Measuring Testosterone Levels and Route of Administration

Symptoms associated with low testosterone level may resemble other medical conditions such as thyroid problems, hormonal imbalance, side effects of medications and illegal drugs, and mental problems. To determine what’s causing these symptoms, it is recommended to schedule an appointment with your doctor for a blood test. Test to determine testosterone levels should be done in the morning between 7:00 and 10:00 am. [601] For normal results, the test should be repeated to make sure that the result is accurate. In healthy men, the levels of testosterone can change a lot from day to day, so a second test is required.

After the decision to restore testosterone levels has been made, the next step is deciding on the most effective route of administration. There are several different modes in which testosterone can be delivered, but the best method varies from person to person. A number of factors should be considered when selecting a specific testosterone modality for replacement therapy. These factors include the following: [602]

  • Acceptability of the therapy to the individual patient.
  • Effects of the therapy in general and of a particular preparation.
  • Efficacy of the treatment, which relates to the levels of the testosterone obtained.

Types of Testosterone Tests
A testosterone test or also called serum testosterone test measures the amount of testosterone in the blood. This test is ordered to determine if a person has low levels of testosterone. It is important to inform your doctor about your current medications as it may affect the result of the test. Medications that can alter testosterone test results are steroids, anticonvulsants, barbiturates, clomiphene and estrogen therapy. [603]
The levels of testosterone in the blood can be measured in terms of total, bio-available, or free testosterone and there are various tests which can be used to measure each type of testosterone:

  • Total testosterone: This test measures free, albumin-bound and Sex hormone binding globulin (SHBG) bound testosterone and is the most commonly used blood test. Total testosterone blood test is used to assess testosterone levels in patients with suspected hypogonadism.
  • Bio-available testosterone: This test measures both free and albumin-bound testosterone, both of which are available for use by cells in the body. [604]
  • Free testosterone: This test measures only the 2% of testosterone which remains unbound to proteins in the blood. [605] Free testosterone levels can also be measured through the saliva.

Types of Testosterone Therapy
The different methods of testosterone delivery are the following:

  • Intramuscular Injections: This method of testosterone delivery has been used for years because it is cost-effective and has longer duration of action. It has a 100% success rate in providing usable hormone. This method allows precise control of the dosage of testosterone administered and is considered as the most effective testosterone replacement method.
  • Implantable Testosterone: This method makes use of pellets containing 75 mg of crystalline testosterone which are implanted beneath the skin of the upper thighs, deltoid, gluteal muscles, or lower abdomen to provide slow release over 4 to 6 months.
  • Transbuccal System: It is administered through a small tablet that adheres to the gum tissue. It is slowly absorbed by the inside lining of the cheeks called buccal mucosa. Transbuccal tablets contain 30 mg of testosterone, which peaks within 30 minutes and attain steady state within 24 hours.
  • Transdermal Testosterone: This method can be applied through a patch or gel. Transdermal testosterone mimics the normal circadian rhythm of testosterone, peaking in the morning and declining to its lowest point at night. TRT gel is the most expensive of the TRT modalities but is currently the most commonly used. Testosterone gel is applied to dry skin on the abdomen, upper arm, or shoulder after bathing.
  • Oral Testosterone: Oral testosterones such as oxandrolone, danazol, fluoxynesterone, or methyltestosterone are available for clinical use. Today, testosterone undecanoate is commonly used because it is able to bypass the liver.
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