Chapter 49: Men as Patients
• Testosterone therapy and monitoring
Testosterone is linked to elevated LDL's and decline in HDL's
Typically, the depot esters are administered parenterally by IM or SQ route
• Transdermal and buccal routes are also available
• If IM route is chosen, patients should be taught to self-administer
• If injected pellets SQ, pellets can fall out, and absorption may differ
• Patches can be applied daily, rotating sites, and watching for skin disruptions
• Liquid, topical gel can be applied, although care should be used with secondary contact of
women and children. Clothing should cover the area of application. Care for thorough hand washing.
Topical gels are expensive and may not be covered by insurance.
• A testosterone level in the midrange (400 to 600 ng/dL) is the goal
• Mood, sense of well-being, and libido may vary among patients. Dosages can be adjusted on
these effects
Dosages:
• Buccal (Striant): 30mg to gums BID
• IM Depot esters (Depo-testosterone): 50-400mg every 2-4 wks
• SQ pellets (Testopel): 10-15 pellets every 3-6 months
• Topical skin patch (Androderm): 5mg/d applied once daily to dry, intact skin of shoulders, upper
arm, or abdomen
• Topical Gel (Androgel 1% or 1.62%): 5-10mg (1-2 packets/tubes or 1-8 pumps depending on
concentration) to clean, dry, intact skin of shoulders, upper arm, or abdomen
• Topical gel (Fortesta 2%): 40mg (4 pumps) applied once daily to inner and anterior thighs
• Topical genital skin patch (Testoderm): 6mg/d patch applied to the scrotal area and worn for 22-
24 hrs
• Topical liquid (Axiron):30-90 mg (2-4 pumps) once daily to axillae
Testosterone Replacement, Risks, and Contraindications
• Restoring testosterone levels within the normal range by using testosterone replacement
therapy (TRT) can improve many of the effects of hypogonadism.
• Risks:
• Erythrocytosis is a risk of TRT, so checking Hgb and Hct periodically is recommended
• Prostate Cancer – periodic check of PSA and digital rectal exam is recommended
• Decreased sperm and infertility
• Adolescents may develop acne and gynecomastia, and more seriously, aggressive behavior and
premature closure of growth plates, leading to the small stature
• Exacerbation of sleep apnea
• Liver toxicity and liver tumor
• Worsening s/s of BPH
• Skin diseases (esp. for topical and dermal routes)
• Testosterone therapy and monitoring
Testosterone is linked to elevated LDL's and decline in HDL's
Typically, the depot esters are administered parenterally by IM or SQ route
• Transdermal and buccal routes are also available
• If IM route is chosen, patients should be taught to self-administer
• If injected pellets SQ, pellets can fall out, and absorption may differ
• Patches can be applied daily, rotating sites, and watching for skin disruptions
• Liquid, topical gel can be applied, although care should be used with secondary contact of
women and children. Clothing should cover the area of application. Care for thorough hand washing.
Topical gels are expensive and may not be covered by insurance.
• A testosterone level in the midrange (400 to 600 ng/dL) is the goal
• Mood, sense of well-being, and libido may vary among patients. Dosages can be adjusted on
these effects
Dosages:
• Buccal (Striant): 30mg to gums BID
• IM Depot esters (Depo-testosterone): 50-400mg every 2-4 wks
• SQ pellets (Testopel): 10-15 pellets every 3-6 months
• Topical skin patch (Androderm): 5mg/d applied once daily to dry, intact skin of shoulders, upper
arm, or abdomen
• Topical Gel (Androgel 1% or 1.62%): 5-10mg (1-2 packets/tubes or 1-8 pumps depending on
concentration) to clean, dry, intact skin of shoulders, upper arm, or abdomen
• Topical gel (Fortesta 2%): 40mg (4 pumps) applied once daily to inner and anterior thighs
• Topical genital skin patch (Testoderm): 6mg/d patch applied to the scrotal area and worn for 22-
24 hrs
• Topical liquid (Axiron):30-90 mg (2-4 pumps) once daily to axillae
Testosterone Replacement, Risks, and Contraindications
• Restoring testosterone levels within the normal range by using testosterone replacement
therapy (TRT) can improve many of the effects of hypogonadism.
• Risks:
• Erythrocytosis is a risk of TRT, so checking Hgb and Hct periodically is recommended
• Prostate Cancer – periodic check of PSA and digital rectal exam is recommended
• Decreased sperm and infertility
• Adolescents may develop acne and gynecomastia, and more seriously, aggressive behavior and
premature closure of growth plates, leading to the small stature
• Exacerbation of sleep apnea
• Liver toxicity and liver tumor
• Worsening s/s of BPH
• Skin diseases (esp. for topical and dermal routes)
