Testosterone Options - Which is Best for You?

If you're curious about your (traditional, on-label) options to treat hypogonadism, check out Monthly Prescribing Reference which is used by many physicians to keep up-to-date regarding all the (new) medications available.  Personally, I've always stated that the best therapy for any given individual is the one that he can afford and is willing to self-administer.  More importantly, this method may change from time to time depending upon specific needs, eg international travel or backpacking/camping in the wild vs staying at home.  After all, you might not want to cross borders & check points and have to explain needles & a vial to some security guard.  Or you might feel a bit apprehensive about injecting under sterile conditions while deep inside a National Park.

While oral androgens do carry FDA approval, I would never prescribe them to any of my patients due to greater concern for liver issues, eg peliosis hepatis, compared to any other form of administration.  I can certainly understand why traditionally we've asked our patients to come into our offices for intramuscular (IM) shots of testosterone.  And I can certainly understand why some patients might not feel comfortable self-administering an IM shot into their gluteus maximus or vastus lateralis.  However, off-label subcutaneous injections (similar to injecting insulin) have been studied and are a consideration.

For hypogonadal men who are still interested in maintaining their fertility, I would avoid any of the above options as they tend to suppress pituitary function and thus testicular production of sperm.  Off-label options to consider are chorionic gonadotropin (for direct testicular stimulation by mimicking LH & FSH) and clomiphene (by inducing the pituitary to produce more LH & FSH).  These latter options might be beyond the comfort level of many primary care physicians but are certainly not without support in published literature.

The take home point?  Make sure you're aware of all your options and make sure your treatment is individualized to you.

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