© The Canadian Journal of Urology™; 19(Supplement 1); October 2012
25
Erectile dysfunction and testosterone deficiency syndrome: the “portal to men’s health”
TABLE 3.
Testosterone replacement therapy (TRT) for male hypogonadism
Name (Brand name)
Route
Dose
Notes*
Testosterone
Buccal
30
mg buccal tablets BID
Apply to gum over incisor;
(
Striant [US, not Canada])
tablets
do not chew or swallow
Testosterone cypionate
IM injection 200 mg-400 mg every 3-4 weeks
(
Depo-Testosterone)
100
mg-150 mg (up to 200 mg)
every 2 weeks preferred
Testosterone enanthate
IM injection 100 mg-400 mg every 4 weeks
(
Delatestryl)
(100
mg-150 mg every 2 weeks
preferred)
Testosterone gel
Topical
5
g-10 g daily (max)
Apply to clean dry shoulder
(
AndroGel 1%)
area, upper arm, or
abdomen
Testosterone gel
Topical
5
g-10 g daily (max)
Apply to clean dry area on
(
Testim 1%)
shoulder or upper arm
Testosterone gel
Topical
10
mg-70 mg daily (max)
Apply to inner thigh area only
(
Fortesta 2% [US only])
Starting dose is 40 mg/day,
then adjust accordingly.
Testosterone (Axiron)
Topical
30
mg-120 mg daily (max)
Apply once daily to
Starting dose is 60 mg/day
axillary region
(30
mg/pump applied to
each axilla)
Testosterone patch
Transdermal 2.5 mg-7.5 mg daily
Apply to clean dry area on
(
Androderm)
back or arm; rotate site; remove
for MRI as patch contains metal
Testosterone implant
Implantable 150 mg-450 mg SC implant
Implant in upper buttock under
(
Testopel [US, not Canada])
pellets
every 3-6 months
local anesthesia
75
mg/each 2 pellets for each 25 mg
testosterone required
weekly
Testosterone undecanoate
Oral
40
mg-160 mg daily,
Take with food
(
Andriol [Canada, not US])
Divided in two doses
Testosterone undecanoate
IM injection 1000 mg every 6-12 weeks
(
Nebido [US, not Canada])
*
Monitor levels of serum testosterone for all agents
An underarm topical testosterone (Axiron)
will be available in Canada in 2013. It is applied
like an underarm deodorant, once a day using an
applicator.
A2% testosterone gel (Fortesta- Endo Pharma) has
been approved by the FDA. It is applied to the inner
thighs. In the clinical trials it demonstrated efficacy
in restoring normal testosterone labels. There was a
report of 16.1% ( 24/149) incidence of skin reactions.
It is unclear if this drug will be submitted for approval
to Health Canada.
Monitoring patients on TRT
All patients on TRT should be monitored on a regular
basis. Guidelines recommend measuring CBC, PSA
and testosterone levels at 3, 6, and 12 months after
patients commence therapy, and yearly thereafter.
Serum testosterone levels aremore difficult to interpret
following injections or oral administration.
The time to clinical response to different symptoms
can vary. Morales et al
34
suggested that enhanced
libido, improved emotional well-being, increased
