Injectable long-acting
T undecanoate in oil (Nebido, Hormus) |
1000 mg IM, followed by 1000 mg at 6 weeks; then, 1000 mg every 10–14 weeks |
Convenient drug regimen (once every 10-14 weeks); stable T levels |
Requires IM injection of a large volume (3 or 4 mL); coughing (rarely); coughing episode immediately after injection (rarely); high cost |
| T enanthate (Delatestryl) |
100–200 mg IM every 2–4 weeks or 100 mg/week |
Flexibility of dosing; low cost |
Requires IM injection; peaks and valleys in serum T concentrations that may be associated with fluctuations in symptoms; coughing immediately after injection (very rarely) |
| T cypionate (Deposteron) |
100–200 mg IM every 2–4 weeks or 100 mg/week |
| T proprionate + isocaproate + decanoate + phenylpropionate (Durateston) |
125–250 mg IM every 2–4 weeks or 125 mg/week |
| Subcutaneous T enanthate (Xyosted) |
Starting dose: 75 mg subcutaneously once a week. The dose can be titrated to 50 mg or 100 mg weekly |
Convenient drug regimen (once weekly); stable T levels |
Increases in hematocrit, PSA, and blood pressure are the most frequent side effects |
| Transdermal T gel(Androgel) |
50–100 mg of 1% transdermal gel once daily |
Provides flexibility of dosing, ease of application, good skin tolerability; less erythrocytosis than injectable T |
Potential of transfer to a female partner or child by direct skin-to-skin contact; T concentrations may be variable from application to application; skin irritation in a small proportion of patients |
| Axillary T solution (Axeron) |
60 mg of T solution applied in the axillae |
Provides good skin tolerability |
Similar to 1% testosterone gel |
| Transdermal T patch (Androderm) |
One or two patches, designed to deliver 2–4 mg of T during 24 hours applied on a clean, dry area of skin on the arm, back, abdomen, or upper buttocks (once daily for most patients) |
Ease of application; stable T levels |
Serum T concentrations in some T-deficient men may be in the low-normal range; these men may need applications of two patches daily; skin irritation at the application site occurs frequently |
| Buccal, bioadhesive, T tablets (Striant) |
30 mg controlled release, bioadhesive tablets BID |
Convenience and discreet |
Twice daily applications are required. Gum-related adverse eventsin 16% of treated men; alterations in taste |
| T pellets (Testopel) |
T Pellets containing 600–1200 mg T implanted SC; the number of pellets and the regimen may vary with formulation |
Requires infrequent administration |
Surgical incision for insertions is required; occasional spontaneous pellets extrusion; local hematoma and infection rarely seen |
| Nasal T gel (Natesto) |
11 mg two or three times daily |
Rapid absorption and avoidance of first pass metabolism |
Multiple daily intranasal dosing required; local nasal side-effects (rhinorrhea, epistaxis, nasal discomfort, nasal congestion, parosmia); not appropriate for men with nasal disorders |
| Oral T undecanoate (Jatenzo) |
Starting dose: 237 mg orally once in the morning and once in the evening (with meals). If needed, adjust the dose to a minimum of 158 mg BID and a maximum of 396 mg BID |
Convenience of oral administration |
Variable clinical responses; administration with fatty meal is required; fat content of meals affects bioavailability; variable serum T concentrations |
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*The cut-off values of serum cortisol levels may change according to the method used for evaluation. # Cut-off value < 9,0 µg/dL.
ITT: insulin tolerance test; GST: glucagon stimulation test.
fT4: free thyroxine; fT3: free triiodothyronine.