Low Testosterone

Diagnosis

Definitions

History/Physical

Labs

Management

Counseling

Prostatic considerations

Testosterone replacement options

Application Advantages Disadvantages Drug Dosing
Intramuscular Low cost Fluctuating T levels
Multiple injections
Pain at injection site
Enthanate 250mg q2-3wk
Cypionate 200mg q2-3wk
Propionate 100mg q2d
Undecanoate 1000mg q10-14wk
SubQ 3-4 treatments per year Invasive placement
Extrusion risk
Infection risk
Native T 4-6 200mg, last ≤ 6mo
Buccal Mimics physiologic range Oral irritation
BID administration
Unpleasant taste
Native T 30mg BID
Transdermal Simple administration
Mimics circadian rhythm
Maintains normal range
Skin irritation
Risk for transfer during contact
Daily administration
T patch 5-10mg daily
T gel 1-2% 5-10g daily
T nasal gel 33mg daily
T solution 60-120mg daily
Oral Oral convenience
Modifiable dosing
Take with meals
Potential hepatotoxicity
Undecanoate 120-240mg BID-TID
Methyl-T 20-50mg BID-TID
Mesterolone 100-150mg BID-TID

Non-replacement therapy options

Class Drug Dosing Side Effects
Selective Endrogen Receptor Modulator (SERMs) Clomiphene citrate 25-50mg PO q1-2d Visual symptoms, flushing, headache, GI distress
Tamoxifen 20mg PO QD Hepatitis, transaminitis, cataracts, VTE/stroke
Aromatase inhibitor Anastrozole 0.05-1mg q1-3d Hot flashes, HTN, nausea, bone pain, dyspnea, edema
Human Chorionic Gonadotropin (HCG) 500-4000IU SQ/IM 2-3x weekly Headache, irritability, depression, fatigue, gynecomastia, injection site pain

Follow up

Sources