Low Testosterone Treatment Therapy
Testosterone Injections, Testosterone Creams, Gels & Patches are used to Increase Low Testosterone Levels
With over 25,000 patients our Hormone Therapy Center can offer the best pricing on your Testosterone Treatments including Pfizer Depo-Testosterone, Cypionate and Enanthate Injections, Androgel®, and Testosterone Creams by prescription.
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Testosterone is an Androgenic anabolic steroid hormone and the principal endogenous androgen used to treat Male Hypogonadism, also known as "Low T" or Andropause or Male Menopause.
Low testosterone levels can also be instrumental in erectile dysfunction (ED) or impotence characterized by very soft erections, or an inability to have or maintain an erection.
Steroid injections like testosterone are used by age management physicians, endocrinologists and urlogists to treat Low T, erectile Dysfunction and Andropause.
What Doctors Treat Low T
Endocrinologists, Urologists, Anti-Aging Doctors and Hormone Specialists may prescribe TRT - Testosterone Replacement Therapy in order to treat male hormone related health symptoms.
Read more about the various treatment options and androgen replacement programs available.
Find a Testosterone Doctor near you.
Low T Treatments
Types of Testosterone Treatment
Topical, Intramuscular, Buccal (Gum), Implantable Pellets, Pills. There are many options for men to treat symptoms of hormone deficiency. Below we discuss the most common therapies
prescribed for treatment.
Low Testosterone Treatment Options
The most common types of Testosterone Therapy are injections (cypionate, enanthate, propionate), creams, gels, pellets and patches. When properly prescribed these Low T Treatment Options will address the signs and symptoms of low testosterone in males including extreme fatigue, depression, lack of sex drive, soft erections, loss of muscle mass, belly fat and weight gain.
A decrease in testosterone production is very common in men over the age of 30, but with male hormone replacement available it is not something that you need to suffer from for the rest of your life. There are many treatments available for low testosterone in men as well as women.
If you are prescribed testosterone replacement therapy, you may notice a difference after the first or second week of low testosterone therapy. Most men report a surge in their sexual desire and frequency of sex, ability to build muscle and recover from workouts, weight loss, a better mood and better sleep. Importantly, men feel confident and a sense of drive again which can positively impact their personal and work relationships.
Low T Injections
Steroid Hormone Injections.. One of the most common types of treatments is testosterone injections, either cypionate, enanthate or propionate - which is injected into a muscle usually once or twice weekly, or even monthly.
You can give yourself these shots or have them done by your hormone physician. Injections are one of the most effective ways of replacing your testosterone.
You must follow your testosterone doctor's protocol in order to avoid side effects. Testosterone replacement therapy effects the natural production of testosterone in your body and you will need to take testosterone stimulating medications and go through a post treatment regimen in order to restart your own natural testosterone production again.
This will usually be accomplished through the use of HCG injections. An estrogen inhibitor or blocker such as Armidex® (Anastrozole), Tamoxifen (Nolvadex®), or Clomid® (Clomiphene Citrate) is normally prescribed to ensure excess estrogen does not build up in your body during testosterone therapy. Although easily managed, Low T treatment can lead to highs and lows in your body's testosterone levels as it peaks shortly after each injection and slowly declines until the next one since your body is producing little to no testosterone on it's own. This form of testosterone treatment requires a licensed doctor's prescription.
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Topical Testosterone Solutions
Testosterone Creams and Testosterone Gels
Testosterone creams and gels are applied topically. These creams and gels can be effective, are pain free and no needles or implant incisions are required. The main disadvantage to using creams or gels is that you can transfer the testosterone to other people via skin to skin contact and cause what is known a s virilization. Most testosterone creams and gels require a licensed doctor's prescription.
Testosterone Pellets - Implantable Hormone Solution
Testosterone pellets are placed under the skin usually in the buttocks and testosterone is released gradually into the body in a steady manner over a 3 to 5 month period. These pellets dissolve evenly without the highs and lows of the injections. Unfortunately, an incision has to be made in your skin in which to place the pellets, this is usually done every three to six months. Some of the pellet solution side effects have been an average extraction rate of 8% - 12%, minor bleeding and infection at the implant site.
This treatment also requires a doctor's office visit for implantation and prescription.
Testosterone Adhesive Skin Patches
Testosterone patches are placed on the skin usually on the abdomen, thigh or scrotum and testosterone is released gradually into the body. Some men find the absorption rate to be rather weak and side effects such as rash and itchiness are common with testosterone patches.
One of the first types of testosterone treatment many men initially try, is the testosterone patch because of convenience. And though they are convenient and require no injection, you need keep replacing it and a rash may form making it very uncomfortable.
If you decide to try the patches, your hormone physician will let you know how many patches to wear and the cost of this type of testosterone treatment. If you start to have side-effects from the patch like skin irritation, don't hesitate to let your doctor know.
