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Testosterone Hormone Replacement Therapy in Men: Treatment Options - M

Testosterone Hormone Replacement Therapy in Men: Treatment Options

Reviewed by Michael Hua, Pharm D
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Testosterone Hormone Replacement Therapy in Men: Treatment Options with Compound Medications (Part 2)

Male hypogonadism, or testosterone deficiency, continues to receive increased medical scrutiny. To address this condition, various medical practitioners are now looking at testosterone replacement therapy to help their patients with low testosterone levels improve their quality of life and long-term health. In this post, we discussed the potential of Testosterone Replacement Therapy in managing the condition and bringing testosterone back to a healthy level.

When it comes to testosterone replacement therapy, many people think of commercially-available prescription options such as testosterone injections, patches, pellets, and gels. While these options may provide effective treatment, they have their downfalls, which is why more patients prefer compounded bioidentical testosterone instead.

Bioidentical Testosterone vs. Synthetic Testosterone

There are two common solutions for men looking to correct their testosterone deficiency: synthetic testosterone or bioidentical testosterone.

Before making a choice, it is vital to understand how hormones work. Each hormone in the body has a unique 3D structure that operates like a key-and-lock system. You need a testosterone molecule to act as a key to open the lock, which is the specialized receptor molecules throughout the body. This prompts the body to turn on numerous cellular behavior to improve symptoms of low testosterone.

Synthetic hormones do not quite have the precise structure for this process — the synthetic testosterone does not fit the body’s receptor design. As a result, a patient may suffer from serious side effects.

In contrast, bioidentical testosterone duplicates the hormonal structure exactly. The body treats it as its own, which leads to increased production of testosterone and relief from symptoms.

Commercially Available Testosterone and their Problems

Commercially available testosterone patches only come in fixed concentrations and cause skin irritation such a pruritus(39%) and burn-like blisters(12%)[1],[2]. Commercially available testosterone pellets, e.g. Testopel, require surgical intervention, may be painful, are only available in one strength, and sometimes extrude spontaneously from the implant site.

Testosterone injections such as Depo-Testosterone may provide the convenience of dosing once every 1-4 weeks, but this was found to have fluctuating plasma testosterone levels at least 50% of the time that were not in the physiological range[3],[4]. The fluctuation in testosterone levels may cause rapid swings in energy, mood, and sexual function. Also, injectable testosterone takes longer to completely metabolize out of your system which poses a problem when serious side effects occur, like erythrocytosis, especially in older men[5]. Furthermore, testosterone injections are not truly bioidentical since they consist of the salt form of testosterone, testosterone cypionate and testosterone enanthate.

Due to the detrimental side effects of testosterone injections, patches, and pellets, commercially available testosterone gels are the most commonly used route for testosterone replacement therapy because these short-acting preparations allow for rapid discontinuation in case of adverse effects[6],[7]. But commercially available testosterone gels, e.g. Androgel, come in fixed, relatively low testosterone concentrations that can not be adjusted to an individual’s unique hormone level.

Benefits of Compounding for Testosterone Treatment

The right amount of testosterone is completely different for every male. As such, there is no one-size-fits-all dosage that will work across the board. Compound medications offer a customized approach that takes into account the patient’s unique medical history, needs, and lifestyle.

Here are the advantages of compound medication over mass-market alternatives:

  • Safe and high quality – Uses only the highest-quality form of testosterone that meets the strictest safety and requirements established by US professionals
  • Custom doses – Upon instruction from the doctor, compound medication dosages are tailored to fit the patient’s requirements perfectly
  • Affordable – Compounding pharmacies typically offer medications at a fraction of what commercially available testosterone therapies cost
  • Convenience – Aside from customized dosages, compounding pharmacies can also personalize the form medication, making it more palatable, easier to take, and combined with other hormones such as chyrsin and DHEA

The Variety of Compound Medications Containing Testosterone

Harbor Compounding Pharmacy provides testosterone replacement options in various formulations: oral capsules, sublingual troches, sublingual drops, transdermal creams, and topical solutions to tailor to each individual. Because testosterone replacement therapy is usually long-term and highly dependent on patient compliance for best results, the patient must directly involve himself in the selection of type of testosterone preparation.

Compounded testosterone capsules can be created as either immediate or slow release formulations in any concentration. They may be a great option for those who travel often, need to pack light, and worry less about storage conditions.

Compounded testosterone sublingual troches and drops are less harsh on the liver and may be a better option for those who do not want to cause extra strain on their liver that oral testosterone capsules may be cause. While most troches require to be stored in the fridge, we also provide the option to have testosterone troches compounded in a special base that can be stored at room temperature.

Our most popular testosterone formulations are compounded testosterone creams and solutions. These topical formulations are applied to the skin and bypass the liver. Several studies have shown that transdermal testosterone options are physiologic, efficacious, and have a good safety profile[8]. We dispense compounded testosterone creams in for either static or biorhythmic dosing similar to the Wiley Protocol.

Fill Your Compound Medication for Testosterone Today

Harbor Compounding Pharmacy can help you achieve the optimal dosage and form for your testosterone replacement therapy. We will work with your doctor to give you fully-customized medication that will help you feel your best.

At Harbor Compounding Pharmacy, all of these testosterone formulations are easily customizable to tailor towards you and we provide the most natural, bioidentical testosterone accurately. Even after our in-house quality check and verification, we send every batch to a third-party testing facility to ensure its potency because only the best is good enough for our patients. No one wears one-size-fits-all shoes, so why are you settling for a one-size-fits-all prescription drug? Customize your testosterone prescription to the exact dose and formulation you need through a compounding pharmacy that you can trust.

Health is everything. Give your health the attention it needs.


  1. Ullah MI, Riche DM, Koch CA. Transdermal testosterone replacement therapy in men. Drug Des Devel Ther. 2014;8:101-112.
  2. Androderm [package insert]. Markham, Ontario: Allergan Inc.;2018
  3. Gooren LJ, Bunck MC. Androgen replacement therapy: present and future. Drugs. 2004;64(17):1861-1891.
  4. Rothenberg R, Hart K, Rothenberg R. Hormone Optimization in Preventative/Regenerative Medicine.2nded. Encinitas, CA: Panda Press
  5. Wang C, Nieschlag E, Swerdloff R, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol. 2008;159(5):507-514.
  6. Aydogdu A, Swerdloff RS. Emerging medication for the treatment of male hypogonadism. Expert Opin Emerg Drugs. 2016;21(3):255-266.
  7. Park HJ, Ahn ST, Moon DG. Evolution of Guidelines for Testosterone Replacement Therapy. J Clin Med. 2019;8(3).
  8. Basaria S, Dobs AS. New modalities of transdermal testosterone replacement. Treat Endocrinol. 2003;2(1):1-9.

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