Defy Medical offers a variety of custom Testosterone creams and gels for patients who prefer topical application.
Topical testosterone is a useful alternative to injections. Testosterone creams and gels are designed to deliver a steady stream of hormones over a period of 24 hours, which can optimize hormone levels in the bloodstream. Topical Testosterone is typically applied once a day, and there are different bases available depending on patient preference and response.
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Topical Testosterone is sometimes called a Transdermal Delivery System (TDS). With this type of therapy, a small amount of cream or gel is applied to the skin. It's absorbed through the skin into the bloodstream over a period of time, typically 24 hours. Topical Testosterone is most often applied daily to provide continual elevation of Testosterone levels – and relief from low-T symptoms.
Transdermal delivery systems work by diffusion. The hormone diffuses from the carrier – the cream, gel or patch base – into the skin. It then circulates throughout the body within the bloodstream.
The most common types of carriers used to create topical Testosterone include:
Gels
Lotions
Creams
Patches
Although the types of topical Testosterone look and feel different, they are all designed to deliver the highest concentration of Testosterone into the bloodstream.
There are also transdermal creams and gels that can carry multiple active ingredients at once. A compounded hormone combination cream is an example of a multi-hormone Transdermal Delivery System. For example, a topical cream may 10% Testosterone and 5% Nandrolone, which can be applied at once for a synergistic effect.
The best type of topical application for you may depend on many factors, including your comfort level and response. Defy Medical's pharmacy partners can compound Testosterone using the type of base that works best for you to create an individualized treatment. This differs from commercial products, which are only available as either a gel or transdermal patch.
Compounding pharmacies usually carry a variety of TDS bases that can be used to make a transdermal hormone. Many pharmacies manufacture their own TDS formulas and even make improvements to existing base formulas.
Common topical Testosterone bases include:
This transdermal cream base is designed to deliver multiple hormones through the skin.
An oil-in-water mixture developed for topical or vaginal delivery in Hormone Replacement Therapy.
While this base is primarily used for women, it can also be useful for men, since it's highly absorbent and specially designed to help soften skin. This base can also be used in a wide variety of other topical medications.
This cosmetic transdermal cream base is designed to deliver fast absorption of medication while also softening the skin. Due to its moisturizing effects, Versabase® can be used for both cosmetic and pharmaceutical application.
Hydro-alcohol aids the gel and hormone in absorbing faster, which can help avoid accidental transference. However, this base can also potentially irritate and/or dry out the skin. Despite this, it is a useful option that can work for many patients.
All types of TDS listed are available at compounding pharmacies.
Absorption can vary between individuals who apply transdermal testosterone to the skin.
The standard measurement of predicted absorption used by compounding pharmacists is 10% - meaning roughly 10% of the total dosage of topically applied hormone will penetrate the skin.
For example, for every 100 mg of testosterone applied, only 10 mg will actually be absorbed through the skin. Because the absorption rate will vary based on the individual, it is important to do follow-up blood tests to determine the right dosage based on your unique absorption rate.
Men typically require 7 mg-10 mg of testosterone daily to reach the upper quartile of optimized testosterone levels and gain relief from hypogonadism symptoms.
Typically, Testosterone cream should be applied once every 24 hours unless your provider suggests otherwise. Common testosterone cream application sites for men are the skin of the shoulders, inner thigh, upper chest or inner arm. For women, topical testosterone is usually applied to the abdomen, inner thighs or vaginally.
Both men and women are typically instructed to rotate application sites to help avoid potential irritation at one site. It’s also important to avoid transferring the topical Testosterone to anyone via skin-to-skin contact, particularly spouses and children.
Using compounded transdermal testosterone appears to be more effective than brand name (manufactured) transdermal testosterone products (Androgel, Testim, etc.) for a few reasons.
Testosterone is available at compounding pharmacies who specialize in hormone preparations.
Compounding pharmacies have the ability customize topically applied testosterone into different strengths and combinations using a variety of transdermal delivery systems (Lipoderm, HRT, Versabase, alcohol gel).
Compounding pharmacies can be used to prescribe a higher concentrated transdermal testosterone which will allow enough of the hormone to be absorbed to maintain a good physiologic level of total testosterone.
In addition, testosterone can be compounded using a custom delivery system which will result in minimal skin reactions. Lipoderm, Versabase, and HRT base are delivery systems that can provide maximum bioavailability and penetration of active ingredients while minimizing skin irritation that can occur with alcohol-based gels or transdermal patches.
The higher dose compounded testosterone creams containing 5% to 20% testosterone have been available by physician’s prescription from any compounding pharmacy specializing in hormone preparations.
The cost for compounded testosterone creams is less than 1% AndroGel® and less expensive generic alternatives can be compounded by many pharmacists. A low dose dihydrotestosterone, DHT gel, labeled Andactrim™, also from Solvay, has been available in Europe for almost a decade. Doctors who specialize in bio-identical hormone replacement therapy have been using cream and gel delivery of female hormones for decades.
Compounded testosterone creams create more physiologic testosterone levels, skin reactions are minimal, and short-term discontinuation of therapy is possible due to the longer half-life of up to 25 hours.
Scrotal application is also convenient and discrete while theoretically producing more DHT than when applied to other locations on the body.
Common brand name testosterone products on the market include:
AndroGel® is a low dose 1% (10 mg/ml), testosterone product. On the market since July 2000, it provides a safe, alcohol-based gel containing testosterone in low physiologic doses.
Due to the low concentration, larger amounts are required for adequate testosterone replacement in men.
Testim®, released in 2004, seems to have slightly better absorption rate than AndroGel, making it more efficient, but it also has a low concentration of testosterone (1%). Therefore, the increased absorption rate may not provide significant elevation of total testosterone.
Patients have also reported a slight musky odor after applying Testim®.
Clinical trials have also proven that testosterone patch called Androderm®, developed by Watson Pharmaceuticals in 1985, is another safe form of testosterone replacement.
Clinical trials have also proven that testosterone patch called Androderm®, developed by Watson Pharmaceuticals in 1985, is another safe form of testosterone replacement.
Androderm® is available in two strengths, as either a 2mg or 4mg transdermal patch. Due to the low strength, two patches are often needed to adequately restore testosterone.
Patients who use testosterone patches have reported problems with the patch falling off, particularly when they are physically active. Patients have also reported skin irritation including a rash at the site where the patch is applied.
Transdermal Testosterone Options: Compounded Testosterone cream, Testim®, Androderm® (patch), Androgel®
Transdermal containers
Dispensing Syringes
Dispensing syringes of various sizes are commonly used for hormone gels and creams. The hormone is dispensed by depressing the plunger until a measured dose releases from the syringe.
Plastic or Glass Jars
Plastic or glass jars can also be used to store medicated transdermal gels and creams. The jar may come with a measuring spoon or the patient can use their finger to apply an estimated amount of hormone.
Topi-Click Containers
Another common dispensing container is called “Topi-Click”, similar to a deodorant container. The patient twists the dial at the bottom of the container to dispense a measured dose of transdermal hormone out of the opening at the top.
One twist or click of the dial equals 1/4ml of medication.
Other containers might be available depending on the pharmacy. If the prescription does not request a specific type of container, then the compounding pharmacy will usually default to one of the more commonly used containers.