HOW TO CHOOSE

Clinical Considerations

• A key study comparing topical, injectable and pellet forms found that while all increased total and free testosterone, erythrocytosis (hematocrit > 50 %) occurred much more often in the injection group (66.7 %) vs pellets (35.1 %) vs gels/creams (12.8 %) in one cohort.

• With creams there is the special concern of transference to others (especially children, women) which is unique to topical delivery.

• Pellets offer the “set it and forget it” convenience—less dosing burden—but less flexibility when changes are needed.

• For injections, patients need to be aware of the “peak-and-trough” phenomenon: you may feel very good after the shot, then levels decline until the next injection. Some providers mitigate this by more frequent, smaller doses.

• Topical creams have more absorption variability; pellet therapy removes daily burden but reduces adjustability..

Practical Tips When Choosing Between Them

• Ask yourself: Do I tolerate injections or prefer to avoid needles?

• How important is dosing convenience vs flexibility?

• For topical routes, watch for transfer risk (especially if around children or pregnant partners).

• For exogenous testosterone, fertility suppression is a concern. SERMs may be a better option if trying to preserve fertility

• Are there any pre-existing conditions (e.g., high hematocrit, polycythemia, cardiovascular risk) that might make one method safer?

• What will the monitoring plan be (labs every X months, hematocrit, estradiol, PSA)?

• Some methods cost more (pellet insertion procedures) or are more laborious (daily cream) versus weekly or fewer interventions.

• Are you willing to commit to the procedure of pellet insertion (and what happens if you need to stop it early)?

• When starting, whichever method, start with lower doses, monitor effects and labs, and adjust accordingly.

Final Thoughts

Choice of method often comes down to individual lifestyle, tolerance for the method, cost, ability to monitor labs, comorbidities (e.g., cardiovascular, hematologic) and personal preference.

No method is “perfect” for all men — the best method is the one that aligns with your lifestyle, goals, and safety profile

At our consultation visit with Dr. Garcia, in addition to discussing all your lab results, he will review all options for therapy along with the risks and benefits associated with each one so that if you decide that testosterone replacement therapy is right for you, you’ll feel confident that you’re making an educated decision.