From the Guidelines
Testosterone supplementation options include various formulations with specific dosing regimens, and the choice of formulation depends on patient preference, cost considerations, and specific health factors, with injectable testosterone cypionate or enanthate typically administered at 100-200 mg every 2 weeks or 50 mg weekly intramuscularly, as recommended in the most recent study 1. The options for testosterone supplementation include:
- Injectable testosterone, such as testosterone cypionate or enanthate, which is typically administered at a dose of 100-200 mg every 2 weeks or 50 mg weekly intramuscularly, with the advantages of being relatively inexpensive and having flexible dosing, but also having the disadvantages of requiring intramuscular injection and fluctuating serum testosterone levels 1.
- Transdermal gels or patches, such as AndroGel or Testoderm, which are applied daily to the skin at doses of 50-100 mg, with the advantages of easy application and good skin tolerability, but also having the potential for transfer to partners or children by skin-to-skin contact 1.
- Subcutaneous implants, such as testosterone pellets, which are implanted under the skin and release 150-450 mg of testosterone over 3-6 months, with the advantages of long-lasting therapy and less fluctuation in testosterone levels, but also having the disadvantages of requiring an incision for insertion and potential pellet extrusion or infection at the site of insertion 1.
- Buccal tablets, such as Striant, which deliver 30 mg of testosterone twice daily, with the advantages of no risk of skin-to-skin transference, but also having the disadvantages of poor adherence and potential gum irritation or changes in taste of food 1. It is essential to monitor treatment with regular blood tests to maintain testosterone levels within the normal range (300-1000 ng/dL) while watching for side effects like polycythemia, sleep apnea, or prostate issues, and dosing is typically started at the lower end of the range and adjusted based on symptom response and laboratory values.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Dosage and Administration for testosterone gel 1.62% differs from testosterone gel 1%. Prior to initiating testosterone gel 1. 62%, confirm the diagnosis of hypogonadism by ensuring that serum testosterone has been measured in the morning on at least two separate days and that these concentrations are below the normal range (2). Starting dose of testosterone gel 1.62% is 40.5 mg of testosterone (2 pump actuations or a single 40.5 mg packet), applied topically once daily in the morning. Apply to clean, dry, intact skin of the shoulders and upper arms. Do not apply testosterone gel 1.62% to any other parts of the body including the abdomen, genitals, chest, armpits (axillae), or knees. Dose adjustment: testosterone gel 1.62% can be dose adjusted between a minimum of 20.25 mg of testosterone (1 pump actuation or a single 20. 25 mg packet) and a maximum of 81 mg of testosterone (4 pump actuations or two 40.5 mg packets).
The options for testosterone supplementation, including dose, are:
- Starting dose: 40.5 mg of testosterone (2 pump actuations or a single 40.5 mg packet) applied topically once daily in the morning.
- Dose adjustment: between a minimum of 20.25 mg of testosterone (1 pump actuation or a single 20.25 mg packet) and a maximum of 81 mg of testosterone (4 pump actuations or two 40.5 mg packets).
- Application site: clean, dry, intact skin of the shoulders and upper arms.
- Administration: apply topically once daily in the morning, wash hands immediately with soap and water after applying, and cover the application site(s) with clothing after the gel has dried 2.
From the Research
Testosterone Supplementation Options
The options for testosterone supplementation include:
- Weekly-to-biweekly injections of testosterone cypionate or testosterone enanthate 3
- Once-daily transdermal therapies, including patch and gel systems 3
- Intramuscular injection of testosterone undecanoate, which can be administered quarterly 3
- Intranasal testosterone gel 4
- Subcutaneous testosterone enanthate autoinjector (SCTE-AI) 5
- Novel 2% testosterone gel (NTG) 6
Dose of Testosterone Supplementation
The dose of testosterone supplementation varies depending on the formulation and route of administration:
- Testosterone cypionate: 100 mg weekly 5
- Testosterone enanthate: 100 mg weekly 5, 200 mg every 2 weeks 4
- Intranasal testosterone gel: 11 mg 3 times daily 4
- Novel 2% testosterone gel (NTG): dose not specified 6
- Subcutaneous testosterone enanthate autoinjector (SCTE-AI): 100 mg weekly 5
Monitoring and Adjustment of Testosterone Supplementation
Monitoring of testosterone levels and adjustment of the dose is necessary to ensure adequate replacement and minimize adverse effects:
- Assessment of clinical responses and measurement of serum testosterone levels 3
- Serial measurement of bone mineral density during androgen therapy 3
- Measurement of hematocrit for detection of polycythemia and digital rectal examination with a serum prostate-specific antigen level measurement for prostate cancer screening 3