I want to start TRT (testosterone replacement therapy), so how do I do it?

There are several ways to administer testosterone with some of the most common and effective being injections and creams. Another common albeit generally less effective way (for men specifically) is with pellets (implants).

Injections

Injectables are probably the most common way to administer TRT and can be done either in the muscle or the fatty tissue. To learn more about the differences between those see the blog titled “Intramuscular (IM) v. Subcutaneous (SQ) Injections” linked here: https://www.wellesleytestosterone.com/post/intramuscular-im-v-subcutaneous-sq-injections

To quickly review each IM testosterone is typically given 1x/week with a larger needle and injected directly into the muscle which makes it more difficult to do on yourself. SQ is given more frequently typically 2-3x/week with a smaller needle and injected into fatty tissue. The more frequent administration of SQ injections provides a more steady state of testosterone compared to the once weekly IM approach not to mention a more comfortable experience and more feasible approach for someone doing on themselves.

Topical Cream

Using cream is another very common approach for TRT. This is a great option for men who do not want to use injectables or have a higher risk of potential complications (the cream tends to produce fewer side effects than the injections). The cream needs to be applied 1-2x/daily so that can be a barrier for some men, but most tend to just work it into their morning and/or evening routines. The other consideration with the cream is that it can be transferred to a partner, so the man needs to be cognizant of that potential risk.

Pellets

Pellets are implanted in the skin by a medical professional and replaced about every three months. At first glance, this seems like a great option but like so many things when it seems to be too good to be true it often is. The issue with pellets is that the dosing can be very difficult to get right. Once inserted there is no way to adjust the dose apart from cutting the implant out. Additionally, even though they are designed to be released slowly over time because of the high doses of testosterone needed levels tend to peak near the time of insertion and slowly drop off and end up quite low by the time a man is due for the next insertion. This can lead to inconsistent management of symptoms with things seemingly well managed early on and often less so with time. It is important to note that for women, pellets can be a reasonable option because the testosterone dose is so much lower allowing it to remain more stable over time. Overall, for men, pellets are a convenient but significantly less effective option. For this reason, at Wellesley Testosterone pellets are not used for TRT in men.