With any of the Low T replacement therapies, there are advantages and disadvantages. Discuss these thoroughly with your hormone therapy doctor.
Natural Testosterone Boosters
Using natural testosterone boosters are the safest way to treat low testosterone. Instead of introducing artificial testosterone into your body, natural ingredients like Yohimbe, Zinc, L-Arginie, Tribulus Terrestris, Horny Goat Weed, Ginseng, Nettles, Saw Palmetto and many others have been shown to marginally increase your body's natural production of testosterone without a prescription drug.
This eliminates the unwanted side effects of highs and lows and does not inhibit your body's natural production of testosterone. However, most men who have Low T or a genuine Testosterone deficiency will require other forms of low testosterone replacement in order to increase their levels back up into the normal range.
For men with normal testosterone levels, natural testosterone supplements do not stop or slow down their own testosterone production. The natural ingredients used in natural testosterone boosters can be effective for these men.
Low Testosterone: Hypogonadism
Aging men are confronted with symptoms of hypogonadism. If you are suffering from Low T, then you should speak with a hormone specialist to see if (TRT)
Testosterone Replacement Therapy may be right for you.
Most men become concerned when low testosterone impacts their sex life.
A decline in your sex drive is one of the symptoms that reflect a decline in testosterone.
A natural and gradual decline in your testosterone levels is normal as you age and at some point symptoms will occur.
Some health conditions, heart medications and obesity can also cause low testosterone levels.
A hormone blood test can tell you if you have low testosterone.
When your body doesn't produce enough testosterone, it's called hypogonadism or Low T. It occurs during the period of a man's life known as Andropause. Symptoms include:
- Soft Erections
- Extreme Fatigue
- Excessive Weight
- Sadness & Depression
- Trouble Sleeping
- Trouble Focusing & Concentrating
- Hot Flashes and Night Sweats
- Flabby Muscles and Weak bones
Testosterone is responsible for male characteristics, a significant decrease can cause:
- Erectile dysfunction
- Less facial and body hair
- Growth of breast tissue and body fat
- Infertility and poor quality of sperm
- Decreased muscle mass and bone mass
Low Testosterone Treatment can save your Relationships & Marriage
As you get older, it is only natural for your testosterone level to decrease. With this decrease you may have the desire to have sex but because of softer erections or the inability to maintain an erection - you are unable to do so.
You may have lost this ability because of your low level of testosterone. You can get tested and find out if you have Low T and seek out the many different treatments that low testosterone therapy comprises as discussed above for taking care of low levels of testosterone.
To restore your ability to make love, it is worth the trip to see your hormone physician and get treated.
When you meet with your hormone physician, discuss all the treatment options for testosterone replacement including pills, patches, injections, pellets, gums, creams and gels.
Also discuss possible side-effects and any risks associated with testosterone replacement. There are men who have or had breast or prostrate cancer, sleep apnea, high red blood cell counts, or congestive heart failure and
the physician may not prescribe testosterone replacement therapy in these cases. To learn more about testosterone prescriptions, visit - Getting a Testosterone Prescription
Get Low Testosterone Treatment Online
Visit the Testosterone Hormone Center contact page online to learn how to buy a low testosterone treatment. When you consider the value of low testosterone replacement therapy treatments, consider your quality of life and how much better you may feel and look.
When it comes to low testosterone treatment, you have many options to choose which can be combined with natural ways to boost testosterone. Fill out the Quick Info Form for information and to talk to an HRT physician for a Free Consultation.
For more information on treating Low T, Testosterone Therapy pricing, prescriptions and online ordering, request a Free Consultation with one of our friendly medical staff - Online Testosterone Treatment Information.
Testosterone Treatments Available
- Pfizer Depo-Testosterone
- Watson Testosterone
- Paddock Testosterone
- Sandoz Testosterone
- Testosterone Cypionate
- Testosterone Enanthate
- Testosterone Propionate
- Testosterone Estradiol
- Testosterone Isocaproate
- Testosterone Decanoate
- Testosterone Undecanoate
- Testosterone Phenylpropionate
- Testosterone Methyltestosterone
- Testred® Android, Methitest
- Testrex® Enanthate
- Testovis® Propionate
- Aveed® Testosterone Injection
- Aveed® Undecanoate Injections
- Delatestryl® Enanthate
- Endo Pharma Testosterone
- AndroDerm® Actavis
- AndroGel® AbbVie
- Androfil® Cipla
- Andriol Testocaps®
- Axiron® Eli Lilly
- Testoderm® Alza
- Testim® Auxilium
- Striant® Actient Columbia Labs
- Testopel® Slate / Barter Pharma
- Fortesta® Endo Pharma
- Metandren® / MethylTestosterone
- Natesto® / Oreto®
- Nuvir® Organon
- Omnadren Sustanon®
- Sustanon® Organon
- Sustrone® Taj Pharma
- Testred® Testosterone Pills
- Testanon® Infar Pharma
- Testolent T-Phenylpropionate
- Testanova® Neiss Labs
- Virilon® / Vogelxo®
- Cernos Sun Pharmaceutical
- Depo Testosterones
- Depo Testosterone Cypionate
- Ditate-DS Estradiol Cypionate
Testosterone Treatment Protocol
As delineated above, there are a different treatments for low testosterone. Low testosterone treatments include testosterone injections, testosterone supplements, testosterone gels, testosterone creams, testosterone patches and testosterone pellets.
