For men who suffer from hypogonadism or testosterone deficiency, there are several ways to provide testosterone replacement: oral, injectable, cutaneous (patches and ointment) and pellets.
Oral and injectable are not bio-identical
They cannot be well monitored and controlled. A long-term oral treatment (methyl-testosterone) is unwarranted because of a strong potential of liver toxicity.
We advise against injectable solutions using propionate or enanthate because they are not truly long-acting (as advertised).
They provide an undesirable roller-coaster phenomenon and often cause hemoconcentration or polycythemia (increase thickness or viscosity of the blood that can be associated with higher risk of thrombus or clot formation leading to strokes).
We strongly advise the use of patches (or ointment) and/or pellets
They both provide the bio-identical (natural) testosterone that can be measured in a blood sample. Therefore, the treatments can be easily titrated and monitored in order to prevent side-effects.
Pellets are superior to other modalities because of their duration of action and release kinetics. Patches (or ointment) have to be applied daily.
PSA, liver function and blood counts must be checked annually with any type of Testosterone treatments.
All patients should be warned that any testosterone treatment will cause a significant decrease or suppression of sperm production.
Therefore, it should not be given to any man who wishes to start a family.