This repository has been archived by the owner on Sep 16, 2022. It is now read-only.
-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathttypes.html
521 lines (520 loc) · 38.1 KB
/
ttypes.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500
501
502
503
504
505
506
507
508
509
510
511
512
513
514
515
516
517
518
519
520
521
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
<head>
<title>Hudson's Guide: Testosterone Types and Delivery</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<meta name="description" content="Information about testosterone types and delivery methods for FTM transsexual and transgender hormone therapy.">
<meta name="keywords" content="FTM, female-to-male transsexual, men, transexual, transgender, F2M, transition,
testosterone, esters, cypionate, enanthate, androgel, gel, patch, pellet, sublingual, buccal, injections, hormone therapy">
<link rel="stylesheet" href="FTM.css" type="text/css">
<style type="text/css">
<!--
.style1 {color: #FF0000}
-->
</style>
</head>
<body bgcolor="#FFFFFF" link="#0000FF" vlink="#FF0000">
<h1><a href="http://www.ftmguide.org"><img src="images/hudsonsguidesmall.gif" alt="Hudson's FTM Resource Guide" width="700" height="56" border="0"></a></h1>
<h1><a name="top"></a>Testosterone Types and Delivery</h1>
<p><strong>DISCLAIMER</strong><br>
The information contained herein is to be used for educational purposes only.
The author is not a medical professional, and this information should not be
considered medical advice. <b>This information should NOT be used to replace
consultation with or treatment by a trained medical professional. </b>The listing
of a medication herein does not imply endorsement by the author.</p>
<p><a href="#overview">Overview</a><br>
<a href="#tlevels">"Normal" testosterone levels<br>
</a> <a href="#takemore">A note of caution about greatly increasing your T dosage</a></p>
<p><a href="#esters">Testosterone esters: what they are and how they work</a></p>
<p><a href="#tdelivery">Testosterone delivery methods </a></p>
<p><a href="#injectables">Injectable testosterone</a></p>
<blockquote>
<p>Injectable T esters commonly used by trans men for testosterone therapy:<br>
<a href="#enanthate">Testosterone enanthate<br>
</a> <a href="#cypionate">Testosterone cypionate<br>
</a> <a href="#sustanon">Sustanon</a></p>
<p> Other injectable forms of testosterone:<br>
<a href="#propionate">Testosterone propionate<br>
</a> <a href="#phenylpropionate">Testosterone phenylpropionate</a><br>
<a href="#omnadren">Omnadren</a><br>
<a href="#aqueous">Aqueous testosterone suspension</a> </p>
</blockquote>
<p><a href="#transdermal">Transdermal testosterone</a></p>
<blockquote>
<p><a href="#patch">Testosterone patches<br>
</a> <a href="#gelcream">Testosterone gels, creams, and other topical applications</a></p>
</blockquote>
<p><a href="#oral">Oral testosterone</a></p>
<p> <a href="#sublingual">Sublingual/buccal testosterone </a></p>
<p><a href="#pellet">Subcutaneous testosterone pellet </a></p>
<p><a href="#bib">Bibliographic resources </a></p>
<p><a name="overview"></a><strong>Overview</strong><br>
In FTM testosterone therapy, testosterone (often called "T" for
short) can be administered into the body in a number of ways. The most common
method is injection (either subcutaneous or intermuscular) with a syringe. Other delivery methods include transdermal
application through gel, cream, or patch applied to the skin; orally by swallowing
tablets (this method is very uncommon as it has been shown to have negative effects
on the liver); sublingually/buccally by dissolving a tablet under the tongue
or against the gums; or by a pellet inserted under the skin. The T-delivery
method used will depend on the type of medication available in the country of
treatment, the health risks/benefits for the patient, personal preference, and cost.</p>
<p>Testosterone is not stored by the body for future use, so in order to maintain
healthy levels, it must be administered in timed intervals and in appropriate
dosages. Injectable and subcutaneous T pellets remain active in the body the
longest. Injectable T is typically administered between once a week to once
every three weeks, and subcutaneous T pellets are replaced every 3-4 months.
Transdermal T (patch, gel, or cream) is typically applied to the skin in smaller
daily doses; oral and sublingual/buccal T are also typically taken daily. </p>
<p><b><a name="tlevels"></a>"Normal" testosterone Levels<br>
</b>An individual's testosterone levels are usually confirmed through a blood
test called a "serum total testosterone test." Testosterone exists
in your bloodstream in two forms-- "bound" testosterone and "free"
testosterone. The majority of bound testosterone in the body is chemically bound
to a protein called "sex hormone binding globulin" (SHBG). The remaining
bound testosterone in the system is mostly bound to albumin, another protein.
