Men: Know the pros and cons of options for medically approved testosterone replacement therapy


The role of the male hormone testosterone in maintaining a man’s health and well-being is crucial. Adequate testosterone levels help men maintain a healthy sex drive, energy levels, skeletal muscles mass and strength, bone mineral density, and the ability to get and maintain an erection. Basically, it’s what helps men feel, act, and be a man. 

Testosterone’s role is so important that a deluge of health clinics, focused solely on marketing testosterone products to men seeking medical help for sexual problems, have sprung up across the United States. In other words, it’s big business. Each year, American men spend $2 billion on testosterone replacement therapies (TRT). In fact, the majority of TRT off-label use is by men aged 40-64, is mainly for normal declining levels of testosterone related to aging.  However, TRT has not been approved by the FDA for age-related declines in testosterone.

Understanding the approved use of TRT

TRT, also called androgen replacement therapy, is a FDA approved medication for treating male hypogonadism (low testosterone or “low T”) due to certain circumstances. Besides normal aging, low T occurs when a man’s body is not making enough testosterone, often due to conditions such as the following:

  • Primary hypogonadism 
  • Hypopituitarism
  • Testicular, prostate, or male breast cancers
  • Bilateral orchidectomy- removal of the testes
  • Delayed puberty
  • Injuries to the testes

These are the conditions that the FDA has approved for medical treatment of low T. Men with these conditions and who are experiencing symptoms of low T should have their levels checked by their primary care physician for an accurate diagnosis and assessment of which TRT is best for them.  

Advantages and drawbacks to testosterone replacement therapy options

There are various medically approved options for low T, each with advantages and drawbacks for men to consider. Once a man is determined to require medically approved TRT, this likely will be a medically necessary lifelong treatment. To assess and regulate if TRT is working, hormone levels will need consistent monitoring by their doctor about every six to twelve months, with adjustments made as needed.

There are various options of TRT available, and like any medication, each with unique advantages and drawbacks. Finding the right one for each man needs to take into account their lifestyle, the ease of use of a treatment option, availability, and insurance coverage. Men should discuss with their doctor the risks and benefits of TRT to maximize the benefits and minimize the risks.

Here are brief descriptions of available TRT options, along with their advantages and drawbacks:

  • Injections

Injections for low T, first approved in 1979, are a standard testosterone replacement therapy treatment. Today, there are various types of injections delivered subcutaneously to replace what the body normally makes. 

Advantages:  Less expensive than other options; can be injected at home typically every one to two weeks; needle is small; provides noticeable improvement in testosterone levels fairly rapidly. 

Drawbacks: Injection site risk of infection, redness, or swelling; May increase liver or heart problems, blood clots, and may worsen pre-existing benign prostatic hyperplasia or prostate tumors. 

  • Patches

Testosterone transdermal patches are applied to clean, dry skin, usually at night and then left on for the next 24 hours before being replaced with a new patch. Patches can be applied to the back, abdomen, thighs, or upper arm but not to the genital area or scrotum.

Advantages: Easy to apply; can be worn during a bath or shower, swimming, and sexual activity.

Drawbacks: Heavy exercise or sweating can cause the patch to slip off; may cause burn-like blisters, redness, itching at the application site in some men, must choose a new spot each night for the patch and wait at least seven days before re-using that spot. 

  • Pellets

About the size of a grain of rice, TRT pellets are implanted under the skin near the hip or on the buttocks. Implantation takes place at the doctor’s office and the pellet remains in the skin for up to three to six months, as it delivers a steady, low dose of crystallized testosterone.

Advantages: Noticeable boost in energy and sex drive; ease of use; implant procedure is quick and convenient.

Drawbacks: The pellet may work its way out of the skin; dosage of implanted pellet is not easily adjusted if needed; risk of infection or scarring.

  • Gels

Testosterone gels are applied directly to the skin by rubbing it in once daily in the morning. The gel is absorbed directly into the skin, delivering a steady dose of testosterone as prescribed by his doctor. Depending on the brand of gel, the application site is typically the shoulders or upper arm, abdomen, or front or inner thighs. Do not apply to the penis or scrotum or to any skin surface with a cut, crack or rash. 

Advantages: Easy to apply; gel dries quickly, easy to fit into a man’s daily routine.

Drawbacks: Somewhat messy application; may irritate skin causing redness, dryness, or itching; accidental transfer from a man’s body to someone else’s can cause serious health reactions to women and children. 

  • Buccal Testosterone

A tablet-shaped patch, buccal testosterone is applied to only the upper gum, above the left and right incisors, and is absorbed through the mucosa of the mouth. It is applied twice a day, every twelve hours, ideally at the same times each day. 

Advantages: Unobtrusive; easy to place on gums; eating, drinking fluids, chewing gum are allowed when wearing the patch. 

Drawbacks: Gums can become easily swollen, red, irritated, painful, tender; may leave an unpleasant or bitter taste in mouth; may impair taste buds; can be easily dislodged; easy to forget to remove and replace with a new patch every twelve hours; should not be chewed or swallowed. 

In conclusion

An important first step for any man deciding on a TRT option is to have a thorough, in-depth conversation with his doctor. Because of the range of reasons for medically necessary TRT for some men, using a safe and effective TRT helping significantly enhance and improve a man’s overall quality of life, can be a literal, life-changing event for these men.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.

Men: Know the pros and cons of options for medically approved testosterone replacement therapy
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Dr. David B. Samadi

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Dr. David B. Samadi