Prescribing TDS treatments on the NHS
One of the goals of testosterone replacement therapy (TRT) is to restore physiologic concentrations of testosterone, without inducing peaks and troughs in plasma testosterone levels, which can result in patients experiencing mood swings, a lack of energy, depression and reduced sexual interest 31.
In addition – and equally as important – TRT aims to alleviate symptoms of testosterone deficiency and to mimic normal concentrations of testosterone, avoiding excessively high levels 31.
A number of different formulations and methods of application/administration are available - including gels, patches, oral, implants and injections. Patients should therefore be provided with sufficient information to enable them to make an informed decision on the choice of suitable therapy.
Testosterone capsules are usually taken three to four times a day for the first two to three weeks. Then once the testosterone level has built up, the dose is gradually reduced to between one and three capsules a day.
Testosterone patches can be applied to the back, stomach, upper arms or thighs. The patch should be changed every 24 hours.
A number of testosterone gels are available, which are applied to the skin and quickly absorbed. Gels need to be applied every day around the same time as they last 24 hours, over the course of which testosterone is released steadily, mimicking the physiological level.
Testosterone implants are placed under the skin in the lower abdomen or buttock. This procedure is usually done under a local anaesthetic in a hospital.
Short-acting injectable testosterone requires injections at 3-weekly intervals (approximately 17 injections per year).
In addition, there is a longer acting formulation that requires less frequent injections (approximately 3 to 5 a year to maintain physiological testosterone levels).