Free testosterone is not chemically attached to any proteins and is considered the "active" form of testosterone, as it is readily available
to bind to androgen receptor sites on cells.</p>
<p>A serum total testosterone test measures the total of bound and free T in the system. What is considered a normal test level of combined bound and free testosterone
in male bodies can range anywhere from 300-1100 ng/dl (nanograms per deciliter).
Levels will vary with age and individual factors.</p>
<p>It is useful to also separately measure the level of free testosterone in the system,
as this may be more indicative of how hormone therapy is progressing. Levels
of free testosterone can range between 0.3%-5% of the total testosterone count,
with about 2% considered an optimal level. Ask your doctor to check for both
total and free levels of testosterone in your system.</p>
<p> Remember that because everyone's bodies have differing sensitivities to androgens,
T levels themselves will not necessarily indicate results in terms of masculinization.
The levels are merely a guideline by which you and your doctor can begin to
measure progress. Your results and your dosing should be guided by your overall
health (especially the health of your heart and liver), your progress in masculinization,
and how your body and moods react to different dosages. Testosterone therapy
is not a one-size-fits-all approach-- be sure to monitor your health and feelings
closely, and remember that even a small adjustment in dosage (either increase or decrease)
can make a big difference.</p>
<p><b><a name="takemore"></a>A note of caution about greatly increasing your T
dosage</b><br>
During the first months of T therapy, many trans men feel impatient waiting for changes
to happen. Some may consider doubling or tripling their dose, thinking that
the more they put in, the faster the changes will come. However, as was mentioned
in the "<a href="ttherapybasics.html">FTM Testosterone Therapy Basics</a>"
section, dramatically increasing your dose might have the effect of <i>slowing</i>
your changes. This is because excess testosterone in your body can be converted
into estrogen by an enzyme called "aromatase." This conversion is
part of the body's natural feedback system-- if there is an abundance of testosterone
in the body, it is converted ("aromatized") to estrogen in order to
maintain a "normal" hormonal balance. Therefore, taking very large
doses of testosterone might not be a great idea. Be patient; if you are not
seeing results in a reasonable period of time, and/or your T levels are low,
discuss modifying your dosage with your doctor.</p>
<p>To learn more about the side-effects and health issues around testosterone
therapy, please see the "<a href="tandhealth.html">FTM Testosterone
Therapy and General Health</a>" section.</p>
<p><a href="#top">back to the top</a></p>
<hr>
<p><a name="esters"></a><b>Testosterone esters: what they are and how they work</b><br>
Much of the testosterone that is prescribed for the purposes of hormone therapy
is in the form of testosterone "esters." An ester is simply a name for a chemical
compound that is formed from reaction between a carboxylic acid and an alcohol.
A simple chemical diagram of this reaction is shown below in Figure A. Figure
B shows the chemical structure of free testosterone (chemical formula C<SUB>19</SUB>H<SUB>28</SUB>O<SUB>2</SUB>) as well as two different
esters of testosterone (testosterone cypionate and testosterone enanthate).</p>
<p><img src="images/esterformation.gif" alt="chemical reaction forming an ester" width="600" height="155" align="bottom"></p>
<p><img src="images/Tand2esters.gif" alt="testosterone molecule and testosterone ester molecules" width="600" height="187" align="top"></p>
<p>There are a number of different esters of testosterone, including the commonly
prescribed injectables of testosterone enanthate and testosterone cypionate,
as well others such as acetate, propionate, phenylpropionate, isocaproate,
caproate, decanoate, and undecanoate. Each of these different esters is a molecular chain
composed of carbon, hydrogen, and oxygen atoms. The main difference between the different esters
is how many carbon and hydrogen atoms make up the chain. For example, the propionate
ester is composed of 3 carbons, 6 hydrogens, and 2 oxygens, whereas the cypionate
ester is composed of 8 carbons, 14 hydrogens, and 2 oxygens.</p>
<p>Esterification of testosterone is done in order to improve the solubility of
testosterone in oil, which in turn slows the release of the testosterone from
the site where it enters the body.</p>
<p>Testosterone, in its free, non-esterified form, has poor solubility in either
oil or water-- though it can be suspended in water. Non-esterified testosterone
is available in an aqueous injectable form with the drug name "Aquaviron."
