As men age, they commonly develop a condition known as hypogonadism, which results in diminishing levels of testosterone. Low levels of this important sex hormone can impair sexual function, reduce fertility, deplete energy and muscle strength, weaken bones, and depress mood. In addition, certain types of medications—psychiatric drugs, anticonvulsants (often used to prevent epilepsy), hormones, immune system suppressants, and opiates—can also lower testosterone, with similar effects. On the bright side, this not uncommon condition can be treated in several ways.

Testosterone Replacement Therapies

Common hormone replacement options include:

  • Topical Gel. Testosterone gel is applied to upper body areas, such as shoulders, upper arms or armpits, or on the inner thighs or abdomen, depending on the product. Some gels come with a dab-on or pump applicator. Gels must be left on the skin for several hours to ensure absorption. To avoid transferring the hormone to someone else, the gel must be completely absorbed or covered before contact with another person.
  • Patches. A testosterone-infused skin patch is applied to a different part of the body (back, abdomen, upper arm, or thigh) each week. The rotation helps prevent the skin irritation often associated with use of a testosterone patch.
  • Injections. Testosterone can be injected into large muscles, such as buttocks or thighs. Injections, which are taken weekly or biweekly, are considered effective and cost-effective. You can be taught to administer your own injections, and testosterone levels may fluctuate throughout the dosing period.
  • Subcutaneous Pellets. Ten to 14 testosterone-containing pellets, each about the size of a grain of rice, are implanted just under the skin. The pellets are auto-dosing, which means they automatically release the correct dose of testosterone, and need to be replaced approximately every four months. There is a very low risk of bleeding, infection, or pellet extrusion (the pellet working itself back out of the skin) upon placement.
  • Buccal Tabs. A gel-like substance containing testosterone is placed inside the mouth, above the top teeth, where it sticks to the upper gum and lip. This method requires twice-daily dosing. In addition, although rarely prescribed, sublingual lozenges that dissolve under the tongue may be available from a compounding pharmacist.

Risks and Benefits

Each of these testosterone replacement methods has obvious pros and cons in terms of convenience, and some forms may work better for some men than others. All hormone replacement therapies come with some risk of side effects, such enlarged prostate or breasts, diminished sperm production, sleep apnea, blood clots, and stimulation of pre-existing prostate cancer cells. Recent studies also hint at a link between testosterone therapy and increased risk of heart attack in older men and also in younger men with established heart disease, although the study results are debatable, and a true link has not been well established.

"Most side effects occur rarely," says Adrian Dobs, MD, MHS, director of the Johns Hopkins Clinical Research Network in Baltimore. "However, all forms of testosterone replacement therapy can result in further suppression of a man’s own secretion of the hormone, and also diminish sperm production."

However, there are also potential benefits: "Testosterone therapy may improve insulin sensitivity and inflammation, and boost serum [in the blood] testosterone to levels that result in improved physical function," Dobs points out.

Alternative Testosterone Boosters

Several non-testosterone treatments can also help increase testosterone levels. For instance:

  • Anastrozole suppresses the conversion of testosterone to estrogen, raising testosterone levels and reducing estrogen levels.
  • Clomiphene citrate increases the body’s production of testosterone, improving semen quality in some men.
  • hCG injections boosts the body’s production of testosterone to preserve fertility; hCG injections stimulate the testicles after periods of testosterone administration.

What You Can Do

Further research is necessary to help medical professionals and patients weigh the benefits of testosterone therapy against the risks for the general population of aging men. If you have concerns about low testosterone levels, speak with your physician. You may be referred to an endocrinologist (a doctor who specializes in issues associated with hormones) or other specialist who can answer specific questions and discuss treatment.

Adrian Dobs, MD, MHS, reviewed this article.


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"Testosterone Buccal." Medline Plus. Page last revised February 15, 2014.