From the Guidelines
The most cost-effective form of testosterone replacement therapy (TRT) is intramuscular testosterone injections, such as generic testosterone cypionate, which can cost around $30-60 per month when self-administered. This recommendation is based on the American College of Physicians' clinical guideline, which suggests that clinicians consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function in men with age-related low testosterone, as costs are considerably lower for the intramuscular formulation and clinical effectiveness and harms are similar 1.
Key Considerations
- A standard regimen involves 100-200mg injected intramuscularly every 1-2 weeks.
- To minimize costs, patients can ask their doctor for a prescription for multi-dose vials rather than pre-filled syringes, purchase syringes and needles in bulk online, and learn to self-inject rather than paying for clinic visits.
- Some patients may qualify for manufacturer assistance programs or GoodRx discounts.
- Compounded testosterone creams from specialized pharmacies can sometimes be affordable alternatives.
- Injectable testosterone is generally more cost-effective than gels or patches because it requires less frequent dosing and has been generic for decades.
Safety and Monitoring
- Patients should never sacrifice safety for cost - proper medical supervision is essential to monitor hormone levels, adjust dosing, and watch for side effects like elevated red blood cell counts, which requires regular blood tests even when using the most economical option.
- The American College of Physicians' clinical guideline also recommends that clinicians reevaluate symptoms within 12 months and periodically thereafter, and discontinue testosterone treatment in men with age-related low testosterone with sexual dysfunction in whom there is no improvement in sexual function 1.
Patient Preferences
- A study found that 53% of patients receiving testosterone treatment chose injectable testosterone over gel-based pellet regimens, mostly because of lower cost 1.
- Another study found that most patients preferred a topical gel over an injection or patch for reasons attributed to convenience, ease of use, and nonstaining of clothes, among others 1.
From the Research
Cost-Effective Testosterone Replacement Therapy (TRT) Options
- The most cost-effective form of TRT is injectable testosterone therapy, as stated in the study 2.
- Specifically, injectable testosterone undecanoate is a long-acting ester formulation of testosterone that can be provided in an injectable form, which is marketed as Aveed and Nebido 2, 3, 4.
- Injectable testosterone undecanoate has a favorable pharmacokinetic profile, with one injection every 3 months maintaining serum testosterone well within the normal range 3, 4.
- Weekly-to-biweekly injections of testosterone cypionate or testosterone enanthate are also widely used and are economical and generally well tolerated 5.
Comparison of TRT Options
- Transdermal therapies, such as patches and gels, have become increasingly popular, but may have higher costs and variable absorption rates 3, 5.
- Oral testosterone undecanoate is a convenient option for many patients, but may have large fluctuations in serum testosterone levels 2, 3.
- Other forms of TRT, such as nasal and subcutaneous applications, may also be available, but their cost-effectiveness and efficacy may vary 2.
Factors Affecting Cost-Effectiveness
- The cost-effectiveness of TRT options may depend on various factors, including the patient's individual needs, insurance coverage, and the specific product used 2, 5.
- A patient-centered discussion focused on goals of care should guide physician prescription of these medications, taking into account the patient's preferences, medical history, and lifestyle 2.