However, this form of testosterone stays active in the body for a very
short period of time (only a matter of hours).
Because of this, it must be injected on a daily basis in order to maintain a
continuous level of testosterone in the blood. Therefore it is rarely used for
testosterone replacement therapy as an injectable.</p>
<p>Once you have added an ester group to testosterone, it becomes even less soluble
in water and more soluble in oil. Additionally, as a general rule, the more
carbon atoms there are in an ester, the more soluble the ester is in oil. For
example, testosterone propionate (with 3 carbon atoms in the ester group) is
less soluble in oil than testosterone cypionate (with 8 carbon atoms in the
ester group). Remember, this is general, simplified rule; the solubility of a molecule depends on structural factors that are beyond the scope of this section.</p>
<p>So generally, the more carbons the ester group has, the more soluble in oil it becomes,
and the less soluble in water. The term for this ratio between oil and water
solubility is called the "partition coefficient"-- the higher the
solubility in oil, the higher the partition coefficient.</p>
<p>The partition coefficient of the ester in question is important because it
effects how long the drug itself stays in the system. If the testosterone transfers
too quickly from the oil to the blood, the result is a sudden spike in testosterone
which then rapidly drops once the dose has been used up. In the example of free testosterone injected into
the body from a water suspension (as in Aquiviron, mentioned above), the testosterone
is essentially immediately available to the bloodstream due to its low partition
coefficient, and thus there is an immediate spike of testosterone which is used
up quickly in the body.</p>
<p>Testosterone cypionate, on the other hand, has a high partition coefficient.
When injected into the body, the drug remains in its esterified form in a
deposit in the muscle tissue or fat tissue, depending on the type of injection. From there, it will slowly enter the circulation
as it is picked up in small quantities by the blood. Once the esterified testosterone
is brought into the blood stream, "esterase enzymes" cleave off the
ester chain in a process known as "hydrolization," thus leaving the
testosterone in its free form to perform its various actions and effects.</p>
<p>When people speak of whether a particular testosterone
ester is "fast acting" or "slow acting," they are usually referring to the partition coefficient/solubility in oil. As
described above, esters with more carbon atoms will generally be more soluble in oil-- they are often referred to as "slow-acting"
esters (they stay active in the system longer). Esters that are less soluble in oil are often referred to as "fast-acting"
forms of testosterone, referring to the fact that they are more quickly available
and used up in the blood stream.</p>
<p>For trans men who are using injectable testosterone, slow-acting esters tend to be preferred, as fewer injections are needed over time to
keep the blood levels of T reasonably constant. Testosterone enanthate (7 carbons)
and testosterone cypionate (8 carbons) both take about 8-10 days to be fully released in the system,
and so they are typically injected once every 7-14 days. Testosterone propionate
(3 carbons) takes about 3-4 days to be fully released in the system, and must be injected in smaller doses at least
weekly if not twice weekly. For this reason it is not often prescribed for men
in transition.</p>
<p><a href="#top">back to the top</a></p>
<hr>
<h2><a name="tdelivery"></a>Testosterone delivery methods </h2>
<p><a name="injectables"></a><b>Injectable testosterone <br>
</b>The dosage amount and timing for injectable testosterone will depend largely
upon which ester is being used, as well as the individual's own response to
the hormone. In general, dosages will vary between 50 mg and 300 mg per injection,
depending on the ester and the dosing regimen. An average injectable dose is
about 200-250 mg every two weeks, though many trans men inject 100 mg every week or every 10 days,
or other variations depending on their own bodies' needs and sensitivities.
