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May 2015

From Urology Times: Injected TRT earns high marks for safety, effectiveness

By: Arkansas Urology


A newly published review suggests that age-related testosterone deficiency treatment with intramuscular injections of testosterone replacement therapy (TRT) offers health benefits and lower cardiovascular risk compared to testosterone replacement by patch or gel.

READ: Studies examine risk factors for low, high T

While TRT can result in increased muscle mass and strength, decreased fat mass, and increased bone mineral density, the therapy has known risks. These include the development of polycythemia, decreases in high-density lipoprotein cholesterol, breast tenderness and enlargement, and prostate issues.

The authors point out, however, that TRT does not increase prostate cancer risk. And whether TRT hurts, helps, or has no effect on cardiovascular risk remains controversial in the literature.

The University of Florida, Gainesville, researchers who conducted this latest review were among the authors of a previously published study suggesting that oral TRT increases cardiovascular risk, but no significant cardiovascular effects were noted with injected or transdermal TRT (BMC Med 2014; 12:211).

For the current study, which was published online in the American Journal of Physiology – Endocrinology and Metabolism (April 21, 2015), study authors Stephen E. Borst, PhD, and Joshua F. Yarrow, PhD, reviewed literature indicating “that intramuscular injected TRT produces greater musculoskeletal benefits and lower cardiovascular risk compared to transdermal TRT… We also review the literature discussing the use of 5α-reductase inhibitors as a promising means of improving the safety profile of TRT.”

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According to the authors, for older hypogonadal men, administering TRT by injection, versus orally or transdermally, offers greater musculoskeletal benefits because doses are higher by injection. But while doses are higher when injected, intramuscular TRT might be less likely to result in cardiovascular risks than transdermal TRT. This could be because transdermal testosterone results in greater serum dihydrotestosterone (DHT) elevation, due to significant expression of 5α-reductase in skin—not muscle.

Published April 29, 2015 by Urology Times