Low testosterone, or hypogonadism, occurs in both men and women and can be treated with testosterone replacement therapy. In men, it is responsible for developing sex organs, bone density, and muscle mass. In women, testosterone works with estrogen and affects sex drive, red blood production, muscle mass, and fat distribution. The treatments for testosterone replacement therapy are safe and effective, but the multiple options often have people wondering which is the best. Methods include creams/gels, injections, pills, patches, pellets, and nasal spray. The most common two, however, are the cream method and the injection method, so which is better? The short answer is there is no right answer, because it varies by patient. What is best simply means ‘what is best for you.’ There are many factors to consider when it comes to cream or injection.
It is important to note that currently, there are no mass-manufactured testosterone creams available in the United States, only gels. For the purposes of this article, however, gel and cream will both be referring to topical TRT treatment. Cream and gel can both be applied daily through skin, where it then passes to the bloodstream.
There are some notable advantages to using these to treat low testosterone. For one, it is less invasive, meaning no needles. It also requires less visits to the doctor’s office as you can apply from home. Also, the daily use of cream mimics endogenous production of testosterone; keeping your testosterone level fluctuation to a minimum.
There are a few disadvantages to consider with topical TRT treatment, a big one being it has a high transference risk. This means if you aren’t good about washing your hands, clothes, sheets, and everything else that comes in contact with skin afterwards, you risk leaving residue. The effects of unnecessary chemicals on others can be severe, so this option requires a close eye. Creams and gels are often the more expensive option between the two.
There are many untrue assumptions people hold about TRT shots. For example, it is believed that because injections go straight to the muscle, it has more potent and prompt effects. While this is false, there are still many benefits to choosing injections over creams or gels.
Injectables also more often achieve consistent, stable levels that creams do not. Injections are not required every day, so there’s less risk of forgetting a dosage. Injections are also more affordable than creams, so they are more fitting for a lower budget.
While some injections can be done from home, it is not always recommended, so the main disadvantage to injections are more office required visits. Injections are usually one shot of 100 mg, once a week for 12 weeks. Regimens of 300 mg every three weeks and 400 mg every four weeks can also be used. Some patients are given a daily dosage to mimic the natural testosterone cycle, but many don’t do this because it’s a lot of travel. Also, due to their invasive nature, injections may not be preferable to people with an inversion to needles.
Some doctors, like Dr. Rand of Regenerative Sports Medicine, do have a preference between the two based on patient experience. He personally recommends injections over creams, for both practical and medical reasons. Practically speaking, he points out that it is indeed a pain to have to remember to dose twice a daily and then have to wait so long for it to dry and absorb before doing any activities. Medically speaking, Rand says because of the daily fluctuations of hormone levels, injectables are time released so you stay therapeutic 24/7, as long as you’re getting those time released shots up to date. In his experience, most patients that go from cream to injections stick with injections. He does make sure to point out, however, that it’s always better to do what’s best for you, which varies by patients and their personal situation.
Aside from some key differentiators, creams/gels and injectables provide essentially the same results if guided by a medical professional. You will end up with the same physiological benefits with either method: muscle mass gain, cognitive enhancement, greater energy levels, and endurance. Find what works best for you!