These hormone treatments require a visit to the doctor and blood work to test your current hormone levels and confirm that you have low testosterone levels.
You will then be examined, diagnosed and receive a prescription for Testosterone Replacement. In addition to your doctor's prescription, a testosterone supplement may also be recommended.
Using natural ways to increase your testosterone levels including exercise and diet is the holistic way to increase your testosterone levels.
Urologists, Endocrine and Testosterone Treatment Specialists.
Low T Treatment is prescribed for the management of congenital or acquired primary hypogonadism such as that resulting from orchidectomy or from testicular failure caused by cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, Klinefelter’s syndrome, chemotherapy, or toxic damage from alcohol or heavy metals.
Another common use for Low T Therapy is in the treatment of congenital or acquired hypogonadotropic hypogonadism such as that resulting from idiopathic gonadotropin or gonadotropin-releasing hormone (luteinizing hormone-releasing hormone) deficiency or from pituitary-hypothalamic injury caused by tumors, trauma, or radiation. Should be used in the treatment of hypogonadotropic hypogonadism only in patients uninterested in or unable to achieve fertility.
Considered the androgen of choice for the treatment of androgen deficiency, hypogonadism (LOW T), and AIDS wasting in HIV-infected men, Testosterone may also be used to stimulate puberty when the diagnosis is well established in carefully selected males with delayed puberty - designated an orphan drug by FDA for this use.
Some medical experts and endocrinologists recommend that men who develop low serum testosterone concentrations (300 ng/mL) while receiving long-term corticosteroid therapy receive testosterone replacement therapy in an attempt to treat hypogonadism and possibly reduce the risk of corticosteroid-induced osteoporosis (bone loss).
Clinical evidence to date regarding testosterone therapy in aging men suggests some beneficial effects on body composition, strength, bone density, frailty, cognitive function, mood, sexual function, and quality of life.
Risks relating to benign prostatic hyperplasia and prostate cancer need to be quantified and The Institute of Medicine states that the nature and extent of therapeutic benefits of Testosterone Replacement in older men requires additional study to document effects on the prostate.
Testosterone treatment may be prescribed for adult men suffering from impotence due to a testosterone deficiency. Low T Therapy is not indicated for the treatment of erectile dysfunction (ED) in men with normal testosterone levels.
Other hormonal agents like tamoxifen, anastrozole, letrozole, exemestane are currently used as estrogen blockers along with testosterone replacement.
Testosterone Misuse and Abuse
Testosterone has been misused and abused by athletes, bodybuilders, weight lifters, and others to enhance athletic performance or physique. Risks and side affects of testosterone shots occurs due to the
excessive dosage injected. Testosterone therapy at normal dosing in a doctor-supervised hormone therapy program is considered safe and effective.
Medical and sports experts including the International Olympic Committee consider such excessive use of Testosterone to be inappropriate and unacceptable because of known adverse effects, potential long-term health issues of mega-doses, and because such use by athletes is contrary to the rules and ethical principles of athletic competition.
Testosterone Cypionate Dosage and Administration
Treating Male Hypogonadism Hormone Physicians prescribe individualized dosages according to the condition being treated; the severity of symptoms; the patient’s age, gender, and history of prior androgenic therapy; and the specific testosterone preparation being used.
When you begin therapy, your Testosterone Replacement Doctor will monitor you every 3–4 months during the first year of testosterone replacement and periodically thereafter to ensure the proper dose of testosterone is being administered.
Every 6 months follow ups will be conducted to ensure positive therapy response and tolerance. If necessary, your physician will adjust the testosterone dosage accordingly to reach optimal T levels for you.
Lear more about low t therapy and hypogonadism - Treating Hypogonadism with Testosterone.
- Administer testosterone intramuscularly, topically or intrabuccally.
- Administer testosterone cypionate and testosterone enanthate by deep IM injection; Testosterone Injections are not for IV administration. IM Administration - Administer your shot by deep IM injection into the upper outer quadrant of the gluteus maximus.
- Topical Administration of Testosterone Gel or Cream
- AndroGel® : Apply testosterone gel topically once daily, preferably in the morning, to clean, dry, intact skin on the shoulders and upper arms and/or abdomen. Do not apply to the genitals.
- AndroGel ® unit-dose packet: Upon opening the unit-dose packet, squeeze the entire contents into the palm of the hand and immediately apply to the application site. Alternatively, squeeze a portion of the contents into the palm of the hand and immediately apply to application site; repeat procedure until entire contents of the packet has been applied.
