Testosterone Replacement Therapy for Low Testosterone

Treatment Recommendations

• The American College of Physicians recommends treatment for symptomatic men to improve sexual function, sense of well-being, muscle mass, strength, and bone mineral density 1
• Topical gel/cream is an effective treatment option for men with age-related low testosterone, with most patients preferring topical formulations for convenience and ease of use 1

Formulation Selection

• 71% of patients preferred topical gel over injections or patches after trying different formulations, due to benefits including convenience, ease of use, and non-staining of clothes 3
• Intramuscular formulation is significantly lower in cost ($156.24 annually vs. $2,135.32 for transdermal) and has similar clinical effectiveness and adverse event profile to transdermal formulations 2, 4

Expected Benefits

• Testosterone replacement therapy results in a small improvement in global sexual function (moderate-certainty evidence) 5
• Testosterone replacement therapy results in a small improvement in erectile function (low-certainty evidence) 5
• Testosterone replacement therapy results in modest improvements in vitality and fatigue (SMD 0.17 higher) 6
• Testosterone replacement therapy results in a slight improvement in depressive symptoms (SMD 0.19 lower) 6

Monitoring and Follow-up

• The American College of Physicians recommends re-evaluating symptoms within 12 months and periodically thereafter, and discontinuing treatment if no improvement in sexual function occurs 1