Editing Testosterone Deficiency (2018) (section)

==== Administration ====
*'''<span style="color:#ff0000">Available formulations (5):</span>'''
*# '''<span style="color:#ff0000">Topical (gel, patch)</span>'''
*#* '''Patients should be informed about the risk of transference</span>'''
*# '''<span style="color:#ff0000">Buccal patch</span>'''
*# '''<span style="color:#ff0000">Nasal gel</span>'''
*#'''<span style="color:#ff0000">Subcutaneous pellets</span>'''
*#'''<span style="color:#ff0000">Intramuscular injections (3 formulations: 2 short-acting, 1 long-acting)</span>'''
*# '''<span style="color:#ff0000">Subcutaneous injections[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9293229/ §]</span>'''
* '''Oral'''
** '''Should not be prescribed'''
** '''Methyltestosterone''' is an oral androgen that is rapidly metabolized in the liver; therefore, achieving consistently therapeutic testosterone levels is a challenge. Its use is also '''associated with liver toxicity'''
** '''Testosterone undecanoate is an oral testosterone''' analogue that is '''absorbed via the intestinal lymphatics allowing it to avoid the first pass liver effect'''. It is approved in some countries for treatment of testosterone deficiency but is not currently approved in the US
*'''Native testosterone either orally or parenterally results in absorption by portal circulation and rapid metabolism by the liver, and only a small concentration reaches the systemic circulation.''' Advancement in chemical modification using esterification results in a series of testosterone analogues with improved bioavailability and pharmacokinetics
* '''Commercially manufactured testosterone products should be prescribed rather than compounded testosterone, when possible.'''
*'''The minimal dose necessary of testosterone therapy should be used to achieve a total testosterone level in the normal physiologic range of 450-600 ng/dL''' (in the middle tertile of the normal reference range)
** Treatments success is defined as achievement of therapeutic testosterone levels to the normal physiologic range of 450 -600 ng/dL accompanied by symptom/sign improvement/resolution.