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Raj Singh MD
September 6, 2023

Is oral Testosterone Better?

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Can you believe it? Oral testosterone is a thing now.

In the past, when a client asked me about oral testosterone, my answer was that we could not take Oral testosterone due to the risk of toxicity to the liver. I am pleased that oral testosterone options are available now with the recent approval by the FDA of testosterone undecanoate with brand names such as kyzatrex, Jatenzo, Tlando.

What are some of the symptoms of low testosterone in men?

The symptoms of low testosterone in men can include:

  1. Low sex drive or libido.
  2. Erectile dysfunction or difficulty achieving and maintaining an erection.
  3. Reduced muscle mass and strength.
  4. Increased body fat, especially around the waistline.
  5. Decreased bone density and increased risk of fractures.
  6. Mood changes, such as depression, irritability, or difficulty concentrating.
  7. Fatigue or lack of energy.
  8. Loss of body hair or thinning of facial or body hair.
  9. Infertility or low sperm count.
  10. Hot flashes or sweats.

What is testosterone undecanoate?

Testosterone undecanoate is a synthetic form of testosterone, a male sex hormone, used for testosterone replacement therapy (TRT) in men with low testosterone levels. It is a long-acting injectable form of testosterone that is slowly released into the bloodstream over several weeks, and recently, the FDA has approved an oral capsule form.

Unlike other forms of testosterone, such as testosterone cypionate or testosterone enanthate, which require frequent injections, testosterone undecanoate is injected less frequently, typically every 10-14 weeks. This can make it a more convenient option for men who require TRT. The oral form is taken daily to twice daily.

Is Oral testosterone a new concept?

Oral testosterone, such as methyltestosterone, has been available for several years; however, this form of testosterone was not recommended due to the increased risk of liver toxicity, jaundice, and risk of liver cancer and so it was rarely prescribed by doctors.

The newer version of oral testosterone therapy, such as Testosterone undecanoate, bypasses the liver. It is absorbed directly through lymphatic channels in the small bowel instead of the portal vein, thus avoiding the liver toxicity effect.

What is the difference between the different types of oral testosterone?

Name/available dose (mg)Dose RangeCommon Side Effects
Kyzatrex :100,150, 200100- 400 mg twice dailyHigh BP
Jatenzo : 158, 198, 237158 to 396 mg twice dailyNausea, Diarrhea,
Tlando : 112225 mg twice daily​Raised prolactin, headache
difference between the different types of oral testosterone

What are some of the benefits of oral Testosterone undecanoate?

When compared to Testosterone injection

- No injection site pain or muscle scarring.

- Excellent for individuals with needle phobia.

- Testosterone elevation is much more physiological.

- Dosing can be easily adjusted.

- Easy Storage.

- Testosterone levels return to baseline quickly after stopping the medication if testosterone reversal is desired due to Secondary polycythemia or other complications of testosterone therapy.

- Possibly reduced hair loss (alopecia).

- Higher free testosterone concentration, possibly due to lower SHBG levels.

When compared to Topical testosterone

- No risk of dermatitis as is with topical testosterone.

- No risk of transfer to partner.

- Levels are much more predictable.

- Much higher levels can be achieved.

When compared to testosterone pellets

- No surgical procedure

- No risk of scarring.

- No recovery time.

Additional:

- maybe an effective therapy for a rare genetic condition, 5α‐reductase deficiency (micropenis, ambiguous genitalia)

What are the side effects and disadvantages of oral Testosterone undecanoate?

- Expensive when compared to other forms of TRT.

- Must be taken with food for ideal absorption.

- Must be taken twice daily to maintain adequate levels of testosterone.

- Significant variation in testosterone levels among different individuals.

- Individuals accustomed to maintaining a high therapeutic level of Testosterone may not see significant improvement in symptoms.

- Nausea, diarrhea, and headache are common side effects of oral testosterone.

- No data on whether this can be used in females.

In summary, testosterone therapy can have excellent results in the quality of life of men suffering from andropause. Oral testosterone therapy is a welcome addition to testosterone replacement medication.

Do you or your partner suffer from symptoms of low testosterone? Looking to get life back on track? Testosterone replacement therapy can help restore balance and keep levels where they need to be for better overall health. Our team at HEALOR can help!

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