- AndroGel® metered-dose pump: Collect gel in the palm of the hand by pressing the pump firmly and fully; apply to application site. This can be done one pump actuation at a time or after completion of all pump actuations needed for the daily dose.135 Alternatively, apply the gel directly to application site (direct application prevents loss of gel during transfer to hand).135 Prime pump by depressing 3 times before using the pump for the first dose; discard gel so that household members or pets are not exposed to the gel (i.e., rinse down sink).
- Testim® : Apply testosterone gel topically once daily, preferably in the morning, to clean, dry, intact skin on the shoulders and/or upper arms Do not apply to abdomen or genitals. Upon opening the unit-dose tube, squeeze the entire contents into the palm of the hand and immediately apply to the application site.
- To avoid transfer to other family member, immediately wash hands with soap and water after application of the gel. Allow the application site to dry for a few minutes after application of gel. After the gel has dried, cover site with clothing (e.g., a shirt) to prevent transfer to another individual.
The Manufacturer of AndroGel® recommends waiting ≥5–6 hours166 and the manufacturer of Testim recommends waiting ≥2 hours after application before showering or swimming. However, showering or swimming after the elapse of just 1 hour should have a minimal effect on the amount of testosterone gel absorbed if done very infrequently.
Wash the application site(s) thoroughly with soap and water to remove any testosterone residue prior to situations in which skin-to-skin contact with other individuals is anticipated at the site of testosterone gel application.170 171 If unwashed or unclothed skin at the site of testosterone gel application comes in contact with the skin of another individual, wash the general area of contact with soap and water as soon as possible.
Consider the possibility of secondary exposure to testosterone topical gel. (See Virilization in Children and Women from Secondary Exposure to Testosterone under Cautions.
- Transdermal System (Patches) Adroderm® or Testoderm® - Apply the transdermal system to clean, dry area of skin on the back, abdomen, upper arm, or thigh by firmly pressing the system with the adhesive side touching the skin. Do not apply to the scrotum or to oily, damaged, or irritated areas of the skin.
To avoid burn-like blisters, do not apply systems over bony prominences or on a part of the body that may be subject to prolonged pressure during sleep or sitting (e.g., the deltoid region of the upper arm, the greater trochanter of the femur, the ischial tuberosity).
Apply once daily at night (e.g., 10 p.m.). Leave transdermal system in place for 24 hours; after 24 hours, remove system and apply a new system. Apply system immediately after removal from its protective pouch and removal of the protective liner.
To minimize and/or prevent potential skin irritation, apply each transdermal system at a different site, with ≥1 week between applications to a particular site.
Mild skin irritation may be ameliorated with topical hydrocortisone 0.5 or 1% cream after system removal; alternatively, apply a small amount of triamcinolone acetonide 0.1% cream to the skin under the drug reservoir (do not use ointment formulations because they may reduce testosterone absorption).
Transdermal system does not need to be removed during sexual intercourse or while showering or bathing.
- Intrabuccal Administration (Adhesive Gum) - Press the extended-release buccal (transmucosal) tablet against the gum above the upper left or right incisor twice daily (morning and evening) about 12 hours apart. These tablets will adhere to the gum and do not dissolve completely; do not chew or swallow.161 Dislodge and remove the tablet after 12 hours. Alternate application sites above the left and right upper incisors.
Consult manufacturer’s patient information for instructions on proper intrabuccal administration and removal of the tablet.
If the gum tablet fails to properly adhere to the gum or falls off within the first 8 hours, replace the old tablet with a new one. The new tablet may remain in place until the time of the next regularly scheduled dose (i.e., 12 hours after the original buccal tablet was administered). If the buccal tablet falls off after 8 hours but before 12 hours, replace the original tablet with one that can serve as the second dose for that day.
Available as testosterone; dosage expressed in terms of testosterone. Also available as testosterone enanthate or testosterone cypionate; dosage expressed in terms of the salts.
AndroGel unit-dose packets contain 2.5 or 5 g of gel (25 or 50 mg of testosterone). Each depression of the metered-dose pump delivers 1.25 g of gel (12.5 mg of testosterone) after priming.
Testim unit-dose tubes contain 5 g of gel (50 mg of testosterone).
Dosage regimens vary.117 162 a Some clinicians recommend that lower dosages be used initially, followed by gradual increases in dosage as puberty progresses; subsequently, the dosage may be decreased to maintenance levels.
Other clinicians state that higher dosages are required initially to induce pubertal changes and lower dosages can then be used for maintenance therapy after puberty.
Usual dosage of testosterone enanthate: 50–200 mg every 2–4 weeks for a limited period of time (e.g., 4–6 months).
Usual dosage: 50–400 mg of testosterone cypionate or testosterone enanthate every 2–4 weeks.