Again, the exact dosage required will vary from person to person, and health
and well-being should be carefully monitored while determining an individual's
ideal dose.</p>
<p>Some doctors recommend decreasing the dosage of injectables to 100-150 mg every
two weeks for those trans men whose ovaries are inactive, or who have had their ovaries
removed. Again, this will vary from person to person.</p>
<p>There are a number of different types of injectable testosterone; those available
may differ depending on the country in which you reside. The drug names for
the same ester of testosterone may also differ depending on the company who
produces it. This is not an exhaustive list, though it does cover the main injectable
forms of T which are used by trans men for testosterone therapy.</p>
<p>Finally, testosterone esters are typically suspended in either cottonseed oil
or sesame seed oil. Some people find that they may have an allergic or skin reaction
to one of the oils. Certain brand-name testosterone esters
are mass produced using one oil or the other (as noted below), but by using
a compounding pharmacy, you can have any testosterone ester suspended in your
choice of oil (with a proper prescription). (<a href="compounding.html">For
more information about compounding pharmacies, click here.</a>)</p>
<p><b>Injectable esters commonly used by trans men for testosterone therapy:</b></p>
<blockquote>
<p><b><a name="enanthate"></a>Testosterone enanthate: </b>Chemical formula C<SUB>26</SUB>H<SUB>40</SUB>O<SUB>3</SUB><br>
Testosterone enanthate is one of the main forms of testosterone prescribed
to trans men in the United States. It is a slow-acting ester with a release time
between 8-10 days. The name-brand of T-enanthate available in the United
States is called "Delatestryl," which is suspended in sesame oil.
Testosterone enanthate is typically injected anywhere between once every week
to once every three weeks. Generic testosterone enanthate can also be obtained
through a compounding pharmacy; such pharmacies can mix T-enanthate in sesame, cotton seed, or any other appropriate oil. (<a href="compounding.html">For more information
about compounding pharmacies, click here</a>.)</p>
<p><b><a name="cypionate"></a>Testosterone cypionate: </b>Chemical formula C<SUB>27</SUB>H<SUB>40</SUB>O<SUB>3</SUB><br>
Testosterone cypionate is the other main injectable form of testosterone prescribed
to trans men in the United States. It is a slow-acting ester with a release time
between 8-10 days, similar to that of enanthate. The name-brand of T-cypionate
available in the United States is called "Depo-Testosterone," which
is suspended in cottonseed oil. Testosterone cypionate is typically injected
anywhere between once every week to once every three weeks. Generic testosterone
cypionate can also be obtained through a compounding pharmacy; such pharmacies
can mix T-cypionate in sesame, cotton seed, or any other appropriate oil.<b> </b>(<a href="compounding.html">For
more information about compounding pharmacies, click here.</a>)</p>
<p><b><a name="sustanon"></a>Sustanon <br>
</b> "Sustanon" is the brand name for two formulas of injectable testosterone that contain a blend of
esters. "Sustanon 100" contains three testosterone esters: testosterone propionate (C<SUB>22</SUB>H<SUB>32</SUB>O<SUB>3</SUB>), testosterone phenylpropionate (C<SUB>28</SUB>H<SUB>36</SUB>O<SUB>3</SUB>), and
testosterone isocaproate (C<SUB>25</SUB>H<SUB>38</SUB>0<SUB>3</SUB>).
"Sustanon 250" contains four testosterone esters: testosterone propionate (C<SUB>22</SUB>H<SUB>32</SUB>O<SUB>3</SUB>), testosterone phenylpropionate (C<SUB>28</SUB>H<SUB>36</SUB>O<SUB>3</SUB>), testosterone isocaproate (C<SUB>25</SUB>H<SUB>38</SUB>0<SUB>3</SUB>), and testosterone decanoate (C<SUB>29</SUB>H<SUB>46</SUB>0<SUB>3</SUB>). Both formulas feature fast-acting and slow-acting esters, and can be injected anywhere
from once every week to once every four weeks. Sustanon is prescribed outside of
the United States.</p>
</blockquote>
<p><b>Other injectable esters of testosterone:</b></p>
<blockquote>
<p><b><a name="propionate"></a>Testosterone propionate:</b> Chemical formula
C<SUB>22</SUB>H<SUB>32</SUB>O<SUB>3</SUB><br>
Testosterone propionate is a fast-acting ester with a release time of 3-4
days. To keep blood levels from fluctuating greatly, propionate is usually
injected between one to three times a week. It is for this reason that it
is not usually prescribed for FTM hormone therapy. Some users also report
that propionate is a more painful injection, with swelling and noticeable
pain around the injection site. Brand names of testosterone propionate include
"Testovis" and "Virormone."</p>
<p><b><a name="phenylpropionate"></a>Testosterone phenylpropionate:</b> Chemical
formula C<SUB>28</SUB>H<SUB>36</SUB>O<SUB>3</SUB><br>
Testosterone phenylpropionate is a slow-acting ester, with a release time
of 1-3 weeks. A popular name brand for T-phenylpropionate is "Testolent."
