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Testosterone
Testosterone is a hormone replacement therapy (HRT) used to treat hypogonadism in men, a condition where the body does not produce enough testosterone. Testosterone is the primary male sex hormone responsible for the development of male characteristics, such as muscle mass, body hair, and deepening of the voice, and it plays a crucial role in maintaining bone density, libido, and mood. It is available in various forms, including injections, gels, patches, and oral formulations. Testosterone therapy can help restore normal levels and alleviate symptoms of low testosterone, such as fatigue, low libido, and reduced muscle mass.
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Frequently Asked Questions
How long does it take for testosterone therapy to start working?
Some symptoms, such as improved libido and energy, may improve within a few weeks of starting testosterone therapy. Full effects on muscle mass, mood, and other symptoms may take several months.
Can testosterone therapy cause infertility?
Yes, testosterone therapy can suppress the body's natural production of testosterone, leading to a reduction in sperm production and potential infertility. Men who want to maintain fertility should discuss alternative treatments with their healthcare provider.
What should I do if I miss a dose of testosterone?
If you miss a dose of injectable testosterone, take it as soon as you remember. If it's close to your next scheduled dose, skip the missed dose and continue as normal. For patches or gels, apply the missed dose as soon as possible.
Can testosterone cause mood changes?
Yes, testosterone can cause mood swings, irritability, and aggression in some individuals. If you experience significant mood changes, discuss this with your healthcare provider.
Can women use testosterone?
Testosterone is generally not recommended for women, except in specific situations (e.g., to treat low libido in postmenopausal women). However, high doses can lead to virilization (development of male characteristics) in women.
Comprehensive Drug Guide
How Does Testosterone Work?
Testosterone works by supplementing the body with exogenous testosterone, replacing the natural hormone that the body is lacking in individuals with hypogonadism. Testosterone helps regulate muscle growth, bone density, fat distribution, red blood cell production, and sexual function. It binds to androgen receptors in tissues such as muscle, bone, and the reproductive system, stimulating the development of male secondary sexual characteristics and maintaining overall male health.
Common Dosages
- Injectable testosterone cypionate: 50-400 mg administered intramuscularly every 2-4 weeks.
- Transdermal gel: 5-10 grams applied once daily.
- Transdermal patches: 2-4 mg applied once daily, usually at bedtime.
- Oral formulations: 158 mg to 396 mg taken twice daily with food.
- Pellet implants: Inserted every 3-6 months.
Typical Dosing
- Injectable testosterone cypionate: Typical dose is 100-200 mg every 1-2 weeks for hypogonadism.
- Transdermal gel: Starting dose is 50 mg applied once daily, adjusted based on serum testosterone levels.
- Patches: 4 mg/day applied to the skin, typically at night, adjusted based on response.
Dosages vary depending on individual needs, testosterone levels, and response to therapy.
Typical Dosing
FDA Approved Indications
- Primary hypogonadism (congenital or acquired): Where the testes do not produce sufficient testosterone.
- Hypogonadotropic hypogonadism (congenital or acquired): Where there is inadequate stimulation of the testes by gonadotropins due to pituitary or hypothalamic disorders.
Who Shouldn't Take Testosterone?
- Prostate cancer or breast cancer in men.
- Severe liver or kidney disease.
- Serious heart conditions, such as heart failure or recent heart attack.
- Known hypersensitivity to testosterone or any components of the formulation.
- Pregnancy or breastfeeding, as testosterone is contraindicated in women for these reasons.
Advice From The Pharmacist
- Follow the prescribed dosing schedule for your testosterone formulation. Whether it’s an injection, gel, patch, or oral form, take it consistently at the same time each day or week.
- For gels, apply to clean, dry skin on the upper arms or shoulders, and avoid swimming, showering, or bathing for at least 2 hours after application to allow proper absorption.
- For patches, apply to a different area of the skin each night, rotating application sites to avoid irritation.
- Monitor testosterone levels through regular blood tests as recommended by your healthcare provider to ensure your levels remain within the therapeutic range.
- Do not share your testosterone medication with others, as it is a controlled substance with potential for misuse.
- Be aware of signs of testosterone overdose, such as extreme fatigue, irritability, or enlarged breasts (gynecomastia), and report these to your healthcare provider.
Side Effects of Testosterone
Common Side Effects
- Acne or oily skin
- Increased hair growth
- Headache
- Mood changes (e.g., irritability, aggression)
- Increased appetite
- Breast enlargement (gynecomastia)
- Swelling in the ankles or feet (fluid retention)
Uncommon/Severe Side Effects
- Prostate enlargement or worsening of prostate cancer.
- Blood clots (deep vein thrombosis or pulmonary embolism).
- Heart attack or stroke, particularly in older men or those with pre-existing cardiovascular conditions.
- Liver toxicity (especially with oral formulations).
Risks and Warnings of Testosterone
- Cardiovascular risk: Testosterone may increase the risk of heart attack or stroke, particularly in older men and those with pre-existing heart conditions. Patients should be closely monitored for cardiovascular symptoms.
- Prostate cancer risk: Testosterone can stimulate the growth of prostate tissue, potentially exacerbating undiagnosed prostate cancer. Routine prostate exams and PSA tests are recommended during therapy.
- Liver toxicity: Oral testosterone can increase the risk of liver problems. Injectable and transdermal forms have less liver impact, but monitoring of liver function is still recommended.
- Polycythemia: Testosterone can increase red blood cell production, which can lead to a thickening of the blood and increase the risk of blood clots. Regular blood tests are needed to monitor red blood cell counts.
Interactions with Testosterone
Common Drug Interactions
- Anticoagulants (warfarin): Testosterone can increase the effects of blood thinners, leading to an increased risk of bleeding.
- Corticosteroids: Combining testosterone with corticosteroids can increase fluid retention, raising the risk of heart failure in susceptible individuals.
- Diabetes medications: Testosterone may affect blood sugar levels, requiring adjustments in insulin or oral diabetes medications.
Alternatives to Testosterone
- AndroGel: A transdermal gel that delivers testosterone through the skin, commonly used for testosterone replacement.
- Testim: Another testosterone gel used to treat low testosterone levels.
- Testopel: A testosterone pellet that is implanted under the skin and releases testosterone over several months.
- Clomiphene citrate: An off-label alternative for men who wish to maintain fertility while boosting testosterone levels.
- Human chorionic gonadotropin (hCG): Sometimes used in men to stimulate natural testosterone production, particularly in cases of secondary hypogonadism.
