Testosterone Patch for Hypogonadism Treatment
For male hypogonadism, transdermal testosterone patches are recommended as a first-line treatment option due to their ability to provide stable serum testosterone levels and avoid the fluctuations associated with injectable forms. 1
Diagnosis and Confirmation
Before initiating treatment with testosterone patches:
- Confirm hypogonadism with at least two morning testosterone measurements showing low levels (<300 ng/dL)
- Verify presence of clinical symptoms (decreased libido, erectile dysfunction, fatigue, reduced muscle mass)
- Complete workup to determine underlying cause (primary vs. secondary hypogonadism)
- Rule out contraindications:
- Prostate cancer
- Male breast cancer
- Desire for fertility in near future
- Severe obstructive sleep apnea
- Uncontrolled heart failure
- Hematocrit >54%
Testosterone Patch Administration (Androderm)
- Dosing: Start with one 2.5 mg patch daily, applied at night to clean, dry skin
- Application sites: Upper arms, back, abdomen, thighs (avoid scrotal application for standard patches)
- Rotation: Change application site daily to minimize skin irritation
- Timing: Apply at approximately the same time each evening
- Duration: Each patch is worn for 24 hours
Advantages of Testosterone Patches
- Provide stable serum testosterone levels throughout the day 1, 2
- Avoid first-pass liver metabolism associated with oral formulations
- No risk of transfer to others (unlike gel formulations) 1
- Convenient once-daily application
- Mimic normal circadian rhythm of testosterone when applied at night 3
Monitoring
- Check testosterone levels 2-3 months after initiation and after any dose adjustment 4, 1
- Target mid-normal testosterone range (500-600 ng/dL) 4
- Once stable levels are confirmed, monitor every 6-12 months 4
- Additional monitoring:
- Hematocrit (risk of erythrocytosis)
- PSA (in men >40 years)
- Lipid profile
- Blood pressure
- Symptom improvement
Potential Side Effects and Management
- Skin irritation: Most common side effect (60% of patients) 2
- Management: Rotate application sites, apply hydrocortisone cream to affected areas
- Only 9% of patients discontinue due to skin reactions 2
- Erythrocytosis: Less common with patches (15.4%) compared to injections (43.8%) 4, 2
- Management: Dose reduction, therapeutic phlebotomy if hematocrit exceeds 54%
- Gynecomastia: May resolve with patch therapy 2
- Fluid retention: Monitor for edema, especially in patients with heart or kidney disease
Special Considerations
- Fertility concerns: Testosterone therapy suppresses spermatogenesis; avoid in men desiring fertility 4
- For hypogonadotropic hypogonadism with fertility desires, consider hCG or FSH therapy instead 4
- Cardiovascular risk: Monitor closely in men with pre-existing cardiovascular disease 1
- Adolescents: Modified dosing regimens may be appropriate (e.g., single patch applied at night and removed after 12 hours) 3
Alternatives to Patches
If patches are not tolerated or preferred:
- Testosterone gel: Provides stable levels but carries risk of transfer to others 1
- Injectable testosterone: Lower cost but causes fluctuating testosterone levels 1
- Testosterone pellets: Long-acting option but requires implantation procedure 1
Common Pitfalls to Avoid
- Failing to confirm diagnosis with multiple morning testosterone measurements
- Not measuring free testosterone in obese patients
- Overlooking secondary causes of hypogonadism
- Inadequate monitoring for adverse effects
- Using testosterone for "age-related" hypogonadism without clear pathology
The testosterone patch (Androderm) represents an effective treatment option for male hypogonadism with advantages over other formulations in terms of providing physiological testosterone levels while minimizing risks of erythrocytosis and interpersonal transfer.