Testosterone phenylpropionate is also one of the components of Sustanon and
Omnadren.</p>
<p><b><a name="omnadren"></a>Omnadren</b><br>
"Omnadren" is the brand name for a blend of four testosterone esters:
testosterone propionate (C<SUB>22</SUB>H<SUB>32</SUB>O<SUB>3</SUB>), testosterone phenylpropionate (C<SUB>28</SUB>H<SUB>36</SUB>O<SUB>3</SUB>),
testosterone isocaproate (C<SUB>25</SUB>H<SUB>38</SUB>0<SUB>3</SUB>), and testosterone decanoate (C<SUB>29</SUB>H<SUB>46</SUB>0<SUB>3</SUB>).
In the past, Omnadren consisted of a blend of different esters, but now is
essentially the same formula as Sustanon, mentioned above. It features both
fast-acting and slow-acting esters, and can be injected anywhere from once
every week to once every four weeks. It is sometimes prescribed in parts of
Europe.</p>
<p><b><a name="aqueous"></a>Aqueous testosterone suspension<br>
</b> In the United States, injectable aqueous (non-esterified) testosterone
is available, but it is very short-acting (it is completely released in the
system within a matter of hours). Therefore, it is not typically used for
men in transition, as it would require constant re-injection to maintain
regular blood levels. The brand name for aqueous testosterone suspension is
"Aquaviron."</p>
</blockquote>
<p><a href="#top">back to the top</a></p>
<p><b><a name="transdermal"></a>Transdermal testosterone</b><br>
The term "transdermal" refers to topical delivery through
the skin, by the use of a patch, gel, or cream.</p>
<p>Transdermal testosterone is usually applied to the skin daily in small doses
in an effort to keep a steady level of testosterone in the system at all times.
This approach avoids the "peaks and valleys" in T-levels sometimes
associated with injectable testosterone. With injectables, T levels can reach
a low-point a few days before the next shot is due, which can cause irritability,
hot flashes, and low energy in some users. Daily transdermal application can
help alleviate such problems. Indeed, some trans men who regularly use injectable
testosterone sometimes supplement with a gel or patch during the last few days
of their dosing cycle to maintain their T levels.</p>
<p>Transdermal application is also attractive to those individuals who are not
comfortable with needles and injections.</p>
<p>However, there are some disadvantages to transdermal delivery. Some forms of
daily transdermal testosterone application, particularly the patch, are substantially
more expensive than injectable testosterone. Testosterone patches often cause
skin irritation and/or allergic reactions to users. They can fall off with excessive
sweating, and they must be fully protected with plastic when swimming. Testosterone
cream and gel can be transferred by direct skin contact with a partner; special
care must be taken with female partners who wish to avoid potential virilization.</p>
<p><b><a name="patch"></a>Testosterone patches<br>
</b>There are currently two brand-name testosterone patches available in the
United States: "Androderm" and "Testoderm." (Note that there
are two forms of Testoderm available: a scrotal patch and a non-scrotal patch.
The non-scrotal patch, "Testoderm TTS," is described herein). Generic
testosterone patches are not yet available. Both Androderm and Testoderm TTS
are very fast-acting once they have permeated the skin. The testosterone in
the patches is suspended in an alcohol-based gel.</p>
<p>In order to deliver testosterone efficiently into the body, chemical enhancers
are added to the patch to increase permeability of the skin. It is these enhancers
that are often the cause of skin irritation in many users. Some individuals
find Testoderm TTS to be less irritating to the skin than Androderm, but this
will vary from person to person.</p>
<blockquote>
<p><b>Androderm<br>
</b> Androderm patches come in two doses: 2.5 mg/patch and 5.0 mg/patch. The
actual amount of testosterone in the 2.5 mg patch is 12.2 mg, and the actual
amount in the 5.0 mg patch is 24.3 mg. The reason is that much of the testosterone
in the patch will not manage to get into the system. So, for example, the
aim of the 2.5 mg patch is to get about 2.5 mg successfully into the bloodstream
per day. Therefore, it is possible to absorb slightly more or slightly less
than the 2.5 mg of the patch's ideal dosage (the same reasoning, of course,
applies to the 5.0 mg patch as well).</p>
<p>Androderm patches are usually applied on the back, abdomen, thighs, or upper
arms. Because the active area of the patch is covered, the wearer does not
have to worry about skin contact with a partner. Dosages will vary between
2.5 mg - 10 mg daily, by applying a single patch or combination of patches.
