One issue is cost. Compounding pharmacies can supply a T-gel for less cost. So your insurance is a factor in cost concerns. I am not happy with the attitude that cost does not matter because the insurance company pays for things. Eventually all of these costs find there way back to increased costs to everyone via increased co-pays, increased premium and increased deductibles.
About only 10% of the T is absorbed. That explains the above.
Drug companies really go after an opportunity to create a costly alternative delivery system, to milk the system. Docs don't care, unless they are HMO corporate puppies.
Some absorb OK.
Some absorb OK then after a few weeks become non-absorbers.
Some never absorb.
Those who have low thyroid levels are classic for not been able to absorb. Thus that problem is a symptom of hypothyroidism.
For non aborbers, their E2 can climb and T levels drop. That makes them feel worse.
Transdermals also create more DHT and that is good for libido. If one absorbs T-gels OK, that probably provides the best libido result. Unfortunately the highest acne and hair loss for those who are so disposed.
These gels are 1% and have to be applied in large amount, covering large amounts of skin, exposing the T to the aromatase in that larger area of skin. T-gels create the largest amounts of E2 from T-->E2 aromatization. A compounded cream is 5, 10, 15 % T, applied to smaller amounts of skin, leading to lower E2 levels. As far as transdermals are concerned, compounded T creams are the least cost option.
Injected T is the least cost option. There are many factors to be aware of, that is why there is a protocol for injections sticky.
Some do well with T-gels. I have a bit of attitude about T delivery systems that are relatively wasteful or expensive. Most of the veterans here are well aware of that. As an engineer, I can't be any other way.
In any case, for most, they will need anastrozole to get the best response from there TRT. E2 management is mission critical to obtain optimal E2 levels. That goes for any T delivery system. And any effective TRT will shutdown the HPTA and then one needs hCG if fertility or physical preservation of the testes is desired.
So that is T+hCG+AI and one really needs to understand all of the related issues.... because... drum roll... it is very very rare for a doctor to have any idea. This site is really all about education and empowering guys by getting them to know more about these things than the medical system. So there is work here for you to do, don't look for easy answers, study.