Finding the right solution

Testosterone injections are given into the muscle and contain testosterone that’s released gradually. There are two types of injections: short-acting and long-acting. As with any medication, it can cause some side effects - most commonly, discomfort at the site of the injection.

A long-acting injection is available. Six weeks after the initial injection, a loading dose is given. Once the testosterone level is stabilised, injections are only needed three to five times per year. This type of injection does contain quite a large volume of fluid. However, once administered, it maintains a steady testosterone level.

Short-acting injections are given every two to three weeks. Short-acting injections have been used in the UK for 30 years, but they may be associated with mood fluctuations. Immediately after the injection, energy levels and mood tend to be significantly improved, but then as the testosterone level falls over time, some men find that symptoms of tiredness and irritability return.

A number of testosterone gels are available, which are applied to the skin and quickly absorbed. Gels need to be applied every day at a similar time, as they last 24 hours, during which testosterone is released steadily.

A particular gel should be applied to a specific area of the body, such as the arms or the abdomen, so be sure to read the patient information leaflet supplied with the therapy. Occasionally testosterone gel can cause skin irritation in some people.

When the gel is first applied, take care to avoid skin-to-skin contact with others (particularly pregnant women and children), as the testosterone could rub off on them. Once the gel is absorbed, clothing can be worn without affecting its release in the body. To minimise the chance of transfer, you can wash the area that the gel was applied to after about six hours.

A testosterone patch is a sticky patch, which releases testosterone slowly. It can be applied to your back, stomach, upper arms or thighs. The patch should be changed at about 10 o’clock each night and left on for 24 hours, so that the testosterone level mimics your natural testosterone cycle.

Most people experience some skin redness, itching or rashes where the patch has been. These effects usually disappear within ten days of removing the patch.

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. Each implant consists of three to six pellets, which dissolve gradually over three to six months. Then the treatment is repeated to maintain the testosterone level.

In some cases, implants can cause slight bleeding, scarring or infection where they’ve been inserted. It is also possible that the implants cause a bump, or that they are naturally expelled from the body.

Testosterone capsules are another option. Usually they are 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.

Capsules should be swallowed whole with a fatty meal to help with absorption. However it can be difficult to maintain a steady testosterone level and the number of capsules needed varies from individual to individual.