From the Guidelines
Yes, oral testosterone replacement therapy is available, with testosterone undecanoate (brand name Jatenzo) being the most common oral medication, taken twice daily with food, and dosages ranging from 158 mg to 396 mg per dose, adjusted based on blood testosterone levels. To use this effectively:
- Take with a meal containing fat to improve absorption
- Avoid grapefruit juice, which can interact with the medication
- Have regular blood tests to monitor testosterone levels and adjust dosage
- Be aware of potential side effects like acne, enlarged prostate, or sleep apnea Oral testosterone is absorbed through the lymphatic system, bypassing first-pass liver metabolism, making it more effective than older oral formulations while reducing liver strain, as noted in studies such as 1 and 1. However, injections or gels are still more commonly prescribed due to their more consistent absorption and established track record. It's essential to consider the potential risks and benefits, including the FDA's approval of oral testosterone undecanoate for use in the United States, as mentioned in 1 and 1, and the contraindications for men with hypogonadal conditions not associated with structural or genetic etiologies. Always consult with a healthcare provider before starting any hormone replacement therapy to ensure it's appropriate for your specific situation, taking into account the latest evidence and guidelines, such as those discussed in 1 and 1.
From the FDA Drug Label
Testosterone Undecanoate Capsules are used to treat adult men who have low or no testosterone due to certain medical conditions The patient is on oral testosterone replacement therapy with Testosterone Undecanoate Capsules, as indicated by the drug label 2.
- The medication is used to treat low testosterone in adult men due to certain medical conditions.
- The patient should take the capsules with food as instructed by their healthcare provider.
From the Research
Testosterone Replacement Therapy
- Testosterone replacement therapy (TRT) is used to treat testosterone deficiency syndrome (TDS) in men, with the goal of establishing a physiological concentration of serum testosterone to correct androgen deficiency and relieve symptoms 3.
- Various forms of TRT are available, including oral, transdermal, injectable, and implantable formulations, each with its own advantages and disadvantages 3, 4, 5, 6.
Oral Testosterone Replacement Therapy
- Oral testosterone undecanoate (TU) is a form of TRT that is free of liver toxicity and has a improved shelf-life compared to older preparations 3.
- Newer formulations of oral TU have been developed to minimize liver toxicity concerns, and studies have shown that they are safe and effective for treating TDS 4.
- However, older oral forms of TRT can affect liver function, and therefore, transdermal, newer oral forms, and injectables are generally favored in men with a history of liver disease 7.
Administration and Monitoring
- The choice of TRT formulation depends on individual patient needs and preferences, and patients should be involved in the selection of the type of testosterone preparation 5.
- Monitoring and management of adverse effects are critical to maximize the benefits and minimize the risks of TRT, including regular hematocrit and blood pressure monitoring, and therapeutic phlebotomy if necessary 7.