Testosterone replacement
Testosterone can be administered in multiple ways.
Gel applied on the skin
This is a clear transparent gel which comes in a cannister. apply 1, 2 or 3 actuations as advised by your doctor. This is best done in the morning . Please read the product insert and apply according to instructions. It is important for it to be administered in areas where transmission to your partner is avoided (eg outer aspect of arms, inner aspect of thighs. it takes about 5 minutes to dry and 5 minutes later you can put on your clothes. This is an alcohol based gel and may dry out your skin. Apply some moisturising cream afterwards to avoid skin drying out.
- Do not exceed prescribed dose
- The levels are most steady with this application
- Apply at the same time every day
Monthly injections
These are intra muscular injections and has to administered after training or by a health care professional. There can be some soreness after the injection. This is in PEANUT oil and advise your health care professional if you are allergic. The levels are higher than normal for 10 days, in normal range for 10 days and below range for 10 days.
- Avoid vigorous exercise for a few hours after injection
- Notify your doctor if you are on blood thinning medications (eg aspirin, rivaroxiban)
3 monthly injections
These injections are only once a month, but a larger volume 4 ml. This is given into the buttocks and can be sore for a few days. Ensure the vial is warmed up and liquid before you administer it. Large bore needle may be needed (20 G). This may have good levels for about 6 – 8 weeks, then in normal range and a couple of weeks may be below range (peak and trough effect).
- Avoid vigorous exercise for a couple for days after injection. Low to moderate activity, like walking is fine.
- This is best avoided if you are on blood thinning medications ( eg aspirin, rivaroxiban)
Daily sub cutaneous injection
This is provided by many “Men’s Health Clinics”. The proposed advantage is a more steady level by injecting smaller amounts daily. A new syringe and needle is required daily, and one has to use strict hygiene techniques to avoid infection. The patient will have to draw up and dilute the injections.
- Often doses are much higher than recommended testosterone replacement dose
- significantly more expensive with needles etc
- More chance of infection
- daily or alternate day injections under the skin
Clomiphene citrate tablets
This seems to be emerging as a safe option for hypogonadism, but is not approved for treatment of hypogonadismon the NHS
Clomiphene is a SERM (Selective oEstrogen Receptor Modulator) . In summary , it prevents the hypothalamus/ pituitary from seeing the oestrogen and androgen in the blood and this leads to increased secretion of GNRH/ FSH/LH ( Hormones to start testosterone production). In effect it releases the brakes on testosterone production.
Most frequent side effects were: mood changes, blurred vision, breast/nipple tenderness, weight gain, headache.
Complex cycling regimes
There are several regimes used by which are not approved for treatment. This can involve HCG injections, testosterone injections and androgen blockers. This in effect BOOSTS rather than replaces Testosterone. In this way you can get to much higher levels of testosterone, bypassing the body’s normal shut off mechanisms. ( Analogous to flooring the accelerator and removing the brakes of a car) This involves giving much higher doses and adding in medications to prevent side effects This includes HCG injections (to prevent testicular atrophy) , Finasteride/ dutasteride ( to prevent hair loss).