Can a patient be on 200mg of testosterone (testosterone) every 2 weeks?

Testosterone Dosing: 200mg Every 2 Weeks

Yes, a patient can be on 200mg of testosterone every 2 weeks, as this is an FDA-approved dosing regimen for testosterone replacement therapy in hypogonadal men. 1

Appropriate Dosing Guidelines

• For replacement therapy in hypogonadal males, the FDA-approved dosage range is 50 to 400 mg administered every two to four weeks via intramuscular injection 1
• The goal of testosterone therapy is to normalize total testosterone levels to the middle tertile of the normal reference range (450-600 ng/dL) while improving symptoms 2
• The 200mg every 2 weeks regimen is one of the most effective dosing schedules in terms of suppression of serum LH to normal levels while balancing frequency of administration 3

Monitoring Requirements

• Testosterone levels should be tested 2-3 months after treatment initiation and after any dose changes 2
• For patients on intramuscular testosterone injections, levels should be measured midway between injections, targeting a mid-normal value (500-600 ng/dL) 2
• Once stable levels are confirmed, monitoring every 6-12 months is typically sufficient 2
• Clinicians should monitor hematocrit levels, as erythrocytosis is the most common side effect of testosterone therapy 4
• If hematocrit exceeds 54%, providers should decrease or discontinue therapy until hematocrit normalizes 4

Advantages and Disadvantages of 200mg Every 2 Weeks

Advantages:

• Less frequent injections compared to weekly dosing 5
• FDA-approved standard dosing regimen 1
• Effective at maintaining testosterone levels within therapeutic range 3

Disadvantages:

• May cause greater fluctuations in testosterone levels compared to more frequent dosing 2
• Potentially higher risk of erythrocytosis compared to weekly dosing (8% vs 1% risk of hematocrit rising above 54%) 6
• Some patients may experience mood and sexual function fluctuations due to the peaks and troughs in serum testosterone 5

Safety Considerations

• Testosterone therapy should not be commenced for a period of three to six months in patients with a history of cardiovascular events 2
• Clinicians should not prescribe alkylated oral testosterone due to risk of liver toxicity 2
• There is evidence suggesting that testosterone injections may be associated with a greater risk of cardiovascular events compared to transdermal preparations, possibly due to increased time spent in both supratherapeutic and subtherapeutic ranges 2
• Patients who are overweight or obese should be counseled regarding weight loss programs concurrent with testosterone therapy due to potential cardiovascular risks 2
• Exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive, as it can interrupt normal spermatogenesis 2

Alternative Approaches

• For patients concerned about the fluctuations associated with biweekly injections, alternative options include:
  • Weekly injections of 100mg, which may provide more stable testosterone levels with lower risk of erythrocytosis 6
  • Transdermal preparations (gels, patches) which offer more stable day-to-day testosterone levels 2, 5
  • For men desiring to maintain fertility, alternatives include aromatase inhibitors, human chorionic gonadotropin, or selective estrogen receptor modulators 2

In conclusion, 200mg of testosterone every 2 weeks is an appropriate and FDA-approved dosing regimen, but requires proper monitoring and consideration of patient-specific factors to minimize potential adverse effects.