This topic comes up from time to time, so I thought it would be good to discuss the different delivery methods for testosterone. I’ll mainly focus on the most prevalent methods prescribed in the United States.
For those outside of the U.S., if you would like to share your input with the common delivery methods in your country, that would be welcomed. Any who would like to add their experiences and personal pros and cons on the less common delivery methods is welcomed also.
- Testosterone Cypionate: this is the longest acting and most commonly prescribed testosterone ester in the U.S., closely followed by Testosterone Enanthate.
-Pros: Has a long half-life of around 7 days. This allows for individuals to inject 1 or more times per week (2-3 preferable) to maintain adequate T serum levels. Injections are the preferred method, since one does not have to speculate how much testosterone they are receiving (100mg yields around 70mg bio-identical T). Can be injected subcutaneously, alleviating prolonged muscle damage from intramuscular injections. Least costly delivery method. Least amount of aromatase to estradiol.
-Cons: Some have fear of needles. For those that metabolize more quickly, more testosterone is needed to reach high-normal T serum levels. In this case, there is a risk of abscesses when large amounts are injected sub-q. Multiple injection sites are required in this instance. Risk of improper sterilization of vial and injection site.
- Testosterone gel/cream: another commonly prescribed testosterone delivery method. This falls under the transdermal category. These can come from large manufacturers (androgel, axiron, etc), or compounded from compounding pharmacies. Compounded formulas are generally cheaper. Second most preferable delivery method.
-Pros: Ease of use. One only has to apply once daily to achieve stable T serum levels. Testosterone is absorbed through the skin over the course of 2 hours. One can achieve mid to high-normal T serum levels. Can increase DHT levels in some.
-Cons: Needs to be applied daily. Physical contact with loved ones must be avoided in application area. Absorption rates vary (around 10% normally). Those with thyroid disorders may have very low absorption rates. Most cannot reach past 700s for total testosterone. Some gels/creams have been known to aromatase to estradiol excessively; possibly due to application area. Can be expensive if not fully convered by insurance.
- Testosterone Pellets: Marketed under the name “Testopel” in the U.S., tiny pellets that release T are placed under the skin in the hip area. These pellets can last from 3-6 months after insertion.
-Pros: Can maintain steady serum levels for prolonged amounts of time. Ease of use due to only have to have them inserted every 3-6 months. No other maintenance is needed.
-Cons: Expensive, even if covered by insurance. Requires doctors visits for insertion. May not achieve high-normal T levels in first insertion. Possibility of extensive bruising at insertion site. Can be felt for months, and can be painful if insertion site is hit. Some require ‘several’ pellets to achieve high-normal serum levels. Each pellet costs around $75.00.
- Testosterone Patch: Also falls in the transdermal category. Marketed under the name “Androderm” in the U.S., a testosterone patch is applied once daily and left on for 24 hours.
-Pros: Ease of use. Patch need only be applied once per day. Can achieve mid-normal T serum levels. Often covered by insurance for little out of pocket expense. Physical contact does not need to be avoided at application site.
-Cons: One of the less preferable testosterone delivery methods. Patch may not remain secure throughout the day, which means it needs to be re-secured via tape or other means. Patch can “bunch up” at application site, causing annoying discomfort. Difficult to achieve high-normal serum T levels. Skin irritation at application site.
We generally recommend that those on testosterone replacement therapy use testosterone injections due to the pros listed above, however, as I’m sure we all have learned, TRT is not one size fits all. What works for some may not work for others. These are just some of the options available if your current delivery method may not be working so well for you.
The T/hCG/AI combo as described in protocol for T injections still applies, so exchanging T delivery methods still requires hCG and aromatase inhibitor for the best possible TRT experience.