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This Fact Sheet has been prepared for patients whose doctors have recommended testosterone replacement. It contains basic information about testosterone replacement therapy. You should discuss any further questions you may have with your doctor.

Introduction

Testosterone replacement for men with low testosterone levels has been available since the 1930s. The testosterone level is measured by a blood test.

Testosterone can be given as:

• A tablet or capsule by mouth;
• An injection into the muscle, usually the buttock; or
• An implant placed under the skin, usually the abdomen or buttock.

Testosterone Action

Testosterone is a hormone produced by the testes which are responsible for:

• Development of male secondary sex characteristics: Body hair growth (e.g. beard, chest, pubic hair); Genitals - penile growth; Deepening of the voice;
• Sexual behaviour: Sex drive (libido); Erections sufficient to achieve successful penetration; and
• Possibly for well-being and energy

Reasons for Testosterone Replacement

Low levels of testosterone in the blood may indicate the need for testosterone replacement, especially if there is decreased libido, or impotence. Replacement may also improve general sense of well-being and physical stamina.

The testosterone level is low if the testes fail to produce sufficient testosterone (hypogonadism). The under-production by the testes is usually due to disease of the pituitary gland (hypopituitarism) which ceases to stimulate the testes to produce testosterone. Rarely it is due to testicular disease.

If testosterone levels in the blood remain low for many years, osteoporosis (brittle bones) may develop. Testosterone replacement can help prevent this.

Methods of Replacing Testosterone

Testosterone Tablets / Capsules

The tablets / capsules contain testosterone and are taken by mouth. They cause a rise in testosterone levels in the blood which peak in 2-4 hours and gradually decline over 8-12 hours. Therefore the tablets / capsules are usually taken with the morning and evening meals. They should be swallowed whole. The biggest dose is usually taken in the morning. The initial dose is sually 120-160mgs per day for 2-3 weeks then 40-120mgs per day. Your doctor will decide on the right dose for you based on the results of your blood tests and how you are feeling.

Testosterone tablets / capsules rarely cause any side effects but testosterone levels in the blood should be monitored regularly.

Testosterone Injections

The injection is usually given into the buttock and the action lasts for approximately one month. The injection may be a little painful, warming the testosterone before administration will lessen the discomfort. Dose: 100mg or 250mg per injection every 2-3 weeks.

Testosterone Implants

Testosterone implants allow a slow release of the natural hormone. They have few side effects and are almost always successful. Testosterone implants are formed by fusing crystalline testosterone at high temperatures under sterile conditions. The implants are about the size of a wheat grain (4.5 x 12mm). The action peaks approximately one month after implantation and lasts for 4-5 months depending on the individual.

The implant / injection is repeated depending on the results of a blood test and the way you feel. It takes a week to ten days for results of blood tests to be available.

Dose: The usual dose is between 100mg and 600mg depending on individual needs. In some cases, larger doses may be required.

Ask Your Doctor

Ask your G.P. about testosterone cream / ointment for topical application - available where injections or tablets / capsules are contraindicated.

Implantation

Implantation is a minor procedure, done under local anaesthetic, as an outpatient. It takes about 15-20 minutes.

The implants are placed into the fat layer just under the skin in an area where there is little movement, usually the abdomen or buttock.

Local anaesthetic is injected into the chosen area. There should be no pain after the anaesthetic takes effect.

A small cut is made in the skin to allow insertion of a small hollow instrument about the size of a straw called a cannula. The testosterone implants are pushed through the cannula. You may have a sensation of pushing as the implant is introduced. The cannula is then removed leaving the testosterone implant in place.

The wound is closed with a small stitch or with adhesive strips and pressure applied to ensure no bleeding occurs.

People often remove the stitch themselves in 5-7 days or go to their local doctor.

If any pain, redness, swelling or discharge occurs, or if the implants extrude, report to the Doctor

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