Transcription
Thank you for joining me, Dr. Amir, here at For Health for another insightful session on the topic of testosterone replacement therapy. The question about the root of administration of testosterone. So, there are several roots that one can use testosterone, testosterone rather. Uh, the first route is the oral route. Now, we don't use that much, and it has two parts to it. What we call the enteral root. So, we've got, obviously, the oral administration, or the sublingual, or the buccal. Now, we don't use that too frequently, um, obviously because it's a couple of reasons. Firstly, you're having to take it regularly every day, and also, we want to try to bypass the liver having any, if you want any need to want to manage an extra chemical inside your body. Whenever you take anything orally, your liver has to go, or the medication goes through a process, known as first-pass metabolism. There's also a second-pass metabolism, but first-pass metabolism, most things go through your liver. Basically, it has to deal with the drug, deal with things like hydrolysis and conjugation, and that can put pressure on the liver. And if we can reduce that, uh, uh, effect, that's better for us.
So, in our clinic, we use what's called parenteral, which is basically anything outside of that area. So, being either through the muscle, or through the skin, or through the subcutaneous fat. So, the muscle will be an intramuscular injection. We choose to use the sites along the leg, sometimes the deltoid, very rarely the glute, if you have someone helping apply it for you. So, that's the intramuscular root, which means going into the muscle, a deep injection. Uh, some people complain about it being quite painful. Actually, we use really small gauge needles, um, 25 to 27 gauge needles are really, really thin.
There's the subcutaneous root, slightly more, um, innovative route. Came about in the last few years, where you can actually use certain testosterones and apply them into the skin, under the, under, under skin rather, into the dermis, into the subcutaneous fat, like you do with an insulin injection in the abdomen. Um, and that can be something feasible as well. Some people like using that as well. Again, they've both got, uh, benefits and, uh, and some, some cons to it.
And then finally, you've got the topical application, which some patients like as well, where you have to apply the gel or the cream every day, regularly, one or two applications a day. Again, pros and cons to that. Compliance is the main one because you've got to maintain using it every single day without failure. Some people are very good, they've got very good regime, protocols, like, you know, brushing teeth and combing hair, what have you, and they keep it in that kind of, that same kind of algorithm where they give it to every day.
Injectables, because they're frequently given out, maybe once, twice, sometimes three times a week, they're slightly more, um, from the compliant point of view, easier to administer. Some injections, actually, we've had patients on one injection every 7 to 10, sometimes every 14 days. So, it depends on the patient, it depends on, um, their preference. Are they neophobic? Are they not neophobic? Um, are they happy to inject? Are they not too keen injecting the muscle, injecting into the leg? Or if, obviously, they are neophobic, then they can use topical rubs instead. And those are the ones that we actually, uh, uh, we prefer to use. But yes, we do also have access to enteral root medications, so oral, buccal, or sublingual.