ASK DR.K: No T, More T?

Updated: Mar 11

Dear Dr. K, my testosterone is low on my blood test. My doctor recommended testosterone replacement. What is the best way to do this?

Testosterone (T) replacement is currently available in several different ways: tablets, sublingual pills, topical creams, injections and pellets. There are advantages and disadvantages to each method. Tablets and pills are poorly absorbed, so they only deliver a relatively low dose to the bloodstream. Topical creams and ointments are absorbed erratically and, if a woman or child comes in contact with the area of application, the T may rub off on them, causing virilizing effects.

Injections and pellets offer the most reliable means for raising T levels. Injectable testosterone has been available for several decades and is relatively safe and well-tolerated. Several formulations of T are available for injection, the most commonly prescribed being testosterone cypionate. The medication is dispensed in an oily base, so it requires a larger caliber needle for injection. Injections are most often done in the upper quadrant of the buttocks, although the front of the thigh or the back of the deltoid may also be used. Men usually are instructed on how to do the injections themselves, or a partner may be willing to do the injections. The injections are usually done weekly. A smaller dose could be administered twice a week to keep a consistent blood level.

Having to have repeated injections is one of the disadvantages of this method. The second disadvantage is that drug must pass through the liver to become active. This can lead to a build-up of chemicals in the liver that may cause damage to the liver cells. Third, this method has the potential for abuse, especially by those who se