Testosterone Therapy: Review of Clinical Applications

Testosterone Deficiency, Erectile Dysfunction, and Testosterone Replacement Therapy

Suppressing your emotions can interfere with normal functions, such as focusing at work or maintaining an erection. If you truly have low-T, underlying stressors can make symptoms worse. If you stop TRT, the symptoms of low T usually come back, so you may have to stay on the drug for life – unless you decide you don’t want to be treated anymore. Apply this patch by pushing it against your gums and to the left or right of your front teeth. Keep it in place by pushing on it from the outside of your mouth as well. The patch continuously releases testosterone into the blood through the oral tissues.

We can also send your injections for testosterone optimization, as well as additional supplements and prescriptions, through the mail. When administering your intramuscular injections yourself, it’s important to ensure that you’re doing so directly into your gluteal area, shoulder, or thigh. After IM or SC administration of a testosterone ester, absorption occurs first by diffusion from the depot into the interstitium (Fig. 2B). The physiology of the IM and SC milieu determines the patterns of absorption after administration.

This medicine may increase your risk of having heart or blood vessel problems, including a heart attack or stroke. Tell your doctor right away if you have chest pain that may spread to your arms, jaw, back, or neck, faintness, headache, nausea, vomiting, trouble breathing, trouble seeing or speaking, or unusual sweating. Testosterone treatment is not advised for men with prostate or breast cancer. Additionally, testosterone therapy may worsen sleep apnea in older people.

A normal range of testosterone for men is anywhere from 300 to 1,000 nanograms per deciliter (ng/dL). Others may not have symptoms until their level is at 150 or even 100. If you have symptoms of low testosterone and tests show you have an abnormally low testosterone level (below 300 nanograms per deciliter), your doctor may suggest treatment. If you have low testosterone levels but no symptoms, low testosterone treatment isn’t recommended. does testosterone increase hair growth levels are highest in men around age 17 and drop as they age, starting between ages 30 and 40. The drop is very gradual (about 1% per year) but increases as you get older. By age 70, the average man’s testosterone is 30% below its peak, but it’s usually still within the normal range.

At Yale Medicine Urology, we try to personalize care to specific needs of the patient. The downsides of IM shots include that absorption of the testosterone is determined by the bulk of your muscle and its vascularity. IM injections can be slightly more painful overall than SubQ, with more bruising.

And all the other benefits that come with raising your testosterone safely. You can connect multiple needles to a syringe, depending on the action required. Needle diameter is measured by gauge numbers, which indicates the bore of a needle’s lumen (a fancy word for the hole at the tip of the needle). The higher the gauge number, the smaller or thinner the hole; the lower the gauge number, the bigger or thicker the hole. Higher gauge needles can reduce pain when injecting, but larger needles are required for injecting larger volumes of oil-based substances (like testosterone) into the muscle. Reusing needles is problematic because they are unsanitary but also because after the first use, the needle is blunted immediately, meaning the next time you use it will be more painful. Always keep a fresh supply of new needles in your home and use one for each injection.

Once a patient qualifies for testosterone therapy (1, 2), risks and benefits of therapy as well as pros and cons of each formulation should be discussed (see Table 1). Patients should be informed that currently, data and experience with SC testosterone therapy both are limited. This discussion should also include cost considerations because the SC autoinjector is more expensive compared to conventional SC injections with testosterone esters. Clinicians should continue to assess testosterone levels periodically. Additionally, though data on this ultralong-acting formulation are available with the 1000-mg dose regimen (26), studies with the 750-mg dose (the approved dose in the United States) are also needed.

It is important to find a doctor who understands and is familiar with multiple options for the delivery of testosterone to patients who would benefit from this therapy. Call your doctor for instructions if you miss an appointment for your testosterone injection. Do not use testosterone if you are pregnant or may become pregnant. Tell your doctor right away if you become pregnant during treatment. Use effective birth control while you are receiving this medicine.

SC testosterone undecanoate also appears feasible, though available data are limited. Some patients have come to us from low-T clinics with testosterone levels as high as 3,000. That’s unnecessary, and so much chemical modification increases the risk of enlarged prostate or increases the risk of prostate cancer.

The androgenic secondary sexcharacteristics (usually occurring at puberty) include deepening of thevoice and growth of beard and axillary hair. There have been postmarketing reports of venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), in patients using testosterone products, such as testosterone cypionate. Evaluate patients who report symptoms of pain, edema, warmth and erythema in the lower extremity for DVT and those who present with acute shortness of breath for PE. If a venous thromboembolic event is suspected, discontinue treatment with testosterone cypionate and initiate appropriate workup and management. Testosterone injections exist in a short-acting and long-acting formulations. Short-acting testosterone injections are given on a weekly or bi-weekly basis and are frequently self-administered in the privacy of one’s home. Testosterone injections are very effective in quickly increasing a man’s testosterone level, however, the testosterone level steadily decreases after the injection is given.