Sexual Medicine (Sep 2015)

Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate‐Specific Antigen

  • Alexander W. Pastuszak, MD, PhD,
  • Lissette P. Gomez, MD,
  • Jason M. Scovell, BS,
  • Mohit Khera, MD,
  • Dolores J. Lamb, PhD,
  • Larry I. Lipshultz, MD

DOI
https://doi.org/10.1002/sm2.76
Journal volume & issue
Vol. 3, no. 3
pp. 165 – 173

Abstract

Read online

Introduction: Numerous testosterone (T) formulations are available, each with differing effects on serum parameters. Aim: The aim of this study was to compare the long‐term effects of topical, injectable, and implantable pellet T formulations in hypogonadal men. Methods: Retrospective review of hypogonadal men treated with a single T formulation was performed: 47 men on T gels, 57 on injectable T, and 74 on T pellets were identified. Total T (TT), calculated free T (FT), estradiol (E), hemoglobin (Hgb), hematocrit (Hct), prostate‐specific antigen (PSA), total cholesterol (Tchol), triglycerides (TG), low‐density lipoprotein (LDL), and high‐density lipoprotein (HDL) cholesterol were evaluated at baseline and every 3–6 months for 3 years. Serum parameters were compared using a mixed model linear regression for repeated measures. Main Outcome Measures: Effects of topical, injectable, and pellet T formulations on serum hormone levels, Hgb, Hct, lipid parameters and PSA. Results: Men in the injectable T group were younger (42.5 ± 12.3 years) than in the gel (54.1 ± 9.8 years) or pellet groups (53.8 ± 13.0 years), and baseline FT, Hgb, and Hct were higher in the injectable T group than in gel or pellet groups. Increases in TT and FT were observed throughout follow‐up in all groups. Increases in E were observed at in all T groups and throughout follow‐up in injectable and gel groups. No PSA increases were observed. Erythrocytosis (Hct > 50%) was more common with injectable T (66.7%) than with T gels (12.8%) or pellets (35.1%, P < 0.0001). Transient changes in cholesterol, TG, and LDL were observed, and no significant changes were seen in HDL for any group. Conclusions: All T formulations increase serum T and FT. More significant increases in E occur with injectable T and T gels. Changes in Hgb and Hct are most significant with injectable T, and effects on lipids are variable and inconsistent. Selection of T formulations must account for individual patient preferences and the effects of each formulation. Pastuszak AW, Gomez LP, Scovell JM, Khera M, Lamb DJ, and Lipshultz LI. Comparison of the effects of testosterone gels, injections, and pellets on serum hormones, erythrocytosis, lipids, and prostate‐specific antigen. Sex Med 2015;3:165–173.

Keywords