(BPT) - A few decades back, testosterone therapy may have conjured images of cartoonishly-muscular bodybuilders pumping iron at the gym. They were associated with aggression and other undesirable side effects and were controversial at best.
How times have changed.
In the medical community, physician-sanctioned testosterone therapy has gained legitimacy for treating hypogonadism, a condition in which the body does not produce enough testosterone (Low T) along with related symptoms.
Men with medical conditions associated with Low T commonly experience negative changes in their energy levels, libido, cognitive function, mood, and physique. They may suffer from "brain fog," feelings of depression, and difficulty building muscle mass and maintaining a healthy weight.
Fortunately, testosterone replacement therapy and testosterone support treatments - which now come in several forms - can help turn things around.
Dr. Russell Van Maele, a physician who specializes in functional medicine, has seen the benefits of testosterone therapy firsthand. He regularly prescribes testosterone treatments to patients through the leading men's telehealth provider Rex MD.
According to Van Maele, men may experience drops in testosterone levels for many reasons, including problems with the gonads or problems with the brain's signaling of testosterone production. Other men experience decreases in testosterone as they age.
"After guys turn 30, their testosterone levels can decrease by 1 to 2% every year," said Van Maele, one of the doctors who helped develop the Rex MD Testosterone Program. "Now, there is a spectrum of solutions that can boost testosterone levels and help men optimize their health."
A far cry from old-school, one-size-fits-all testosterone treatments, today's medication offerings have been carefully vetted for their safety and efficacy.
Here are four forms of testosterone-related treatments Dr. Van Maele prescribes through the Rex MD Testosterone Program.
#1: Testosterone cypionate injections
Testosterone cypionate is an injectable form of testosterone.
It's one of the most popular options for testosterone replacement therapy (TRT) due to its effectiveness in restoring and maintaining stable testosterone levels.
Additionally, its long-acting formulation allows for less frequent dosing - typically two times per week - which is convenient for patients who don't want to administer medication on a daily basis.
Also, unlike some other forms of testosterone therapy, testosterone cypionate works relatively quickly. In a study, patients using testosterone cypionate injections saw a significant increase in their testosterone levels within 48 hours.1
It's important to note that this form of treatment can lead to increased blood pressure levels, so it must be used cautiously with oversight from a licensed provider.
#2: Testosterone gel
Another form of testosterone replacement therapy (TRT) is testosterone gel. These topical gels are applied to the skin and provide a steady release of testosterone, which is absorbed through the skin and into the bloodstream.
This type of medication, which comes in both generic and branded forms, is an especially attractive treatment option for those who prefer not to self-inject. It is available in different strengths and can be more easily tailored to individual needs.
Like testosterone cypionate, testosterone gel also shows swift effects. After the first application of a branded testosterone gel on hypogonadal men, serum testosterone levels began to increase within 30 minutes.2
Keep in mind that testosterone gel has the potential to increase blood pressure levels. It's critical for children to avoid contact with unwashed or unclothed application sites on men using the gel.
#3: Oral testosterone (Kyzatrex®)
Oral testosterone capsules, which are often sold under the brand name Kyzatrex®, work by supplementing or replacing the testosterone that the body is not producing adequately on its own.
Once ingested, they help the testosterone get absorbed through the lymphatic system and, ultimately, released into the bloodstream.
Oral testosterone capsules are typically taken twice a day and are an attractive treatment option for men who feel uncomfortable administering injections or would like to avoid the risk of transfer that comes with topical solutions.
While oral testosterone capsules work more gradually than injectable and topical treatment options, they are still highly effective.
In a clinical study, 139 men with Low T used Kyzatrex® for six months. Researchers found that 96% of the men who completed study had normal testosterone levels within the first 90 days of treatment.3
#4: Clomiphene citrate (Clomid®)
Clomiphene citrate, which is commonly known by its brand name, Clomid®, is another popular treatment for increasing testosterone levels. While this oral medication was designed to treat female infertility, it is often prescribed off-label to men with conditions relating to Low T.
Clomiphene citrate is a selective estrogen receptor modulator, meaning it belongs to a class of medications that interact with estrogen receptors in the male body.
Unlike treatment options that supplement the body with external testosterone, it naturally stimulates testosterone production in the body. It also helps increase sperm count and motility.
Because clomiphene citrate works with the body's natural hormone production pathways, it's especially beneficial for men who are concerned about the long-term effects of testosterone therapy on fertility. It can also appeal to men who prefer a more natural approach to increasing their testosterone levels.
In a study of 153 hypogonadal men who were treated with clomiphene citrate, 89% of patients experienced an increase in testosterone levels and 74% of the patients experienced improvement in their hypogonadal symptoms.4
It's important to note that people using this medication may occasionally experience blurred vision and other visual symptoms and should notify their provider if they notice anything unusual.
Finding the right path
Clearly, men now have an array of options for addressing conditions related to Low T. The key is finding the option that best fits their needs.
"Hormones and hormone-related health issues are highly complex, and every patient is different," Van Maele said. "A reputable company like Rex MD will carefully consider your health metrics, medical history, symptoms, goals, and other factors when determining which treatment (if any) is right for you."
The Rex MD Testosterone Program arranges for patients to get lab tests to determine their testosterone levels and assess their eligibility for a prescription medication.
After they've completed their labwork, men meet via video call with a Rex MD-affiliated healthcare provider (like Van Maele) to discuss potential treatment avenues.
Then, if it's medically appropriate, the provider will prescribe a treatment as part of a personalized treatment plan.
"If you're feeling less confident than you used to - or you're just feeling 'off' - some simple lab tests can help determine if testosterone therapy is right for you," Van Maele said. "Don't assume low energy levels, declining muscle mass, a waning libido, and brain fog are normal symptoms of aging and be forthcoming with your provider about your concerns. These issues may be related to lower-than-normal testosterone levels, which can be due to a medical condition, and can often be treated with medication and doctor support."
Sources:
1Bhasin S, Basaria S. Diagnosis and treatment of hypogonadism in men. Best Practice & Research Clinical Endocrinology & Metabolism. 2011;25(2):251-270. doi:https://doi.org/10.1016/j.beem.2010.12.002
2Lakshman KM, Basaria S. Safety and efficacy of testosterone gel in the treatment of male hypogonadism. Clin Interv Aging. 2009;4:397-412. doi:10.2147/cia.s4466
3Bernstein JS, Dhingra OP. A phase III, single-arm, 6-month trial of a wide-dose range oral testosterone undecanoate product. Ther Adv Urol. 2024;16:17562872241241864. Published 2024 Apr 10. doi:10.1177/17562872241241864
4Huijben M, Lock MTWT, de Kemp VF, Beck JJH, De Kort LMO, van Breda HMK. Clomiphene citrate: A potential alternative for testosterone therapy in hypogonadal males. Endocrinol Diabetes Metab. 2023;6(3):e416. doi:10.1002/edm2.416
