The best way to prescribe testosterone is to work closely with a hormone specialist or endocrinologist to determine if hormone replacement therapy (HRT) with testosterone is appropriate for a patient's needs and medical history. A physical exam and discussion of symptoms and goals is key, along with conducting important blood tests to check current testosterone levels and rule out conditions that could be impacted by testosterone therapy.
If HRT is deemed appropriate, there are a few main testosterone administration options to consider:
- Testosterone injections, such as testosterone cypionate or testosterone enanthate injections every 1-2 weeks. This allows testosterone levels to remain more consistent compared to gels or patches.
- Testosterone gels/creams that are applied to the arms, shoulders or upper body daily. These provide a convenient daily application, but some testosterone can transfer through skin contact.
- Testosterone patches applied to the skin daily, which provides a time-release of testosterone. Skin irritation is a potential side effect.
- Testosterone pellets that are surgically implanted under the skin every 3-6 months. This provides consistent testosterone levels but requires minor surgery for ongoing use.
When initiating HRT, it’s important to
start with a conservatively low dose and gradually make adjustments based on follow-up bloodwork and symptom evaluation.
Monitoring via blood tests should be conducted regularly in the first year and periodically long-term to avoid adverse effects from having too high or too low testosterone levels.
Potential side effects to monitor closely include impacts on red blood cell count, cholesterol levels, prostate health, emotional changes, acne, and sleep quality. HRT may increase risks for cardiovascular events in some patients, so conducting CV risk assessment is prudent.
At Optimal Hormone Health Center we specialize in precision testosterone optimization for men and women. Our board-certified physicians and nurse practitioners take a holistic approach to HRT, considering your symptoms, health history, fitness goals and lab testing to craft a customized treatment plan. We offer all testosterone therapy options for the utmost convenience and comfort of our patients and provide caring ongoing care with monthly follow-ups in the first year of therapy.
In terms of specific best practices in prescribing testosterone:
For testosterone injections:
- Cypionate or enanthate esters injected every 7-14 days is typical
- Inject deep into large muscles like upper buttocks or thighs
- Use small gauge needles, inject slowly
- Rotate injection sites to minimize discomfort and scarring
- Adjust dose and/or frequency based on lab testing and symptom evaluation
For testosterone gels:
- Start with lower doses like 50mg daily
- Apply to clean dry skin of shoulders, upper arms or thighs
- Allow gel to dry before dressing to avoid transfer
- Wash hands thoroughly after application
- Be mindful of skin irritation, but try other product formulations if it occurs
For testosterone patches:
- Vary location from day to day on abdomen, back, thighs or upper arms
- Do not apply patches to the same skin site consecutive days
- Use adhesives designed for skin sensitivity if irritation occurs
- Apply pressure to patch edges to ensure adhesion
For testosterone pellets:
- 400-800mg pellets implanted every 3-6 months
- Use local anesthetic; insert into subdermal layer of buttocks
- Use sterile procedure and compression dressing after to minimize bleeding/bruising
- Schedule follow up 1 week post-implantation to check incision site
The decision of which testosterone delivery method is most appropriate is based on the
patient's lifestyle factors, preferences, sensitivities and treatment goals. Close provider-patient collaboration with
careful, regular monitoring and follow-up care is key to successful long-term testosterone replacement outcomes.