Some clinicians recommend testosterone cypionate or testosterone enanthate dosage of 50–100 mg every 7–10 days or 100–150 mg every 2 weeks.
While dosage of 300 mg every 3 weeks also may be considered for convenience, such dosing is associated with wider testosterone fluctuations and generally is inadequate to ensure a consistent clinical response.123 Serum total testosterone concentrations generally should exceed lower limit of normal (in the range of 250–300 ng/dL) just before the next dose.123
Adult males with prepubertal onset of hypogonadism who are going through puberty for the first time with testosterone replacement: Initially, 50 mg every 3–4 weeks;f increase dosage gradually in subsequent months as tolerated up to full replacement within 1 year.123
Attainment of full virilization may require up to 3–4 years of IM testosterone replacement.
Topical Testosterone (Gel)AndroGel and Testim: Apply 50 mg of testosterone (5 g of 1% gel) once daily, preferably in the morning; this dose delivers about 5 mg of testosterone systemically.135 157 Adjust dosage according to serum testosterone concentrations obtained at regular intervals after initiating daily application of AndroGel166 and approximately 14 days after initiating Testim.157
AndroGel: If serum testosterone concentrations are below the normal range or the clinical response is inadequate, the dosage can be increased initially to 75 mg of testosterone (7.5 g of 1% gel) and, if necessary, subsequently to 100 mg of testosterone (10 g of 1% gel).135 If serum testosterone concentrations exceed the normal range, the daily dosage may be decreased.166 If serum testosterone concentrations consistently exceed the normal range at a daily dosage of 50 mg of testosterone (5 g of 1% gel), discontinue application of the gel.166
Testim: If serum testosterone concentrations are below the normal range or the clinical response is inadequate, may increase dosage to 100 mg of testosterone (10 g of 1% gel).157
Topical (Transdermal Testosterone System)
Usual initial dosage is 1 system delivering 5 mg/24 hours or 2 systems delivering 2.5 mg/24 hours applied to the skin nightly.133
Adjust dosage according to morning serum testosterone concentrations.133 Depending on requirements, increase dosage to 7.5 mg once daily (administered nightly as 1 system delivering 5 mg/24 hours plus 1 system delivering 2.5 mg/24 hours or as 3 systems delivering 2.5 mg/24 hours) or decrease dosage to 2.5 mg once daily (administered nightly as 1 system delivering 2.5 mg/24 hours).
Gum Oral - Intrabuccal
30 mg (1 extended-release transmucosal tablet) twice daily (morning and evening) about 12 hours apart.161 Serum testosterone concentration may be determined just prior to the morning dose at 4–12 weeks after initiation of intrabuccal therapy; if total serum testosterone concentration is excessive, discontinue intrabuccal therapy and consider alternative treatments.161
200–400 mg of testosterone cypionate or testosterone enanthate every 2–4 weeks.
Medical PreCautions for Testosterone Cypionate
Men with breast cancer or known or suspected prostate cancer.
Known hypersensitivity to testosterone, testosterone cypionate, testosterone enanthate, or any ingredient in the formulation.
Some manufacturers state that testosterone is contraindicated in patients with serious cardiac, renal, or hepatic disease.
Manufacturers of testosterone cypionate and testosterone enanthate injections (preparations indicated for the treatment of breast cancer) state that androgens are contraindicated in women who are or may become pregnant.
Manufacturers of testosterone gel (AndroGel, Testim) state that testosterone is contraindicated in women who are or may become pregnant, or who are breastfeeding.
Manufacturers of buccal and transdermal testosterone preparations state that these preparations should not be used in women.
Replaces diminished or absent endogenous testicular hormone in hypogonadal males.
Endogenous androgens are essential hormones that are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics.
Androgens are responsible for the growth spurt that occurs during adolescence and for the eventual termination of linear growth that results from fusion of the epiphyseal growth centers.
Large doses of androgens may suppress spermatogenesis.
Increases protein anabolism and decreases amino acid catabolism; improves nitrogen balance only when there is sufficient intake of calories and protein.
Androgens reportedly stimulate the production of erythrocytes, apparently by enhancing production of erythropoietic-stimulating factor.
Advice to Testosterone Therapy Patients
Risk of virilization in females. Advise female patients receiving testosterone therapy and female partners of patients treated with topical testosterone preparations (e.g., gel, transdermal systems) to contact their clinician if they notice changes in body hair distribution, substantial increases in acne, or other manifestations of virilization.
Risk of virilization in children resulting from secondary exposure to testosterone. Contact clinician if inappropriate changes in genital size, development of pubic hair, increased erections and libido, or aggressive behavior occur in children when transfer of topically administered testosterone gel from another individual is possible.
Importance of children and women avoiding contact with application sites on the skin of men using testosterone gel. If contact with unwashed or unclothed skin at the site of testosterone gel application occurs with the skin of another individual, importance of washing the general area of contact with soap and water as soon as possible.
