by Dr. Gary Bellman M.D.
The 2 main methods of testosterone replacement are injections and topical gels or cream. Testosterone replacement in men is growing and companies are making new testosterone products all the time. These companies take testosterone and change or modify it so they can then patent it and sell it.
The drug companies’ focus for producing products has mostly been with gels. For a long time Androgen was the main topical product and then Testimony came – and suggested by the way they modified their product, that absorption is better. Recently a product came on to the market called Axiron, which is placed under the armpit. These products are synthetic testosterone’s that are identical to the testosterone in our bodies but changed somewhat. There are those that are concerned that the body won’t recognize synthetic testosterone, even though it does.
This concern over synthetic testosterone fueled those companies that popularized the concept of bio-identical testosterone, which is based only out of plant products. Bio-identical testosterone is generally produced in compounding pharmacies. Large companies are not interested in this product because they cannot patent testosterone that is unchanged, as you cannot patent a naturally occurring product. The buzz about bio-identical hormones came from celebrities like Oprah. The context about these discussions and recommendations surrounding bio-identical and synthetic hormones were mostly for women. I am not aware of any real medical advantage of a bio-identical gel or cream versus a synthetic one for men. I have men taking both and they both seem to be effective.
The main differences surrounding these products can be price, insurance coverage and consistency. The compounding pharmacies can make the cream or gel in a consistency that may be preferable to some men without the perfume of some other products. Likewise, the compounding pharmacy can alter the concentration, which is more applicable to a woman’s needs as they need a fraction of the testosterone given to men. One of this applies to injectable testosterone, which is synthetic testosterone. The take home message is they are both effective so long as it is well absorbed. Just be cause it sounds better doesn’t mean it is!