Navigating TRT: What You Need to Know About Testosterone Replacement Therapy

Hypogonadism, commonly known as testosterone deficiency or low T, refers to low gonadal activity or the reduced production of the male hormone. Because some of the factors that can make you more susceptible to developing low testosterone are on the rise, adequate treatment — in the form of testosterone replacement therapy, is garnering more interest.

Depending on the exact criteria you use to define testosterone deficiency, there are between 10% to 40% of male adults currently living with hypogonadism. The majority of individuals affected are over the age of 40, as your testosterone levels naturally decrease with age, at a rate of about 1% every year

Given the increasing demand, a wide range of testosterone replacement therapy is key in providing diverse treatment options to patients. The good news is that TRT has evolved so much that if you have low T, it’s easy to find a suitable form of therapy.

What is Testosterone Replacement Therapy (TRT)?

Having numerous TRT options to choose from can enhance your health journey. As a matter of fact, testosterone replacement therapy has come a long way — promoting treatment compliance and thus the successful restoration of normal testosterone levels.

Below is a comprehensive list of testosterone replacement therapy options that are available to you today.

Oral TRT

Oral medications are the most popular route of administration for most medical conditions and there’s a reason for that. Oral testosterone replacement therapy is highly convenient; you can self-administer it and store the capsules easily. 

An issue with some of the other forms of TRT is that absorption can be erratic and inaccurate. Testosterone replacement therapy gel, for example, can be absorbed differently and is impacted by transference. However, oral TRT offers exact and reliable dosing and is taken twice daily with food.

Because oral TRT is so easy to take, you’re more likely to adhere to the treatment — and increased compliance means you have a better chance at achieving normal testosterone levels.

Oral testosterone undecanoate (TU) was developed in the 1970s and is absorbed into your lymphatic system. There are currently three oral testosterone undecanoate options available in the U.S., all of which have been approved by the Food and Drug Administration (FDA) — KYZATREX, Jatenzo, and Tlando.

Oral TU has been shown to provide significant symptomatic relief and has a small risk of erythrocytosis, which means that it doesn’t increase the concentration of red blood cells like some of the other forms of TRT can do. It also doesn’t lead to full gonadal suppression, which is imperative for men who would like to start a family.

Topical TRT

Topical application of testosterone is a mainly safe and easy way to use testosterone and is available as transdermal patches and topical gels. However, there are a couple of downsides to using testosterone replacement therapy gels — varying levels of absorption is a concern and leads to you not knowing exactly how much testosterone you’ve administered.

Another aspect you should consider is the possibility of transference, meaning that you can transfer the testosterone replacement therapy gel onto family members upon touch. This can be a particular concern if you have women and children in the house.

Nonetheless, patches and testosterone replacement therapy gels are painless and make a good alternative to injections — something that is especially appealing if you don’t like needles, even if they might be a bit messier. Examples of topical applications include Androgel and Testim.

TRT Injections

Testosterone replacement therapy injections are currently the most commonly administered form of testosterone. They are inexpensive and available in various forms, including testosterone cypionate, enanthate, and undecanoate.

Most patients require testosterone replacement therapy injections weekly or biweekly and have to come into their physician’s office for administration. If you’re comfortable with self-administration, however, you can ask your provider to send in a prescription for needles and syringes.

Within days of your injection, your testosterone levels will peak and then decrease again afterward — meaning they are lower at the end of each dosing window. With that being said, injections tend to cause ups and downs in your levels, which may also be reflected in your symptoms. 

Another thing to keep in mind with testosterone replacement therapy injections is that they may cause secondary erythrocytosis — which increases your red blood cells and can lead to blood hyperviscosity. Your provider will, therefore, monitor your hematocrit levels and make sure they stay within normal limits.

Other Forms of TRT 

There are other forms of TRT available for use, which include Natesto — an intranasal testosterone gel. Natesto is easy to use and effective, however, it’s also short-acting and requires administration three times per day. While it can also get a little messy, it’s a completely painless form of TRT.

On the other hand, pellets, another form of TRT, are long-acting and were approved by the FDA in 1972. Your physician will have to insert multiple pellets under your skin via a small surgical incision in the hip area. The pellets can then last for a few months and dissolve on their own.

How to Get TRT 

If you think you may be experiencing low T symptoms and are wondering how to get TRT, here’s how it works: Testosterone is regulated as a controlled substance, meaning it falls under the umbrella term of Schedule III drugs and is classified as an anabolic steroid. As such, you will need a prescription from a qualified healthcare professional to try one of the TRT options.

These prescriptions can be sent to your pharmacy by your primary care physician, endocrinologist, or other qualified provider. Before that, your doctor will want to learn more about your symptoms and will likely order labwork before starting you on testosterone replacement therapy.

Still wondering HOW to get TRT, meaning whether it’s covered by your insurance? Many forms of TRT are, in fact, available through insurance — while others are cash-only medications.

However, with so many treatment forms on the market, you should be able to find the right fit for you!

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