Importance of promptly discontinuing testosterone gel when virilization occurs in children or women in contact with men using testosterone gel products until the cause of virilization is identified.
Risk of developing benign prostatic hyperplasia or prostate cancer.157 166 Importance of evaluating patients for prostate cancer, especially geriatric patients and those with clinical or demographic characteristics associated with increased risk, prior to initiating and during testosterone therapy.
Risk of priapism; importance of adult or adolescent males informing their clinician if too frequent or persistent penile erections occur.
Importance of periodic assessments to determine the rate of bone maturation in prepubertal males receiving testosterone therapy for delayed puberty.
Importance of patients informing their clinician of nausea, vomiting, changes in skin color, ankle swelling, or breathing disturbances (e.g., sleep apnea).
Importance of instructing patients in the proper use (see Administration under Dosage and Administration) and disposal of testosterone preparations and of providing patients a copy of manufacturer’s patient information.
Importance of advising patients receiving therapy with extended-release buccal tablets to regularly inspect the gum region where the tablet is applied and to report any abnormality to their clinician.
For patients using gel preparations, importance of strictly adhering to the recommended instructions for use and precautions from the manufacturers.
For patients using gel preparations, importance of washing hands immediately with soap and water following application of gel and covering the application site with clothing after allowing gel to dry.166 170
For patients using gel preparations, importance of avoiding fire, flames, and smoking until gel has dried.
Importance of women informing their clinician if they are or plan to become pregnant or to breast-feed.
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and herbal supplements, as well as any concomitant illnesses.
Importance of informing patients of other important precautionary information.
Testosterone Treatment Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Most preparations containing testosterone or its salts, esters, or ethers are subject to control under the Federal Controlled Substances Act of 1970, as amended by the Anabolic Steroids Control Act of 1990 and 2004, as schedule III (C-III) drugs.113 164 However, manufacturers of certain preparations containing androgenic anabolic steroid hormones (principally combinations that also include estrogens) have applied for and obtained for their products(s) an exemption from the record-keeping and other regulatory requirements of the Federal Controlled Substances Act.121 165 Under provisions of the Act, specific products can be exempted from such control by the Attorney General, in consultation with the Secretary of Health and Human Services, if the product is determined not to possess any significant potential for abuse because of concentration, preparation, combination, and/or delivery system. Because regulatory requirements for a given preparation containing an androgenic anabolic steroid may be subject to change based on these provisions, the manufacturer should be contacted when specific clarification about a preparation’s status is required.
2.5 mg/24 hour (12.2 mg/37 cm2)
5 mg/24 hour (24.3 mg/44 cm2)
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Injection (in oil)
Testosterone Cypionate (C-III)
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Injection (in oil)
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Cost of Testosterone Therapy - Comparative Estimated Pricing
This pricing information is for estimate purposes only. Actual costs to patients will vary depending on the specific testosterone replacement treatment program prescribed.
- Androderm 2MG/24HR Patches (WATSON LABS): 60/$352.00 or 180/$1,026.01
- Androderm 4MG/24HR Patches (WATSON LABS): 30/$332.00 or 90/$965.99
- AndroGel 50MG/5GM Gel (ABBOTT): 150/$368.97 or 450/$1,015.95
- AndroGel Pump 1% Gel (ABBOTT): 150/$360.97 or 450/$986.92
- AndroGel Pump 20.25 MG/ACT(1.62%) Gel (UNIMED): 75/$326.45 or 225/$959.76
- First-Testosterone 2% Ointment (CUTIS PHARMA): 60/$55.99 or 180/$145.97
- First-Testosterone MC 2% Cream (CUTIS PHARMA): 60/$53.19 or 180/$139.62
- Striant 30MG Misc (ACTIENT PHARMACEUTICALS): 60/$357.90 or 180/$1,027.07
- Testim 1% Gel (AUXILIUM PHARMACEUTICALS): 150/$330.00 or 450/$949.94
About Testosterone Cypionate Injection, USP
By Prescription Only
Testosterone Cypionate Description
Testosterone Cypionate Injection, USP for intramuscular injection contains Testosterone Cypionate, USP which is the oil-soluble 17 (beta)- cyclopentylpropionate ester of the androgenic hormone testosterone.
Testosterone Cypionate, USP is a white or creamy white crystalline powder, odorless or nearly so and stable in air. It is insoluble in water, freely soluble in alcohol, chloroform, dioxane, ether, and soluble in vegetable oils.
The chemical name for Testosterone Cypionate, USP is androst-4-en-3-one,17-(3-cyclopentyl-1-oxopropoxy)-, (17β)-. Its molecular formula is C27H40O3, and the molecular weight 412.61.
Testosterone Cypionate Manufacturers
Testosterone Cypionate Injection, USP is available in one strength, 200 mg/mL Testosterone Cypionate, USP.
