What's The Best Testosterone To Take for TRT?

What is Testosterone Cypionate?

Testosterone cypionate is a synthetic form of the naturally occurring male sex hormone testosterone. It’s chemically identical to the testosterone naturally produced by the body, so its use is generally referred to as bio-identical. Bioidentical hormone replacement therapy (BHRT) involves the use of hormones that are chemically identical to those produced by the human body.

These hormones are derived from natural sources, such as plants, and are designed to replicate the molecular structure of hormones like estrogen, progesterone, and testosterone. When synthesized in a lab, bioidentical testosterone is usually made from plants like yams or soy. Testosterone cypionate is a commonly prescribed form of bio-identical testosterone and is often used to treat conditions associated with low testosterone levels in men, such as hypogonadism.

This medication is administered through intramuscular injections and helps to supplement testosterone levels in the body and bring them in to more optimized ranges for men on TRT.

What is Bioidentical hormone replacement therapy (BHRT)?

The main idea behind BHRT is to provide a more personalized approach to HRT (hormone replacement therapy), tailoring an individual's specific treatment to their unique hormonal needs. Proponents will argue that bioidentical hormones may offer advantages over synthetic hormones in terms of mimicking the body's natural hormones more closely and thus offer fewer potential side effects and risks.

It's important to note that while BHRT is a term often associated with natural hormones, the safety and efficacy of these treatments can vary. As with any hormone replacement therapy, it should be prescribed and monitored by qualified healthcare providers based on an individual's specific health needs and circumstances.

Typically, endocrinologists, urologists, OBGYN’s and Physicians who specialize in the field of hormone replacement therapy can offer the best guidance and can help you test for Low T. A consultation and review of bloodwork tests needed for TRT, signs/symptoms and past medial history will help determine the medical needs for each patient.

What is testosterone enanthate?

Testosterone enanthate is another synthetic form of the male sex hormone testosterone. Just like testosterone cypionate, it is considered bio-identical and is often used to treat conditions caused by low testosterone levels. Testosterone enanthate is also administered through intramuscular injections and has a similar purpose of supplementing testosterone levels in the body to address symptoms of low testosterone.

What is the difference between Testosterone cypionate and Testosterone enanthate?

The main difference between testosterone cypionate and testosterone enanthate lies in their chemical structures and the duration of action in the body. Both are synthetic forms of bio-identical testosterone and are administered through intramuscular injections, but they have distinct esters attached making the frequency of injection slightly different. In testosterone medications like cypionate and enanthate, the ester refers to a chemical compound attached to the testosterone molecule. These esters affect the release rate and duration of activity in the body. For testosterone cypionate, the ester attached is the cypionate ester, while for testosterone enanthate, it's the enanthate ester. These esters impact the absorption rate, metabolism, and duration of action of the testosterone in the body after administration. One patient may need to inject testosterone once as week while a different patients protocol may require 2 injections per week. This will be determined by the type of testosterone and medical needs/tolerance of the specific patient.

The esters in testosterone medications, like cypionate and enanthate, are usually dissolved in specific oils, (called carrier oils) for intramuscular injections. Commonly used oils often include:

1. Cottonseed Oil: This is a popular carrier oil due to its stability and low potential for allergic reactions.

2. Sesame Oil: Another popular option for a carrier oil, it is well-tolerated by patients and is stable.

3. Grapeseed Oil: Grapeseed oil is also used as a carrier due to its light texture and is well tolerated by patients.

4. Olive Oil: While much less common, olive oil has been used as a carrier oil in some formulations but is not typically used by most pharmacies.

The choice of carrier oil often depends on various factors such as the stability of the oil, its compatibility, and the potential allergic reaction of the patient to the product. It's also determined by the pharmaceutical formulation of the testosterone product in regards to the ester and total milligrams of testosterone. Some pharmacies may even include other medications such as an AI like anastrozole with the testosterone however this complicates the physician’s job when trying to make adjustments to a patient’s protocol. It becomes difficult to adjust one medication without impacting the adjustment of the other, eliminating any independent control over the medication when combined.

Testosterone cypionate has a longer half-life than enanthate, meaning it stays active in the body for a slightly longer time. This may affect the dosing schedule and the frequency of injections. Some individuals may respond differently to each form, and the choice between them often depends on the prescribing healthcare professional's preference and the patient's specific needs and preference. The goal is to provide a stable level of hormones in the body and to keep the patient within a stable range between highs and lows. Taking testosterone cypionate injections once every 2 weeks will cause a very large gap between the peak (highs) and troughs (lows) due to its half-life. A smaller dose more frequently will provide a lower peak level but eliminates a lower trough that comes after the medication is metabolized in the body.  Having a provider who understands this is vital in providing the best patient care possible.  

Testosterone propionate and Testosterone undecanoate are also different forms of testosterone but have much different half-lives and are less frequently prescribed. Some patients may prefer the outcomes on one medication over the other so personal tolerance and preference play an important factor when determining with your physician the best protocol.

Half-Life of Testosterone Ester Injections

*The total milligrams of testosterone injected may impact the duration the medication stays in the body

How do pharmacies make testosterone?

Compounding pharmacies prepare testosterone formulations based on specific prescriptions from doctors and providers who may send the Rx to a trusted pharmacy. The process involves several steps in preparing a prescription of testosterone:

1. Receiving the Prescription: The compounding pharmacy receives a prescription either directly from a physician or licensed healthcare provider or is brought the prescription from a patient who obtained it from their doctor. It will specify the type of testosterone, dosage, and any additional instructions such as frequency of use and if there are any refills allowed. Needles and syringes will also be prescribed and filled by the pharmacy depending on local/state laws.

2. Selecting Ingredients: The compounding pharmacist will choose the appropriate testosterone ester (e.g., cypionate or enanthate) and a preferred carrier oil. Sometimes a patient may specifically request one oil over the other. The selection will depend on the patient's needs and any potential allergies and preferences from past experiences.

3. Weighing and Mixing: The pharmacist will use digital scales and equipment to carefully measure the precise amounts of testosterone and chosen carrier oil. They will then mix these ingredients to create a homogeneous solution in a sterile work environment often using chemical hoods, filtration systems, vents and suits and masks to ensure sterile, safe products.

4. Sterilization: The compounded solutions are typically sterilized to ensure it is free from contaminants and is sent to be independently tested for both sterility and potency before being shipped to patients. These steps are crucial to maintain the safety of the product and ensure efficacy.

5. Quality Control: The compounded testosterone undergoes quality control measures to verify the accuracy of the formulation and ensure it meets established standards and complies with all regulations. Pharmacies can provide certificates of sterility and quality upon request. Every lot produced will be labeled and put into a data base to ensure that it can be linked to these tests as well as provide proof that a specific bottle was sent to an established patient.
6. Packaging: Once the formulation passes quality control and is given approval, it’s packaged into the appropriate containers, often vials, and labeled with relevant information, including dosage instructions, patient’s name and date of birth, physician name and phone number and specialized instructions.

Compounding pharmacies adhere to strict quality and safety standards to produce customized medications that are tailored to an individual patients needs. It's extremely important to note that compounded medications are typically prescribed when commercially available formulations are not suitable for a patient's specific requirements and offer safe and convenient options for people to receive appropriate medical care otherwise not available to them.