Adapted from Minhas and Mulhall, 2017.5
AI – aromatase inhibitor, CV – cardiovascular, CVD – cardiovascular disease, FSH – follicle-stimulating hormone, FT – free testosterone, HCG – human chorionic gonadotropin, LH – luteinising hormone, MRI – magnetic resonance imaging, PSA – prostate-specific antigen, SERM – selective oestrogen receptor modulator, SHBG – sex hormone-binding globulin, T Therapy – testosterone therapy, TT – total testosterone
*For men with TT levels <5.2 nmol/L plus low LH and FSH or increased prolactin levels, refer to endocrinology or arrange a pituitary MRI scan to exclude a pituitary adenoma.3,4
**These drugs should not be used if pituitary function is compromised. SERMs and AIs are not currently licensed for TD.
***Please refer to SmPC for the posology and method of administration of Nebido
Serum testosterone- measure between 7–11 am,5 with a reliable method, on at least 2 occasions5,7 preferably 4 weeks apart. Fasting levels should be obtained where possible, as recommended by the European Association of Urology (EAU).5
If low/borderline, measure LH* and FSH, **plus SHBG to calculate FT
FT- can be calculated using our Free testosterone calculator
Formulation | Route of administration | Frequency of administration | Advantages | Disadvantages |
---|---|---|---|---|
Testosterone 1%, 1.62%* and 2% gel available *1.62% = 16.2 mg/g |
Transdermal gel 1% (sachets/tubes) 1.62%* (pump) 2% (pump) *1.62% = 16.2 mg/g |
|
|
|
Testosterone undecanoate | Intramuscular injection | Every 10–14 weeks, adjusted to maintain trough testosterone >12 nmol/L |
|
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Testosterone enantate | Intramuscular injection | Every 2–3 weeks | Can be administered every 3–6 weeks for maintenance, according to individual requirement18 |
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Mix of 4 testosterone esters (including propionate) as Sustanon 250 | Intramuscular injection | Usually administered every 3 weeks May cause a reaction at the injection site19 |
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