- West-Ward Pharmaceutical
Each mL of the 200 mg/mL solution contains:
Testosterone Cypionate, USP 200 mg
Benzyl Benzoate, USP 0.2 mL
Cottonseed Oil, USP 560 mg
Benzyl Alcohol, USP (as preservative) 9.45 mg
Testosterone Cypionate - Clinical Pharmacology
Endogenous androgens are responsible for normal growth and development of the male sex organs and for maintenance of secondary sex characteristics. These effects include growth and maturation of the prostate, seminal vesicles, penis, and scrotum; development of male hair distribution, such as beard, pubic, chest, and axillary hair; laryngeal enlargement, vocal cord thickening, and alterations in body musculature and fat distribution. Drugs in this class also cause retention of nitrogen, sodium, potassium, and phosphorous, and decreased urinary excretion of calcium. Androgens have been reported to increase protein anabolism and decrease protein catabolism. Nitrogen balance is improved only when there is sufficient intake of calories and protein.
Androgens are responsible for the growth spurt of adolescence and for eventual termination of linear growth, brought about by fusion of the epiphyseal growth centers. In children, exogenous androgens accelerate linear growth rates, but may cause disproportionate advancement in bone maturation. Use over long periods may result in fusion of the epiphyseal growth centers and termination of the growth process. Androgens have been reported to stimulate production of red blood cells by enhancing production of erythropoietic stimulation factor.
During exogenous administration of androgens, endogenous testosterone release is inhibited through feedback inhibition of pituitary luteinizing hormone (LH). At large doses of exogenous androgens, spermatogenesis may also be suppressed through feedback inhibition of pituitary follicle stimulating hormone (FSH).
There is a lack of substantial evidence that androgens are effective in fractures, surgery, convalescence, and functional uterine bleeding.
Testosterone esters are less polar than free testosterone. Testosterone esters in oil injected intramuscularly are absorbed slowly from the lipid phase; thus, Testosterone Cypionate can be given at intervals of two to four weeks.
Testosterone in plasma is 98 percent bound to a specific testosterone-estradiol binding globulin, and about 2 percent is free. Generally, the amount of this sex-hormone binding globulin in the plasma will determine the distribution of testosterone between free and bound forms, and the free testosterone concentration will determine its half-life.
About 90 percent of a dose of testosterone is excreted in the urine as glucuronic and sulfuric acid conjugates of testosterone and its metabolites; about 6 percent of a dose is excreted in the feces, mostly in the unconjugated form. Inactivation of testosterone occurs primarily in the liver. Testosterone is metabolized to various 17-keto steroids through two different pathways.
The half-life of Testosterone Cypionate when injected intramuscularly is approximately eight days.
In many tissues the activity of testosterone appears to depend on reduction to dihydrotestosterone, which binds to cytosol receptor proteins. The steroid-receptor complex is transported to the nucleus where it initiates transcription events and cellular changes related to androgen action.
Indications and Usage for Testosterone Cypionate
Testosterone Cypionate Injection, USP is indicated for replacement therapy in the male in conditions associated with symptoms of deficiency or absence of endogenous testosterone.
- Primary hypogonadism (congenital or acquired)-testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome; or orchidectomy.
- Hypogonadotropic hypogonadism (congenital or acquired)-idiopathic gonadotropin or LHRH deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation.
- Known hypersensitivity to the drug
- Males with carcinoma of the breast
- Males with known or suspected carcinoma of the prostate gland
- Women who are or who may become pregnant
- Patients with serious cardiac, hepatic or renal disease
Testosterone Cypionate Warnings
Hypercalcemia may occur in immobilized patients. If this occurs, the drug should be discontinued.
Prolonged use of high doses of androgens (principally the 17-α alkyl-androgens) has been associated with development of hepatic adenomas, hepatocellular carcinoma, and peliosis hepatis —all potentially life-threatening complications.
Geriatric patients treated with androgens may be at an increased risk of developing prostatic hypertrophy and prostatic carcinoma although conclusive evidence to support this concept is lacking.
Edema, with or without congestive heart failure, may be a serious complication in patients with pre-existing cardiac, renal or hepatic disease.
Gynecomastia may develop and occasionally persists in patients being treated for hypogonadism.
Androgen therapy for low t should be used cautiously in healthy males with delayed puberty. The effect on bone maturation should be monitored by assessing bone age of the wrist and hand every 6 months. In children, androgen treatment may accelerate bone maturation without producing compensatory gain in linear growth. This adverse effect may result in compromised adult stature. The younger the child the greater the risk of compromising final mature height.
This drug has not been shown to be safe and effective for the enhancement of athletic performance. Because of the potential risk of serious adverse health effects, this drug should not be used for such purpose.
Testosterone Treatment Precautions
Patients with benign prostatic hypertrophy may develop acute urethral obstruction. Priapism or excessive sexual stimulation may develop. Oligospermia may occur after prolonged administration or excessive dosage. If any of these effects appear, the androgen should be stopped and if restarted, a lower dosage should be utilized.
