How Is Hypogonadism Treated?
If a man has been diagnosed with androgen deficiency, he may be a candidate for testosterone therapy (TT). It should be a therapeutic goal to raise his T levels to the low to mid range of the reference range (240-950 ng/dl)[i]. Pharmaceutical companies have developed and commercialized several types of TT for low T. Following is a list of some of the most prevalent types of TT products in the U.S.:
Intramuscular Injection: Until recently, injection therapy was one of the most frequently used treatment methods. Injections, usually self-administered, are taken at periodic intervals of typically two weeks or more. Available products include:
- DEPO-Testosterone, which is manufactured by Pfizer; and
- Delatestryl, which is manufactured by Endo Pharmaceuticals.
Transdermal/Topical: Transdermal testosterone delivery includes daily gel applications and patches. These products are far and away the most prescribed products. They include:
- Forestra, which is manufactured by Endo Pharmaceuticals. Forestra is a gel that is applied once daily to the thighs in the morning.
- AndroGel, is currently promoted by AbbVie, formerly part of Abbott Labs, and Actavis AndroGel is applied once daily in the mornings to the shoulders and upper arms.
- Androderm, is manufactured by Actavis, formerly Watson Pharm. Androderm is applied a patch product that is applied daily to the back, abdomen, upper arms, or thighs.
- Axiron, is manufactured by Lilly. It is a topical solution that is applied once daily, generally in the morning, to the underarms.
- Testrim, is manufactured by Auxilium Pharmaceuticals. It is a gel that is applied once daily to the shoulders and upper arms.
Buccal: Buccal formulations of testosterone involve placing a product with a bioadhesive onto the gums where it delivers an extended dose of testosterone through the gums and cheeks. Available products include:
- Striant. Striant is currently marketed by Auxilium in the U.S. It is applied to the upper gum twice daily, approximately 12 hours apart.
Subdermal Implant: Subdermal testosterone implants are surgically implanted underneath the skin. They deliver prolonged, steady-doses of testosterone. Products include:
- Testopel. Testopel is manufactured by Auxilium. Is placed underneath the skin where it delivers 3-6 months of testosterone.
[i] J Clin Endocrinol Metab. 2007;92:3844–3853, “Androgen receptor gene CAG repeat length and body mass index modulate the safety of long-term intramuscular testosterone undecanoate therapy in hypogonadal men.”