Oral testosterone (Restandol;Andriol/Testocaps) Tablets containing 40mg testosterone undecanoate taken 2-3 times a day Route of absorption via lymphatic system –Needs to taken with a meal containing fat –Without dietary fat, absorption is minimal and pharmacokinetics unreliable
Buccal testosterone (Striant) 30mg tablet placed above incisor tooth bd Avoids first pass hepatic inactivation –Absorbed across oral mucosa Good pharmacokinetics, achieving normal testosterone levels May be difficulties with site reactions, etc.
Subdermal (Testosterone implants) Pellets ( mg) implanted subdermally –3 to 6 pellets (600mg to 1.2g) maintain plasma testosterone concentrations for 4-6 months 1 Risk of supraphysiological levels Minor surgical procedure –Pain/infection/extrusion (10%)/scarring –A new insertion site is used each time
Transdermal patches (e.g. Andropatch) mg testosterone starting dose Daily circadian profile of testosterone delivery Alcohol base to enhance permeation Skin reactions common (>50% patients) Size of patch and noise can be obtrusive
Transdermal gels (Testogel; Testim) mg gel applied each morning to shoulders, back, or abdomen Daily circadian profile of testosterone delivery Skin reactions in 4-10% patients Avoid washing for 6 hours Risk of transfer to another person via skin contact
Intramuscular injections - short acting (Sustanon 100; Sustanon 250; Testoviron) Most widely used form of testosterone Two short-acting preparations available –Sustanon 100 (fortnightly) & Sustanon 250 (3-weekly) Injection site reactions/patient discomfort Reaction to excipients (nut allergy )
Intramuscular injections - long acting (Nebido) 1000 mg testosterone undecanoate in 4 ml castor oil Loading dose (6 weeks) then every weeks Testosterone levels maintained in physiological range –Avoids frequent peaks and troughs from short-acting injections Increased patient convenience (quarterly injections) Injection site reactions/patient discomfort
Summary Several testosterone preparations available Differ by route of application Patient choice and satisfaction important Patients should be sufficiently informed to enable them to make a decision