Testosterone Cypionate should not be used interchangeably with testosterone propionate because of differences in duration of action.
Testosterone Cypionate is not for intravenous use.
Testosterone Information for patients
Patients should be instructed to report any of the following: nausea, vomiting, changes in skin color, ankle swelling, too frequent or persistent erections of the penis.
Laboratory tests Hemoglobin and hematocrit levels (to detect polycythemia) should be checked periodically in patients receiving long-term androgen administration.
Serum cholesterol may increase during androgen therapy.
Testosterone Drug interactions
Androgens may increase sensitivity to oral anticoagulants. Dosage of the anticoagulant may require reduction in order to maintain satisfactory therapeutic hypoprothrombinemia.
Concurrent administration of oxyphenbutazone and androgens may result in elevated serum levels of oxyphenbutazone.
In diabetic patients, the metabolic effects of androgens may decrease blood glucose and, therefore, insulin requirements.
Drug/Laboratory test Interferences
Androgens may decrease levels of thyroxine-binding globulin, resulting in decreased total T4 serum levels and increased resin uptake of T3 and T4. Free thyroid hormone levels remain unchanged, however, and there is no clinical evidence of thyroid dysfunction.
Carcinogenesis Animal data - Testosterone has been tested by subcutaneous injection and implantation in mice and rats. The implant induced cervical-uterine tumors in mice, which metastasized in some cases. There is suggestive evidence that injection of testosterone into some strains of female mice increases their susceptibility to hepatoma. Testosterone is also known to increase the number of tumors and decrease the degree of differentiation of chemically induced carcinomas of the liver in rats.
Human data. There are rare reports of hepatocellular carcinoma in patients receiving long-term therapy with androgens in high doses. Withdrawal of the drugs did not lead to regression of the tumors in all cases.
Geriatric patients treated with androgens may be at an increased risk of developing prostatic hypertrophy and prostatic carcinoma although conclusive evidence to support this concept is lacking.
Testosterone and Women - Pregnancy
Teratogenic Effects, Pregnancy Category X - Nursing mothers - Testosterone Cypionate injection is not recommended for use in nursing mothers.
Testosterone Adverse Reactions
The following adverse reactions in the male have occurred with some androgens:
Endocrine and urogenital: Gynecomastia and excessive frequency and duration of penile erections. Oligospermia may occur at high dosages.
Skin and appendages: Hirsutism, male pattern of baldness, seborrhea, and acne.
Fluid and electrolyte disturbances: Retention of sodium, chloride, water, potassium, calcium, and inorganic phosphates.
Gastrointestinal: Nausea, cholestatic jaundice, alterations in liver function tests, rarely hepatocellular neoplasms and peliosis hepatis (see WARNINGS).
Hematologic: Suppression of clotting factors II, V, VII, and X, bleeding in patients on concomitant anticoagulant therapy, and polycythemia.
Nervous system: Increased or decreased libido, headache, anxiety, depression, and generalized paresthesia.
Allergic: Hypersensitivity, including skin manifestations and anaphylactoid reactions.
Miscellaneous: Inflammation and pain at the site of intramuscular injection.
Testosterone is a controlled substance under the Anabolic Steroids Control Act, and Testosterone Cypionate injection has been assigned to Schedule III.
Testosterone Cypionate Dosage and Administration - Testosterone Overdose - There have been no reports of acute overdosage with the androgens.
Testosterone Cypionate injection is for intramuscular use only.
It should not be given intravenously. Intramuscular injections should be given deep in the gluteal muscle.
The suggested dosage for Testosterone Cypionate injection varies depending on the age, sex, and diagnosis of the individual patient. Dosage is adjusted according to the patient's response and the appearance of adverse reactions.
Various dosage regimens have been used to induce pubertal changes in hypogonadal males; some experts have advocated lower dosages initially, gradually increasing the dose as puberty progresses, with or without a decrease to maintenance levels. Other experts emphasize that higher dosages are needed to induce pubertal changes and lower dosages can be used for maintenance after puberty. The chronological and skeletal ages must be taken into consideration, both in determining the initial dose and in adjusting the dose.
For replacement in the hypogonadal male, 50 to 400 mg should be administered every two to four weeks.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Warming and shaking the vial should redissolve any crystals that may have formed during storage at temperatures lower than recommended.
How is Testosterone Cypionate Supplied
Testosterone Cypionate Injection, USP, 200 mg/mL is a clear, pale yellow oleaginous viscous, sterile solution intended for intramuscular administration available as:
- 10 mL Multiple Dose Vials, Cartons of 1 vial NDC 0143-9726-01
Store at 20º to 25ºC (68º to 77ºF) [see USP Controlled Room Temperature].
Protect from light.
- Testosterone Cypionate Injection, USP
2,000 mg/10 mL
- Testosterone Cypionate Injection, USP
2,000 mg/10 mL
One 10 mL Multiple Dose Vial
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