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What are the different ways to treat Low T?

Health, Wellness & You
Wednesday, November 20, 2013

By Christopher Manakas, MD

You’re not feeling yourself: low energy, low sex drive, can’t get an erection when you want to, it takes a week to recover from a 20 minute jog.  If this sounds like you, you may want to consider having your doctor check an early morning testosterone (or two).  If you come to the conclusion that your testosterone is low, now what?  How does your testosterone get back to normal?  Where is this magic pill?

It turns out that there used to be a pill used pretty frequently, but it turned out not to be so magic.  Testosterone oral therapy was used for a while but it turned out to be bad news for your liver and this is no longer recommended. 

The big problem with testosterone as a pill is that your liver has to work pretty hard while converting the testosterone to something your body can use.  All of the other therapies available  are designed to bypass that “first pass” metabolism of the liver:  the patch, pellets, gels, creams,  injections and even nasal sprays.

So here we go with a little pros and cons list of each delivery system for testosterone replacement therapy:

The Gels/Creams: AndroGel, Testim, Axiron, Fortesta

Pros:  Achieve a steady-state concentration, avoiding the peaks and valleys of some of the other therapies.  No needles.

Cons: Cost, up to $400/month if you have to pay cash.  Compliance:  you need to apply every day, otherwise you are wasting your money.  Transfer issues:  wet gel can transfer from one person to another.  Dangerous if you have women of child-bearing age or young children around.  Some people have difficulties absorbing one brand or another. 

The Patch

Pros: Apply once a day.  No transfer issues of the gels.  Less expensive than the gels, covered by more insurance companies.

Cons: A large percentage of men have problems with local skin irritation at the patch site. 

Intramuscular injections

Pros: Affordable, by far the most cost-effective way to replace testosterone.  Consistent delivery, no questions about “is it getting absorbed?”.  Can learn how to do injections at home every 3-7 days, just like Barry Bonds. 

Cons:  Needles.  A little Peak/valley phenomenon between doses. 


Pros:  Have a slow-release implant placed once every 4-6 months as part of in-office procedure.  

Cons:  Insurance coverage is an issue. 

So there you have it.  No magic pill but still plenty of options.  Decisions are often significantly affected by your own insurance plan and what is the preferred testosterone replacement on the formulary.  Make sure you know this before meeting with your physician.

Fort HealthCare Urology Associates