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Comparing Testosterone Delivery Methods: Creams vs. Injections for Men undergoing Testosterone Replacement Therapy

Testosterone, the primary male sex hormone, plays a crucial role in several different bodily functions, including lean muscle growth and increased strength, bone density, libido, and mood regulation. Testosterone replacement therapy (TRT) is a common approach to address low testosterone levels in men, which can lead to several unwanted symptoms like fatigue, decreased sex drive, and loss of lean muscle mass.

Among the options for TRT, testosterone creams and injectable testosterone are two of the more popular methods of administration for patients to take. This post will talk about the differences between testosterone creams and injectable testosterone, exploring their mechanisms of action, effectiveness, convenience, side effects, and considerations for choosing one over the other for men on hormone replacement therapy.

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Mechanism of Action

Testosterone creams, also known as transdermal testosterone, deliver testosterone through the skin. They typically come in gel form and are applied daily to specific areas of the body, such as the shoulders, upper arms, or abdomen. Once applied, the testosterone is absorbed through the skin into the bloodstream, where it exerts its effects throughout the body.

Androgel is a popular brand name testosterone gel and is a prescription medication used to treat low testosterone levels in men. It comes in the form of a gel that is applied to the skin, typically on the shoulders, upper arms, or abdomen. The active ingredient in Androgel is 1.62% testosterone, which is absorbed through the skin into the bloodstream. It's often prescribed when the body doesn't produce enough testosterone naturally, a condition known as hypogonadism. Androgel helps restore testosterone levels, which can improve symptoms such as low libido, fatigue, depression, and decreased muscle mass. It's important to use Androgel exactly as prescribed by a healthcare professional and to follow all instructions for application and dosage. Gels/creams from compounding pharmacies can have significantly higher doses of testosterone and be adjusted as needed.

On the other hand, injectable testosterone involves administering testosterone directly into the muscle tissue usually once or twice weekly. This method bypasses the skin barrier, allowing for rapid absorption and distribution throughout the body. Injectable testosterone comes in various ester forms, such as testosterone enanthate and testosterone cypionate, which dictate the release rate and duration of action.

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Typically, patients use 23-25g, one-inch-long needles to administer, however this is a patient preference and can be adjusted to meet the specific needs of each individual. Compounding pharmacies can create various formulations of injectable testosterone for patients based on their specific needs. Some common types of injectable testosterone formulations made in compounding pharmacies include:

Testosterone Cypionate This is a long-acting ester of testosterone that is typically injected intramuscularly. It is often prescribed in cases of testosterone replacement therapy (TRT) and is usually administered every one to two weeks.

Testosterone Enanthate Similar to testosterone cypionate, testosterone enanthate is a long-acting ester of testosterone that is injected into the muscle. It has a similar dosing schedule to testosterone cypionate and is commonly used for TRT.

Testosterone Propionate Unlike testosterone cypionate and enanthate, testosterone propionate is a short-acting ester of testosterone. It requires more frequent injections, often every other day or every third day. It may be preferred by some individuals who want more control over their testosterone levels or who experience fewer side effects with shorter-acting formulations.

Testosterone Suspension Testosterone suspension is a water-based testosterone formulation that is fast-acting and short-lived. It requires frequent injections, often daily or every other day. It may be preferred by athletes or bodybuilders looking for a rapid increase in testosterone levels before competitions.

Testosterone Mixtures Compounding pharmacies can also create custom mixtures of different testosterone esters to meet the specific needs of patients. For example, a mixture of short-acting and long-acting esters may provide a more stable release of testosterone over time.

It's important to note that while compounding pharmacies can create these custom formulations, they should only do so under the supervision and prescription of a healthcare provider. Additionally, the use of compounded medications should be carefully monitored to ensure safety and efficacy.

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Effectiveness of testosterone creams vs injectables

Both testosterone creams and injectable testosterone are effective in raising testosterone levels in men with hypogonadism or other conditions responsible for causing low testosterone. Studies have shown that both methods can improve symptoms such as low libido, fatigue, and decreased muscle mass. However, the effectiveness of each method may vary depending on individual factors such as absorption rates, metabolism, genetics, lifestyle factors and adherence to treatment protocols and physician instructions.

Injectable testosterone often leads to more consistent and predictable increases in testosterone levels compared to testosterone creams. Since it bypasses the skin barrier and directly enters the bloodstream, injectable testosterone can achieve higher peak concentrations of testosterone, resulting in more immediate effects.

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Convenience

One of the primary advantages of testosterone creams is their ease of use and convenience. They can be applied at home without the need for medical supervision or special equipment, travels easily and is a good choice forpatients who are terrified of self-injection. Additionally, testosterone creams allow for flexible dosing, as they can be easily adjusted by applying more or less gel as needed.

On the other hand, injectable testosterone, such as testosterone cypionate, enanthate or propionate requireadministration via injection, which may be a deterrent for some individuals. However, the advantage is that injectable testosterone typically requires less frequent dosing compared to testosterone creams. Depending on the ester form used, injectable testosterone may be administered weekly, bi-weekly, or even monthly, reducing the frequency of injections. Also, most patients are pleasantly surprised at how painless the injections are when a smaller needle like a 25 or 27 gauge needle is used.

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Side Effects

Both testosterone creams and injectable testosterone can cause side effects, although the type and severity may vary between the two methods. Common side effects of testosterone therapy may include acne, increased red blood cell production (hematocrit), fluid retention and changes in mood or libido. In most cases, testosterone therapy’s risks may be mitigated with the guidance of an experienced physician who can change the protocol and offer solutions to reduce the risks associated with HRT.

Testosterone creams may carry a higher risk of skin irritation or allergic reactions due to their transdermal delivery method. Users may experience redness, itching, or irritation at the

application site. In contrast, injectable testosterone may pose a risk of injection site reactions, such as pain, swelling, or infection. When done carefully these risks are usually quite rare.

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Considerations for Choosing

When considering testosterone replacement therapy, individuals should weigh the advantages and disadvantages of testosterone creams versus injectable testosterone based on their personal preferences, lifestyle, and medical needs. Testosterone creams may be preferred by those who prioritizeconvenience and prefer a non-invasive method of administration. However, individuals who require more precise control over testosterone levels or prefer less frequent dosing may opt for injections.

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