As with any form of testosterone, dosage should be determined by your overall
health, your testosterone levels as checked by your doctor, and your progress
in masculinization.</p>
<p><b>Testoderm TTS<br>
</b> There are two types of Testoderm patches: one is intended for scrotal
application, and one for application on other areas of the body. Testoderm
TTS refers to the non-scrotal version of the patch-- this is the patch that
should be used by trans men.</p>
<p> Testoderm TTS patches come in two doses: 4.0 mg/patch and 6.0 mg/patch.
As with Androderm, the actual amount of testosterone in these patches is greater
than the listed dose. The reason is the same as explained above in the Androderm
section. </p>
<p>Testoderm TTS patches are usually applied on the back, abdomen, thighs, or
upper arms. Because the active area of the patch is covered, the wearer does
not have to worry about skin contact with a partner. Dosages will vary between
4.0 mg - 10 mg daily, by applying a single patch or combination of patches.
As with any form of testosterone, dosage should be determined by your overall
health, your testosterone levels as checked by your doctor, and your progress
in masculinization.</p>
</blockquote>
<p><b><a name="gelcream"></a>Testosterone gels, creams, and other topical applications</b><br>
There are currently two brand-name versions of testosterone gel available in
the United States: Androgel and Testim. A brand-name under-arm application of testosterone called Axiron is also available in the U.S. There are no brand-name testosterone
creams at this time. Both cream and gel formulations of testosterone can be
made by compounding pharmacies. (<a href="compounding.html">For more information
about compounding pharmacies, click here</a>.) Gel formulations of testosterone
are typically alcohol-based, whereas creams are typically safflower oil-based.
The testosterone in creams and gels is typically very fast-acting once absorbed
through the skin. Thus, it must be applied once or twice daily to maintain
T levels.</p>
<p>Creams and gels are applied directly onto the skin. Care must be taken to avoid
skin-to-skin contact with a partner on the site of application. Transfer of
the testosterone from the site can be prevented by keeping the area covered.</p>
<blockquote>
<p><b>Androgel<br>
</b> Androgel is a clear, alcohol-based gel that contains 1% non-esterified
testosterone. It is very fast-acting once it has been absorbed by the skin,
and so must be applied 1-2 times daily to maintain T levels. It is available
in either unit-dose packets or multiple-dose pumps. The unit dose packets
contain either 25 mg or 50 mg of testosterone. Approximately 10% of the applied
testosterone from the packets is absorbed into the system, resulting in an
effective dose of 2.5 mg or 5.0 mg, respectively.</p>
<p>Androgel should be applied to clean, dry skin and should not be applied to
the genital area. Application sites should be allowed to dry for a few minutes
prior to dressing. Hands should be washed thoroughly with soap and water after
application. </p>
<p>In order to prevent transfer to another person, clothing should be worn to
cover the application sites. If direct skin-to-skin contact with another person
is anticipated, the application sites should be washed thoroughly with soap
and water. Users should wait at least 2 hours after applying before showering
or swimming; for optimal absorption, it may be best to wait 5-6 hours.</p>
<p><b>Testim<br>
</b> Testim, like Androgel, is a clear, alcohol-based gel that contains 1%
non-esterified testosterone. It is very fast-acting once it has been absorbed
by the skin, and so must be applied 1-2 times daily to maintain T levels.
It is available in 5.0g unit-dose tubes. A 5.0g unit dose tube contains 50
mg of testosterone. Approximately 10% of the applied testosterone from the
tube is absorbed into the system, resulting in an effective dose of 5.0 mg.
</p>
<p>Testim should be applied to clean, dry skin-- preferably to the shoulders
and/or upper arms. It should not be applied to the genitals or to the abdomen.
Application sites should be allowed to dry for a few minutes prior to dressing.
Hands should be washed thoroughly with soap and water after application. </p>
<p>In order to prevent transfer to another person, clothing should be worn to
cover the application sites. If direct skin-to-skin contact with another person
is anticipated, the application sites should be washed thoroughly with soap
and water. Users should wait at least 2 hours after applying before showering
or swimming; for optimal absorption, it may be best to wait 5-6 hours.</p>
<p><strong>Axiron</strong><br>
Axiron is an alcohol-based solution that delivers 30 mg of testosterone per 1.5 mL solution, available via a metered-dose pump. Each pump actuation delivers 30 mg of testosterone, which is applied to the armpit(s) with the supplied applicator. It is typically applied once daily as directed to maintain T levels; dosage may vary from one pump (30mg) to up to four pump doses (120mg) per day as directed by your doctor.</p>
<p>Axiron should be applied to clean, unbroken skin in the armpits-- there is no need to shave the armpit before application. It should not be applied to the genitals, the abdomen, or any other application site.
