Transdermal Testosterone Delivery Systems

Recently approved methods for testosterone delivery have provided increased options for men who require hormonal replacement therapy. Intramuscular administration of testosterone has classically been associated with early, high serum peaks in hormone followed by a gradual decline over the dosing interval. Transdermal patches are now available as an alternative. Testoderm® is applied to the scrotum; Androderm® is applied to nonscro-tal skin. Using either system, the majority of patients can achieve normal serum testosterone levels with a circadian variation and normal estradiol levels. Serum luteinizing hormone levels generally decrease but not to suppressed levels. Testoderm® use leads to an increase in plasma dihydrotestosterone. Clinical response in mood, energy level, and sexual function are improved with both systems and are generally comparable with intramuscular injection of testosterone. There are no clinically significant changes in laboratory parameters, including prostatic specific antigen, and prostate size did not increase to above normal. Skin reactions, however, are common and may require some patients to discontinue therapy. Patients with inadequate scrotal size may not have satisfactory results with Testoderm®. Patches are more costly than IM injections but do not require frequent office visits. Both the transscrotal and transdermal testosterone delivery systems offer a good alternative treatment for hypogonadal men who do not desire fertility during the treatment period.