Counseling Male Patients on Testosterone Replacement Therapy With Efficacy and Safety in Mind

Andrea G. Douglas, PharmD Candidate 2016; Joylaina Speaks, PharmD Candidate 2016; Jennifer Elliott, PharmD; Deirdre B. Fanning, PharmD


US Pharmacist. 2015;40(8):25-30. 

In This Article


When initially counseling a patient starting TRT, it is essential that he understand that this therapy is used to treat hypogonadism. It is not effective as monotherapy for erectile dysfunction. However, there are data suggesting a benefit of TRT in hypogonadal males who have failed phosphodiesterase type 5 (PDE5) inhibitor treatment.[14]

TRT products should always be used as directed by the physician.[15,16] It is important to advise the patient to clean the area prior to administration.[17–22] With gel and solution products, the patient must take precautions to avoid transference to women and children, such as washing hands after application and covering the application site with clothing; the products may also cause fetal harm.[15–24] Other general counseling points include the following:

  • Watch for potential signs and symptoms of a thromboembolism (e.g., shortness of breath, chest pain, swelling of extremities)

  • If a patient misses a dose, apply the dose immediately. However, if it is close to the next dose, the patient should skip the missed dose and apply at the next scheduled time. DO NOT double-up on dosing

  • If the patient is diabetic, monitor blood glucose levels closely while taking TRT. Contact physician if blood glucose levels are not within therapeutic range despite the use of diabetic medication

  • Contact physician if the patient experiences increased fatigue, prolonged erection, irregular breathing, or skin color changes

  • Caution patients who are using oxyphenbutazone. Using testosterone in conjunction with oxyphenbutazone may increase the medication serum levels

  • Counsel patients regarding the possible adverse effects including gynecomastia, sleep apnea, dyslipidemia, hypercalcemia, and an increased prevalence of acne

  • A summary of counseling points by dosage form and brand name for self-administered testosterone formulations is included in Table 3.[15–24]

In addition to the preparations mentioned in Table 3, two other formulations of testosterone must be administered in the healthcare provider's office, Aveed and Testopel.[25,26] Thus, the community pharmacist may not have the opportunity to counsel patients on these dosage forms. Aveed (testosterone undecanoate) is a long-term injectable. Patients must be monitored for 30 minutes at the physician's office after administration for any adverse reactions. Dosing for Aveed is 750 mg initially, then 750 mg 4 weeks later, then repeat every 10 weeks.[25]

Testopel is a testosterone pellet inserted by a clinician just under the skin in the hip or another fatty area.[26] Patients are advised to speak to their physician if they have prolonged irritation or rash at the sign of insertion. Testopel has similar drug interactions and adverse events as other forms of TRT, such as decreased insulin requirements and prolonged erection.