Armpits should be allowed to dry for a few minutes prior to dressing.
Hands should be washed thoroughly with soap and water after application. If an individual is using deodorant or anti-perspirant, these should be applied to the armpit a few minutes before applying Axiron.</p>
<p>In order to prevent transfer to another person, clothing should be worn to
cover the application sites. If direct skin-to-skin contact with another person
is anticipated, the application sites should be washed thoroughly with soap
and water. Users should wait at least 2 hours after applying before showering
or swimming; for optimal absorption, it may be best to wait 5-6 hours.</p>
<p><b>Compounded creams and gels<br>
</b> Compounded creams and gels can be mixed by compounding pharmacies, and
are similar in dosing, application, and precautions to what is described above
for Androgel and Testim.</p>
<p>There are two advantages of using compounding pharmacies for testosterone
gel or cream. The first is cost: until a generic version of the gel is available,
compounded gel will usually be the cheaper alternative. The second is customization:
your doctor can write a prescription of varying concentration for gels or
creams. (<a href="compounding.html">For more information about compounding
pharmacies, click here</a>.)</p>
</blockquote>
<p><a href="#top">back to the top</a></p>
<p><b><a name="oral"></a>Oral testosterone <br>
</b>Chemically unbound testosterone, if taken orally, is not effective for masculinization
since it is immediately deactivated by the liver. However, two chemically-modified
forms of testosterone have been successfully shown to induce masculine secondary
sex characteristics when taken orally: methyltestosterone and testosterone undecanoate.
</p>
<blockquote>
<p><b>Methyltestosterone (C-17 alpha methylated testosterone)</b><br>
Methyltestosterone is one of the earliest available oral testosterones. Its
chemical structure is the hormone testosterone with an added methyl group
at the c-17 alpha position of the molecule. The use of oral c-17 alpha methylated
testosterone for masculinization is obsolete due to its toxicity to the liver.
As such, <b>methyltestosterone is not recommended for FTM hormone therapy</b>.
Brand names include "Metesto," "Methitest," "Testred,"
"Oreton Methyl," and "Android."</p>
<p><b>Testosterone undecanoate</b><br>
Testosterone undecanoate is not a c-17 alpha alkylated hormone. Therefore,
it is considered a safer oral form of testosterone. It is designed to be absorbed
through the small intestine into the lymphatic system, posing less burden
on the liver. Brand names for testosterone undecanoate include "Andriol,"
"Androxon," "Understor," "Restandol," and "Restinsol."
It is not available in the United States.</p>
<p>One disadvantage of orally administered undecanoate is that it is eliminated
from the body very quickly, usually in 3-4 hours. Thus, frequent administration
is necessary-- usually between 3-6 capsules a day. This can prove to be expensive when compared to injectable testosterone.</p>
<p>Finally, when used in FTM hormone therapy, it has been reported that oral testosterone undecanoate has not
always been successful in suppression of menstruation.</p>
</blockquote>
<p><a href="#top">back to the top</a></p>
<p><b><a name="sublingual"></a>Sublingual/buccal testosterone <br>
</b>Sublingual and buccal testosterone delivery works by either placing a dissolving
tablet under your tongue (sublingual) or by placing a tablet against the surface
of the gums (buccal). It is different from oral delivery in that very little
of the substance is swallowed, avoiding potential liver toxicity.</p>
<blockquote>
<p><b>Sublingual<br>
</b> Sublingual testosterone can be obtained through compounding pharmacies.
(<a href="compounding.html">For more information about compounding pharmacies,
click here</a>.) </p>
<p><b>Buccal<br>
</b> In 2003, the FDA approved a sustained-release buccal testosterone tablet
called "Striant." It acts by adhering to the buccal mucosa (the
small depression in the mouth where the gum meets the upper lip above the
incisor teeth). Once applied, the tablet softens and delivers testosterone
through the buccal mucosa, where it is then absorbed directly into the bloodstream,
bypassing the gastrointestinal system and liver.</p>
<p> The recommended dosage for Striant is to replace the tablet about every
12 hours, though a different dosing schedule or number of tablets might be
required depending on the needs of the patient.</p>
</blockquote>
<p><a href="#top">back to the top</a></p>
<p><b><a name="pellet"></a>Subcutaneous testosterone pellet <br>
</b> Another relatively new form of testosterone delivery is via a pellet of
pure, crystalline testosterone implanted beneath the skin. The pellets are about
the size of a grain of rice, and are typically placed in the buttocks or abdomen.
