The name for the condition where you don't produce enough testosterone is hypogonadism. A low testosterone level by itself doesn't need treatment. Many testosterone formulations are available (Table 459,60 ), and no formulation has superior clinical effects. The FDA has mandated that testosterone product manufacturers conduct a large-scale randomized controlled trial specifically to determine cardiovascular risk,38 but results of any such trial would not be available for years.
The autoinjector is filled with 50, 75 or 100 mg of testosterone in sesame oil and the recommended starting dose is 75 mg every week. The starting dose of testosterone enanthate or cypionate is 200 (or 250) mg intramuscularly every two weeks in adult men. Testosterone enanthate injection was the main testosterone preparation for therapeutic use in hypogonadal men for over 50 years.71 Testosterone enanthate (Delatestryl®) and testosterone cypionate (Depo-Testosterone®) formulated in sesame or cotton seed oil, respectively, have similar pharmacokinetics.
Your body slowly absorbs the testosterone into the bloodstream. They do this by making a small cut in your skin and using a special tool to implant 10 pellets of testosterone. A health care provider inserts these pellets under your skin (usually in the buttocks area) every 3 to 6 months. A nurse or technician may give you testosterone as a shot directly into a muscle. The patch continuously releases testosterone into the blood through the oral tissues.
After a single intramuscular injection of 200 to 250 mg of testosterone enanthate or cypionate, serum concentration of testosterone rise to above the physiological level and then gradually decrease remaining in the adult reference range for about two weeks.72,73 These testosterone esters are rapidly converted to testosterone in the body and are not hepatotoxic. The dose adjustment should aim at testosterone ranges usually within the mid adult male reference range. However, the permeation enhanced patches are a closed system with an enhancer; mild irritation at the application site occurs in over two thirds of patients and up to 10 to 15% of men discontinue treatment because of skin irritation. Some modified androgens are available in the US, such as methyltestosterone, mesterolone, oxandrolone oral tablets and stanozolol injections, but are not recommended for testosterone replacement in hypogonadal men (Fig. 1). Table 1 shows the available testosterone replacement options in the United States (US) which includes topical patch and gels; nasal gel and buccal tablets; oral pills and capsules; injections and implants. The increase in testosterone prescriptions was the highest in men over 60 years.2 The striking increase in prescribed testosterone usage in the first decade of the 21st century may be related to the introduction of new testosterone gels in 2003; continued medical education for general physicians on recognition of testosterone deficiency; rising prevalence of blood testosterone testing, and direct marketing of testosterone products to the public.
Obesity, lack of sleep, stress, and poor nutrition can all tank testosterone levels. The stigma around testosterone therapy runs deep. Generally, total testosterone levels below 300 ng/dL (nanograms per deciliter) may indicate low T, but it’s nuanced.
Healthy testosterone levels are also important for people assigned female at birth, along with other key hormones such as estrogen and progesterone. For starters, a healthy sex life is important in regulating your sex hormone and testosterone levels. In a 2021 study, zinc supplementation increased testosterone levels and improved sexual function in postmenopausal women with low blood levels of zinc. Additionally, a 2020 review found that taking a vitamin D supplement increased testosterone levels and improved erectile dysfunction.
Only men with symptoms of low testosterone and blood levels that confirm this as the cause of symptoms should consider testosterone replacement. In February 2016, the first results from the Testosterone Trials sponsored by the National Institutes of Health were published.14 This set of seven randomized controlled trials assessing sexual function, vitality, physical function, cognitive function, anemia, bone density, and cardiovascular health represents the largest, most rigorously conducted study of the benefits of testosterone therapy for older men. Most experts agree that the goal serum testosterone level should be in the midnormal range (i.e., 400 to 700 ng per dL 13.9 to 24.3 nmol per L); values outside of this range require a dose adjustment.9 Most importantly, ongoing evaluation of treatment effectiveness is required. Based on postmarket reports, in 2014 the FDA required manufacturers of testosterone products to add a warning to the drug label about the risk of venous thromboem-bolism.56 Subsequently, a large case-control study and another large retrospective cohort study found no evidence of increased venous thromboembolism risk.57,58 Use of supplemental testosterone has been shown to cause a small increase in prostate-specific antigen (PSA) levels,52 but the significance of this increase is questionable.

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