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Alan R. Jacobs MD PCAlan R. Jacobs MD PC
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Two new oral testosterone products are pricey. Are they worth it?

August 3, 2022 General Neuroendocrine, Hypogonadotropic Hypogonadism, Male Sexual Dysfunction

Since 2019 the FDA has approved two novel oral testosterone products: both are categorized as generic testosterone undecanoate. The two brands are Tlando and Jatenzo.

Photo courtesy of Michigan Institute of Urology

Until this, patients with hypogonadism (low libido, erectile dysfunction, loss/decline in nocturnal/morning erections) in the setting of low bioavailable testosterone levels, had two main options – IM injections every one to three weeks, or gels to rub on skin each morning.  Each of these strategies has pros and cons.  For example, the IM injections are considerably less costly, but do require comfort with periodic butt shots, which they can administer themselves.  The morning gels are expensive, but are convenient and may mimic better the natural morning surge in testosterone.  

Of course, there has been an oral tablet to increase testosterone indirectly for decades, first created for women, called clomiphene citrate (Clomid).  This pill stimulates an increase in pituitary LH and FSH, which then cause testicular increased production of testosterone and sperm.  Clomid is warranted when LH and FSH deficiency is the problem, as opposed to primary testicular deficiency.

But the new oral Tlando and Jatenzo promise to be effective and more convenient to directly replace testosterone.  Yet, these also have pros and cons.  Both are even more expensive than gels.  They also can somewhat increase red blood cell counts, somewhat more than the other forms, and this has been related to causing blood pressure increases.  These issues can be monitored and dealt with, but are notable.

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