of this key hormone. Testosterone is the primary sex hormone found in men. It controls fat absorption, sexual function, muscle mass, and bone density. Men should have 10 to 35 nanomoles per liter (nmol/L) of testosterone. Individuals with low testosterone levels may experience:

  • Fatigue.
  • Difficulty sleeping.
  • Sexual dysfunction.
  • Trouble concentrating.
  • Difficulty with memory.
  • Irritability, anxiety, and depression.
  • Reduced muscle mass and bone density.

If you're suffering from low testosterone levels, there are several therapies you can try to remedy the situation.

Intramuscular injection

Testosterone injections are one of the most common choices for testosterone therapy. While some treatments are available as at-home injections, all forms of testosterone injections should ultimately be supervised by a healthcare provider to make sure you have the appropriate dosage and formula for your needs.

How testosterone injections work

Injectable testosterone is designed to last for several days. There are three primary types of testosterone ester that patients use. Testosterone cypionate and testosterone enanthate are common options that are injected into the muscle every two to four weeks at a dose between 50 mg and 400 mg. Testosterone undecanoate (TU) is usually given at a dose of 750 mg every 10 weeks. Many patients receive a compounded testosterone product, which is a custom formula using two or more forms of testosterone to meet the patient's exact needs.

Common side effects from testosterone injections include headaches and worsening of an enlarged prostate. Patients may also experience bruising, redness, or pain at the injection site.

Results from intramuscular injections

Nine hypogonadal males received intramuscular injections of 250 mg of mixed testosterone esters every three weeks. In these patients, testosterone levels peaked 24 to 48 hours after the injection. Serum estradiol levels also peaked at this time. After this point, testosterone levels decayed exponentially until they returned to the patient's baseline levels two to three weeks after the initial therapy. Though these patients reached a mean peak level of 71 nmol/1, the overall mean T level for these patients was 27-7 nmol/1.

Subcutaneous implantation

Subcutaneous implantation refers to the placement of small testosterone pellets underneath the skin. Testosterone pellets were approved by the FDA for certain uses in 1972, but this form of therapy wasn't marketed until 2008. Testosterone pellets are one of the most convenient options for testosterone therapy.

How subcutaneous implantation works

If you're looking for a low-maintenance form of testosterone therapy, subcutaneous implantation is the best option. These small pellets contain bioidentical hormones derived from plants. These hormones act just like those the body naturally produces. The testosterone pellets are about the same size as a grain of rice. A healthcare provider inserts several of these pellets in a small incision made in your upper hip. The body metabolizes the testosterone in the pellets slowly, delivering a steady supply of the hormone over several months.

You should avoid swimming or bathing for about five days after the initial pellet insertion. Results are often apparent in as little as 24 to 48 hours. In men, testosterone pellets can last for as long as five months.

Results from subcutaneous implantation

Six hypogonadal males received implantation of six 100 mg pellets of fused testosterone. This created a gradual increase in testosterone levels followed by a slow decline. Patients experienced normal testosterone levels for four to five months. Over the course of 21 weeks, these patients had a mean testosterone level of 170 nmol/1. Serum estradiol levels stayed within the normal range throughout the study.

Oral administration

Oral therapies seem the most familiar to patients because most people have taken pills at some point to treat various health conditions. Testosterone therapy is available orally, but this isn't always the best option.

How oral testosterone therapy works

Oral testosterone therapy is usually administered at least once a day. You can easily take these capsules yourself, which makes them convenient. However, you may struggle with adherence to oral medications as it's easy to forget these medications in one's busy lifestyle.

Results from oral testosterone therapy

Six hypogonadal males received 80 mg of oral TU twice daily for eight weeks. Their testosterone levels were tested at initiation, after four weeks, and after eight weeks of therapy.

With oral administration, testosterone levels showed significant variability. Not only did the test subjects have markedly different readings, but the readings also varied for each individual on different testing occasions. This is likely due to the varying absorption levels of the TU when formulated in oleic acid. The mean testosterone level across the test subjects was 120 nmol/1. Throughout the study, the patient's serum estradiol levels remained in the normal range for men.

Study conclusions

In the study cited above, the costs were comparable for subcutaneous implantation every five months and intramuscular injection every three weeks. However, oral TU taken twice daily was seven to eight times more expensive than either of these alternatives. The study concluded that oral testosterone is best reserved for the initial phases of therapy, while testosterone implantation is the best overall choice for ongoing treatments.

Personalized testosterone therapy solutions

If you're suffering from low testosterone levels, pursuing one of the therapies mentioned above can make a dramatic difference in your life. In a short amount of time, you can enjoy increased muscle mass, lowered body fat, greater energy levels, and an enhanced mood. Our team at the biostation can help assess your testosterone levels and design a custom program that's suited to your needs.