From the Guidelines
Alternative therapies to testosterone cypionate include testosterone enanthate, testosterone undecanoate, transdermal gels, patches, and subcutaneous implants, with the choice depending on patient preference, cost, and individual response. When considering alternatives, it's essential to evaluate the advantages and disadvantages of each formulation, as outlined in a study published in Gastroenterology 1. Testosterone enanthate, for example, is a long-acting injection with a similar dosage to testosterone cypionate (100-200 mg every 2 weeks) but may have a slightly shorter half-life.
Some key points to consider when selecting an alternative therapy include:
- Administration method: injections (testosterone enanthate, testosterone undecanoate), transdermal gels (AndroGel, Testim), patches (Androderm), or subcutaneous implants (Testopel)
- Cost and insurance coverage
- Individual patient response and preference
- Potential advantages and disadvantages, such as risk of transference, skin irritation, or injection-associated complications
Testosterone undecanoate (Aveed, Nebido) offers longer-lasting effects, requiring injections only every 10-14 weeks after initial loading doses, as noted in the study 1. Transdermal formulations like AndroGel or Testim provide steady hormone levels without injections, while testosterone patches (Androderm) applied nightly to non-genital skin areas are another alternative. Implantable testosterone pellets (Testopel) can provide sustained release for 3-6 months. Ultimately, the choice of alternative therapy should be based on a thorough evaluation of the patient's needs and preferences, as well as the potential benefits and drawbacks of each formulation, as discussed in the study 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Prior to initiating testosterone enanthate injection, confirm the diagnosis of hypogonadism by ensuring that serum testosterone concentrations have been measured in the morning on at least two separate days and that these serum testosterone concentrations are below the normal range Male hypogonadism: As replacement therapy, i.e., for eunuchism, the suggested dosage is 50 to 400 mg every 2 to 4 weeks.
The alternative therapy to testosterone cypionate is testosterone enanthate.
- The dosage of testosterone enanthate is 50 to 400 mg every 2 to 4 weeks for male hypogonadism 2.
- Testosterone enanthate can be used as replacement therapy for conditions associated with a deficiency or absence of endogenous testosterone, including primary hypogonadism and hypogonadotropic hypogonadism 2.
From the Research
Alternative Therapies to Testosterone Cypionate
There are several alternative therapies to testosterone cypionate, including:
- Testosterone undecanoate (TU) 3, 4, 5
- Testosterone enanthate (TE) 6, 4, 5
- Human chorionic gonadotropins, aromatase inhibitors, and selective estrogen receptor modulators 7
- Lifestyle modifications, such as diet and exercise, improvements in sleep, decreasing stress, and varicocele repair 7
Comparison of Alternative Therapies
Studies have compared the efficacy and safety of these alternative therapies, including:
- A comparison of TU and TE found that both were effective in improving sexual functions in hypogonadal men, with TU having a lower frequency of administration and a better tolerability and safety profile 4, 5
- A comparison of intramuscular testosterone cypionate and subcutaneous testosterone enanthate found that the latter was associated with lower levels of post-therapy estradiol and hematocrit 6
- A review of alternatives to testosterone therapy found that lifestyle modifications and medical therapies, such as human chorionic gonadotropins and aromatase inhibitors, can increase testosterone levels and should be considered before testosterone therapy 7
Key Findings
Key findings from these studies include:
- TU and TE can improve sexual functions in hypogonadal men 4, 5
- Subcutaneous testosterone enanthate may have a preferable safety profile compared to intramuscular testosterone cypionate 6
- Lifestyle modifications and medical therapies can increase testosterone levels and should be considered before testosterone therapy 7
- TU has a lower frequency of administration and a better tolerability and safety profile compared to TE 4, 5