In medicine, like so many other human ventures, we are always revisiting what we have considered to be the gold standard for various processes or philosophies. We are constantly updating treatment styles and techniques, changing protocols and medications when we find that an update of the current one or a change to a completely different one works better.
This is especially true when it comes to testosterone replacement therapy.
Remember that the goal of treating testosterone deficiency is to reduce or eliminate the symptoms, improving a man’s health and wellbeing, without messing up other hormones or introducing complications such as infertility or high blood counts.
Forty years ago, the standard of care was to give monthly doses of intramuscular testosterone meaning that men would get huge painful bolus injections into their muscles. They would then be supratherapeutic for the first 9 or 10 days, therapeutic for the next 9 or 10, then subtherapeutic for the rest of the month.
What a rollercoaster to ride.
What’s New & Improved?
The dosage and interval have steadily declined such that, while some clinics still administer large doses biweekly, most are now administering testosterone in smaller doses on a weekly basis. The peaks and troughs are much shallower, and most patients remain in the therapeutic range throughout the week.
That said, there are still significant peaks, which may be higher then are needed to achieve the goal, and there are still troughs that may still be deep enough to allow for some symptoms to return in the last day or two. Over the decades we have seen that increasing the frequency and reducing the dosage of the injections reduces the peaks and valleys, improves the therapeutic effect, and reduces the side effects.
So now there is an emerging interest in taking it to the daily dosing level: microdosing. Based on our prior experience, it makes sense that, with daily subcutaneous injections of less than a quarter of a ml, the variation in the testosterone level narrows such that the dosage can be fine tuned and most of the side effects and complications can be reduced or eliminated. For those who are currently receiving 200 mg of testosterone cypionate by intramuscular injection or 100 mg by subcutaneous injection, your dosage may be as small as 12-15 mg. Some clinics have already instituted daily subcutaneous dosage with very good success, and I am considering adding this as an option for Helios Telemedicine. I’ll update you when I make that decision.