Testosterone Replacement Therapy Prescription Drug Options
Testosterone Replacement Therapy (TRT)
Testosterone deficiency is loosely defined as decreased or completely absent production of testosterone. This condition is common in post-pubertal men and men suffering from various co-morbidities.
It can lead to many side effects, some more serious than others. When the degree of testosterone deficiency is substantial, generally decreased libido and lack of energy are the first side effects to appear. However, over the course of months to years, side effects such as decreased strength and muscle mass, anemia, erectile dysfunction and osteoporosis can develop.
Here are 10 questions to consider before you consult your prescriber about testosterone deficiency or testosterone replacement therapy:
1. Do you have a decrease in libido (sex drive)?
2. Do you have a lack of energy?
3. Do you have a decrease in strength and/or indurance?
4. Have you lost height?
5. Have you noticed a general decline in your enjoyment of life?
6. Are you sad and/or grumpy?
7. Are your erections less strong?
8. Have you noticed a recent deterioration in your ability to play sports?
9. Are you falling asleep immediately after dinner?
10. Has there been a recent deterioration in your work-related performance?
If you answered "yes" to some or all of these questions, you may have symptoms associated with testosterone deficiency and should consider contacting your prescriber about possible testosterone replacement therapy after appropriate lab work is complete.
What are your prescription drug options if you have been diagnosed with testosterone deficiency by your prescriber?
Unfortunately, it is not as simple as taking an oral testosterone tablet or capsule like you would your daily multivitamin pill. Our liver rapidly metabolizes testosterone when taken orally, so drug manufacturers have had to get a bit creative and offer a variety of application options.
Most are very patient-friendly and focus on compliance and quality of life. Testosterone replacement therapy products include Androgel, Testim, Fortesta, Axiron, and Androderm. Although these products all utilize our skin’s permeability in delivering testosterone to the bloodstream, these products are certainly not the same.
1.) Fortesta Gel is just one of many transdermal products prescribed to adult men who suffer from a deficiency or complete absence of testosterone. Fortesta Gel is supplied in a patient-friendly pump and is applied once daily in the morning to the front and inside of the thighs. After application, the patient should wash their hands thoroughly with soap and water, and cover the area with clothing as soon as the gel has dried. Since the drug is only approved for safe use in adult men, women and children should not be in contact with unclothed application sites or unwashed areas where the medication has been applied. The most common side effects of treatment are mild skin irritations at gel application sites and an increase in prostate specific antigen (PSA). Ask us about how Fortesta Gel's Patient Savings Program (pictured above) can save you money!
3.) Testim is yet another topical testosterone replacement product. Unlike Androgel and Fortesta, Testim is supplied in fail-safe unit dose tubes in which the entire contents of the tube are applied once a day to a clean, dry area of the shoulder or upper arm. As with the others, it is important to wash your hands, cover the application site once the gel has dried, and ensure the area of application does not come in contact with women or children. The side effects of this product are very similar to the others we have discussed and include elevated PSA, skin irritation at application site, headache, and increased blood pressure. The LEVEL-UP Patient Savings Plan for Testim offers $40 per month savings toward out-of-pocket expenses!
4.) Axiron is currently the only topical testosterone replacement product that is applied to the underarm. Axiron is also supplied in a convenient pump applicator. The solution is then dispensed into an applicator cup and applied to the underarm. As with the other topical testosterone gels and solutions, wash your hands when finished, cover the application site, and be mindful of contact with women and children. Most common side effects of Axiron include redness or irritation at the application site, elevated PSA, headache, and prolonged erection. Axiron's Co-Pay Savings Card allows eligible patients to pay no more than $25 per month for their prescription!
5.) Androderm is currently the only transdermal testosterone formulation supplied in an adhesive patch. It comes in both a 2mg and 4mg strength to meet differing patient needs. With this product, one patch is applied in the evening, left on for 24 hours, removed, and replaced with an unused patch. It is important to rotate sites of Androderm patch application. The approved locations for patch placement include the thighs, upper arm, abdomen, and back. Unlike the other topical products, this product is not known to cause any changes in prostate specific antigen or any other prostate-related side effects. Also, the risk of transmission of testosterone to women and children is greatly reduced with Androderm. The most common side effects of Androderm include rash or irritation at the application site, as well as back pain.
6.) Intramuscular testosterone injections can be injected every 2-4 weeks into the gluteal muscle via deep intramuscular injection. This route allows the greatest freedom of dosing as it only needs to be administered one to two times per month. The dose can be specifically adjusted to meet individual patient needs. This option, as with Androderm, poses little risk of transmission to women and children. Common side effects of intramuscular testosterone injections include injection site reactions (such as redness, itching, or rash), elevations in blood pressure, and prostate related side effects.Be advised that your prescribing healthcare provider will perform necessary lab work to determine if testosterone replacement therapy is necessary and even an option for you. Continuous monitoring of testosterone levels throughout the course of the therapy is essential as most regimens and goals are individualized.
Be sure to thoroughly discuss your conditions/symptoms and give a complete list of all your current medications (over-the-counter and herbal products included) to your pharmacist and healthcare provider before considering testosterone replacement therapy. As you can see, many of these products come with much financial assistance to minimize monthly out-of-pocket expenses so be sure to inquire about potential savings.
If you would like to transfer your prescriptions to us today or have any questions, always feel free to contact our Halsted HealthMart Pharmacy team members to assist you! Simply call us at (312)-624-9397 or send us an email!
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For more detailed information feel free to visit their websites directly:
Nathan Armbruster, Student Pharmacist
Jill Drury, Pharm.D., BCOP, Clinical Pharmacy Specialist, Contributing Editor
Renny Kurup, Pharm.D., Director of Pharmacy, Executive Editor