Hormone replacement treatment

 If testosterone levels are below the normal range, hormone replacement therapy (HRT) is typically prescribed.

This is generally in the form of testosterone administered by gel or injection. There is no ideal method of testosterone delivery – it is often down to individual choice.
The best method for any patient will depend on their own personal circumstances.

Some will find the routine of daily gel application difficult while some may dislike the highs and lows of the injections. 

Testosterone replacement will not improve fertility. In fact most urologists say that, if fertility procedures are being considered, then testosterone replacement therapy should be delayed.

Sometimes no medication will be required if natural testosterone levels are sufficiently high. Some adults may not wish to have hormone treatment because they don’t like the effect that testosterone has on them. Occasionally the use of oestrogen may be preferred.

Here are some FAQ about hormone replacement therapy.

The changes to the charging system for HRT means that one prescription will cover one year’s supply of HRT.

It is usual to prescribe a gel initially in case the patient does not like the effect of testosterone.

Nebido is commonly prescribed and must be administered by a nurse or doctor.

Advantages:
needs to be administered only 3 to 5 times per year
no special precautions required

Disadvantages:
injection can be painful
some patients dislike the initial high level of testosterone
some patients find that they run out of steam before the next injection is due
some patients forget to book their appointment

We realise many medical professionals have little or no experience of administering a Nebido injection, so please make sure all concerned have read the instructions. Incorrect use can be harmful to your patient.

Nebido must not be cold when it is administered. Hold the ampule in your hand for a few minutes.

A small needle is used to extract the liquid from the ampule but a large needle must be used to inject it.

The patient should be comfortable and relaxed, lying face down or leaning against the bed.

The injection should be given in the buttock.

The injection should take at least  2 minutes.

Many like the gel preparations because they give a very even delivery of testosterone. They are short-acting and can be discontinued immediately if the patient is uncomfortable with the effects.
There are several products on the market. If the patient doesn't like one, try an alternative one.

Advantages:
daily dosage gives an even delivery without highs and lows.
easy to discontinue if patient unhappy with effect

Disadvantages:
have to be applied every day
should be applied after a shower
take a few minutes to dry (time varies between products)
accidental transference to others must be avoided

As KS/XXY guys are usually not good at remembering spoken instructions, please write things down or demonstrate.

Read the instructions for y carefully because they vary from product to product. Some should be rubbed in, others should just be spread evenly on the skin. Some should be applied to the shoulders, while others may stipulate different areas. 
Advise that hands should be washed thoroughly and gel allowed to dry before putting on clothing. Suggest clean  teeth or have a shave while waiting.

It is important that testosterone and haematocrit levels are monitored carefully until a stable dose is established. After that annual checks should continue.

As with most drugs, there are pros and cons.

TRT can have  very positive effects, although the extent of these will vary from person to person. The most common are:

  • increased assertiveness
  • improved self esteem
  • clarification of thought processes
  • growth of facial and body hair
  • possible reduction in danger of osteoporosis
  • possible improvement in muscle bulk
  • increased  stamina

  • some adults dislike the masculinising effect testosterone will have on their personality and body
  • untreated KS adults have a reduced risk of prostate cancer compared to XY men. TRT  will remove this advantage.  The prostate should be checked before treatment is started and should be monitored
  • Testosterone is known to increase the red blood cell count. This can be a problem if testosterone levels are not monitored
  • increased aggression particularly soon after injections when levels are high
  • mood swings when levels are high or low
  • increased probability of male pattern baldness
  • acne