The insertion of the pellets is a quick procedure, usually done under local
anesthesia. Pellets are typically replaced after 3-4 months. "Testopel"
is a brand name for testosterone pellets in the United States.</p>
<p>A 200 mg testosterone pellet releases testosterone at a steady rate of 1-3
mg per day. Several pellets can be inserted at the same time to increase dosage.</p>
<p>Some users have reported problems with the pellets working their way out from
under the skin.</p>
<p><strong><span class="style1">Was this page helpful to you?</span><br>
Please consider <a href="donate.html">donating</a> to ftmguide.org! </strong></p>
<p><a href="#top">back to the top</a></p>
<hr>
<p><b><a name="bib"></a>Bibliographic resources </b></p>
<p>Ebbing, Darrell D., <i>General Chemistry, </i>Houghton Mifflin, 1987.</p>
<p>Prescribing information sheets for:<br>
Testosterone Cypionate (<a href="http://www.pfizer.com/pfizer/download/uspi_depo_testosterone.pdf">www.pfizer.com/pfizer/download/uspi_depo_testosterone.pdf</a>)<br>
Androderm Testosterone Transdermal System (<a href="http://www.androderm.com">www.androderm.com</a>)<br>
Androgel Topical Testosterone (<a href="http://www.androgel.com">www.androgel.com</a>)<br>
Striant Buccal Testosterone system (<a href="http://www.striant.com/Consumer/striant_consumer_home.asp">www.striant.com/Consumer/striant_consumer_home.asp</a>)<br>
Organon's Testosterone Implant Pellet (<a href="http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=7303">emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=7303</a>)</p>
<p><a href="http://www.nickgorton.org">www.nickgorton.org</a><br>
Contains the downloadable book <em>Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers</em> by R. Nick Gorton MD, Jamie Buth MD, and Dean Spade Esq. This is the most complete care guide available for FTM patients to date-- an excellent resource to show your doctor.</p>
<p>Trans-Health<br>
<a href="http://www.trans-health.com">www.trans-health.com</a></p>
<p>International Journal of Transgenderism<br>
(now a publication of The World Professional Association for Transgender Health (WPATH))<br>
<a href="http://www.wpath.org/publications_ijt.cfm">www.wpath.org/publications_ijt.cfm</a></p>
<p>Tom Waddell Health Center Protocols for Hormonal Reassignment of Gender (PDF) <br>
<a href="http://www.sfdph.org/dph/comupg/oservices/medSvs/hlthCtrs/TransGendprotocols122006.pdf">www.sfdph.org/dph/comupg/oservices/medSvs/hlthCtrs/TransGendprotocols122006.pdf</a></p>
<p>WebMD<br>
<a href="http://www.webmd.com">www.webmd.com</a></p>
<p>U.S. National Library of Medicine and<br>
National Institute's of Health<br>
Medline Encyclopedia<br>
<a href="http://www.nlm.nih.gov/medlineplus/encyclopedia.html">www.nlm.nih.gov/medlineplus/encyclopedia.html</a></p>
<p>U.S. National Library of Medicine and<br>
National Institute's of Health<br>
PubMed<br>
<a href="http://www.ncbi.nlm.nih.gov/entrez/">www.ncbi.nlm.nih.gov/entrez</a></p>
<p>E-medicine.com<br>
<a href="http://www.emedicine.com">www.emedicine.com</a></p>
<p>Health Central.com<br>
<a href="http://www.healthcentral.com">www.healthcentral.com</a> </p>
<p><a href="#top">back to the top</a></p>
<p><a href="index.html">Back to Hudson's FTM Resource Guide main page</a></p>
<p><a href="copyright.html">Copyright, disclaimer, and privacy information</a></p>
<p> </p>
<p> </p>
<p> </p>
<p> </p>
<p> </p>
<p> </p>
<p> </p>
<p> </p>
<p> </p>
</body>
</html>