Options for Increasing Testosterone If You Have Symptoms

Testosterone replacement therapy or TRT is a treatment option for men with confirmed low testosterone, also known as hypogonadism. Consistent symptoms and signs include low energy, low sex interest or libido, and decreased muscle mass. Other more vague complaints might be erectile dysfunction and changes in mood. Typically, one has at least two separate morning blood tests showing low total testosterone (<300 ng/dL). Once both lab findings and clinical symptoms are present, treatment may be considered.

Testosterone can be delivered several ways. Each method has pros and cons, and the best choice depends on lifestyle and personal preference.

Arguably, injections are the most widely used method to deliver testosterone. Testosterone cypionate and enanthate are the most common injectable forms. They are given as intramuscular or below-the-skin injections. The procedure is done every one to two weeks depending on the medication, the individual, and the decision made between the patient and provider.

Advantages: Injections are generally the least expensive form of TRT. They can be adjusted easily depending on lab results and symptoms, and they have been studied and used for decades.

Disadvantages: Injections require needles and self-injection training. Some men notice highs and lows in how they feel if doses are spaced too far apart. Soreness at the injection site can occur as well. They also are the most common form of replacement that causes a rise in blood volume or “hematocrit,” which sometimes requires bloodletting or blood donation.

Daily testosterone gels and compounded creams are applied to the skin, usually on the shoulders, arms, or thighs. Testosterone is absorbed transdermally or through the skin, which then travels into the bloodstream.

Advantages: These forms are easy to apply, avoid needles, and generally keep testosterone levels more stable than infrequent injections, since they mimic the body’s natural rhythm of testosterone release. They are also usually covered by most insurance plans.

Disadvantages: If skin contact happens before the gel is fully absorbed, testosterone can be unintentionally transferred to others, including partners or children. Skin irritation is also possible. And application usually requires strict adherence to see the full benefits.

Testosterone patches are applied nightly and deliver hormone steadily over 24 hours.

Advantages: They mimic the body’s natural rhythm of testosterone release and are easy to apply.

Disadvantages: Patches are very likely to cause skin irritation compared to gels. They may also peel off, especially if the skin is sweaty. Rashes are common.

Testosterone pellets are inserted under the skin, usually in the buttock area, in a minor office procedure. The pellets slowly release testosterone over two to three months.

Advantages: Pellets are convenient for men who do not want to think about daily or weekly dosing. They provide very stable levels once placed, and there is no risk of transference like with gels.

Disadvantages: They require a minor office procedure and carry rare risks such as infection, scarring, or the pellet working its way out of the skin. The dose cannot be adjusted until the next insertion.

Newer oral testosterone options, such as testosterone undecanoate, are designed to be absorbed through the lymphatic system rather than the liver, which reduces the risk of liver damage. The old oral testosterone therapy such as methyltestosterone had a high incidence of liver damage. This is NOT seen with the newer versions.

Advantages: These are easy to take and avoid needles or skin application and have a low incidence of raising your blood count or “hematocrit.”

Disadvantages: They must be taken twice a day. Insurance coverage is typically not as good for this option. Direct payment may run about $150 a month.

There is no best way to deliver testosterone. Each method has unique benefits and drawbacks. The choice depends on cost, convenience, comfort with needles, lifestyle, and how well testosterone levels can be maintained safely.

Regardless of the form, regular monitoring is essential. This includes routine bloodwork at established intervals, and an annual physical exam. Monitoring ensures that therapy is effective and safe. At Yale Urology, we have extensive experience with all delivery systems for testosterone.

Testosterone should not be used in patients who are interested in starting a family soon. Typically, testosterone will lower your sperm count, in some cases to zero. Although this is usually reversible, it is not recommended whenever a couple is considering growing their family. There are other options, similar to testosterone, that are available to patients in this situation.

Testosterone therapy can improve energy, mood, sexual function, and muscle strength in men with confirmed low levels. The key is choosing the right application, using it consistently, and following up with lab monitoring and regular check-ins. With the right plan, TRT can be safe, effective, and tailored to each individual’s needs.