Treatment options

The essential aim of testosterone replacement therapy is to restore serum testosterone to the middle of the normal physiological range and to minimize the signs and symptoms of hypogonadism.1-7 In all types of male hypogonadism testosterone replacement therapy forms the core of the treatment. A number of different androgen preparations and dosage forms are available, and treatment can be individualized to correct the testosterone deficiency in primary and secondary hypogonadism and to enhance patient health and well-being.1-7

Testosterone replacement therapy is characterized by a wide margin of safety and good tolerability. Treatment can be initiated when a diagnosis of hypogonadism has been confirmed and contraindications ruled out. Close monitoring of the treatment is essential.

What treatments are available?

Currently marketed treatment options for testosterone replacement therapy for male hypogonadism are summarized below.

Available formulations of Testosterone Replacement Therapy

Not all preparations are available in all markets. An ideal preparation of testosterone will raise testosterone levels back into the mid-normal range to reverse the symptoms of hypogonadism. It will also be safe, and offer a convenient dosing schedule and means of administration at a reasonable cost. Several months of treatment may be required before changes are apparent.1,7

Intramuscular injections of testosterone enanthate, which have been the standard form of testosterone therapy in male hypogonadism, are increasingly being replaced by more recent therapies using transdermal formulations of testosterone and long-acting injectables such as testosterone undecanoate. Such preparations are easier to administer and provide more stable physiological levels of testosterone. One of such preparations is injectable long-acting testosterone undecanoate (Nebido®).
Nebido® Ampoule
The long-acting injectable formulation of testosterone undecanoate was developed to overcome the shortcomings of conventional testosterone injections, usually requiring only four injections per year to maintain testosterone levels constantly in the eugonadal range, without the nonphysiological peaks and troughs associated with conventional testosterone injections.2,6 Patients value the consistent, reliable efficacy and the long duration of effect, which means they are not dependent on taking frequent medication.8 Consequently, testosterone undecanoate is likely to become the standard preparation for long-term testosterone replacement therapy.

Read more on Nebido®

The transdermal gel/solution contains native testosterone in a clear and colorless formulation which is absorbed by the skin within a few minutes after the morning application to the upper arms, shoulders and abdomen, without leaving any residue. The serum testosterone concentration remains very reliably within the normal range for 24 hours after application.2,4,6 A new testosterone formulations is an underarm transdermal solution (Axiron®).

In summary, testosterone patches are transdermal formulations of native testosterone applied to the skin of the abdomen, back, shoulders, upper arms or thighs (or scrotum, in the case of scrotal patches). Although a steady absorption of testosterone is provided over a 24-hour period, some men may require two patches daily to achieve serum testosterone levels in the middle of the normal physiological range recommended as a goal for testosterone replacement therapy.1

Oral testosterone undecanoate has the convenience of oral administration without the same potential for liver toxicity as another oral testosterone formulation, 17-α-testosterone.1-4 However, a short duration of action requires 2-3 times daily dosing, and clinical responses are less consistent than with the long-acting injectable formulation of testosterone undecanoate or the testosterone gel.1,2


1 Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM; Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010 Jun;95(6):2536-59.

2 Qoubaitary A, Swerdloff RS, Wang C. Advances in male hormone substitution therapy. Expert Opin Pharmacother 2005; 6(9): 1493-506

3 Seftel A. Testosterone replacement therapy for male hypogonadism: part III. Pharmacologic and clinical profiles, monitoring, safety issues, and potential future agents. Int J Impot Res 2007; 19(1): 2-24

4 Sharma V, Perros P. The management of hypogonadism in aging male patients. Postgrad Med 2009; 121(1): 113-21

5 Tung DS, Cunningham GR. Androgen deficiency in men. The Endocrinologist 2007; 17(2): 101-115

6 Zitzmann M, Nieschlag E. Testosterone substitution: current modalities and perspectives. J Reproduktionsmed Endokrinol 2006; 3(2): 109-116

7 ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Wang C, Nieschlag E, Swerdloff RS, Behre H, Hellstrom WJ, Gooren LJ, Kaufman JM, Legros JJ, Lunenfeld B, Morales A, Morley JE, Schulman C, Thompson IM, Weidner W, Wu FC. Aging Male. 2009 Mar;12(1):5-12.

8 Bayer Pharma AG. Global Nebido Satisfaction Study 2009
Last updated: 2017