Therapeutic Modalities and Management Strategies
The goal of testosterone replacement therapy (TRT) is to restore hormone levels to the mid-normal physiological range and alleviate clinical symptoms. Treatment is available in several formulations, including topical gels, transdermal patches, and various injectable esters. Topical gels provide stable daily levels but require care to avoid skin-to-skin transfer to others. Injectable options, such as testosterone cypionate or long-acting undecanoate, offer convenience but can sometimes cause "peaks and valleys" in mood and energy levels.
For men who wish to preserve their fertility, standard TRT is often avoided because exogenous testosterone suppresses the signals required for sperm production. In these cases, alternative treatments like human chorionic gonadotropin (hCG) or selective estrogen receptor modulators (SERMs) may be used to stimulate the body's own production of testosterone without shutting down the reproductive system. Regardless of the method chosen, therapy must be individualized based on the patient's lifestyle, cost considerations, and specific health goals.