How long do testosterone injections last for, and are there any side effects?

Doctor's Answers 3

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Dr Claudine Pang

Ophthalmologist

In addition to Dr Winston Lee’s excellent answer, I would like to share that I have seen in my practice, many patients with eye retinal problems triggered by testosterone treatments.

This is because testosterone is a form of steroid and some people are more susceptible to steroid-induced side effects than others.

Although the mechanisms are not yet well-understood, steroids in some people may lead to a hyper-dynamic blood circulation in the eye, which in turn may lead to leakage of fluid or blood into the retina. Patients will experience central blurring of vision and may require treatment by laser or injection.

How can you tell whether you are susceptible to steroids? Well, as a retinal specialist, I am able to tell by doing a specialised retinal scan that shows me microscopic details of your retina. Based on the scan findings, I am able to identify signs of a hyper-dynamic circulation in your eye and I will be able to advice accordingly. You may wish to have your retina checked before or during your testosterone treatments just to be safe.

I hope that this was helpful to you.

Better for me to set the background right first. In Singapore, recreational use of testosterone (steroid) is frowned upon by the Ministry of Health. Although in the real world, there are people who utilise it in the realms of bodybuilding for the purpose of bulking up.

Testosterone can also be used for replacement purposes, if you are deficient in the hormone (see my article on Testosterone Deficiency Syndrome or ‘TDS’).

Such benefits include:

  • Improved mood
  • Better bone density
  • Reduction in diabetes risk
  • Improved muscle bulk
  • Less abdominal fat accumulation.

If you are asking about testosterone jabs for the purpose of replacement however, I would be happy to advise that there are several options for Testosterone Replacement.

  1. Creams/Gels. There are topical transdermal creams and gels which can be used for replacement. The advantage is no pain, generally less suppression of the normal body secretion of the hormone. But some people find it a hassle to do it everyday in the morning. Cost wise:$130-180 a month depending on the preparation used.
  2. Shorter acting Testosterone: Testosterone Cypionate is the most commonly used injection. This is done usually once every 1-2 weeks in the buttock region, and the dosage is titrated based on the degree of deficiency. The cost would be approximately $100-$120 a month inclusive of procedural fees.
  3. Longer release Testosterone (Nebido being the most common brand). This is done every 10-12 weeks and the frequency adjusted based on the deficiency. The cost would be about $380 a month.

You have also asked about the duration: That really depends on why you are having the testosterone replacement.

Some people undergo periods where they suffer low moods due to lowish testosterone, or low energy.

In this scenarios, after a short period of replacement (say months) they actually recover and the replacement can be removed.

Side effects of testosterone replacement include:

  1. Long term use especially of high dose steroids leads to suppression of the body’s normal secretion of testosterone. I see this as less of a problem IF you are already not producing sufficient levels. But for the bodybuilders, please practice a good cycle of POST CYCLE THERAPY (PCT) which will help your body recover somewhat (but maybe 70-80% of what it used to be maximally).
  2. Hair loss – This is more evident in people with already receding hair.
  3. Sperm count – This will drop during replacement and this can be an issue for people keen for children in the near future
  4. Acne – This can worsen, and I usually see it in the patients who use the shorter acting testosterones. The patients who use Nebido tend to be spared from this acne flare (perhaps they are older and thus less prone in the first place).
  5. Mood swings – Shorter acting testosterones tend to lead to aggression. Longer acting ones tend to have a mood uplifting effect.

Hope the above helps!

What are The Symptoms of Low Testosterone Levels?

Testosterone injections are for the treatment of men with low testosterone levels associated with typical symptoms such as:

  • Reduced sex drive (libido)
  • erection difficulties
  • Mood changes
  • loss of drive/ fatigue
  • Loss of strength
  • Weight gain.

You can check if you have symptoms that may point to a low testosterone level here - https://www.tanurology.com.sg/mens-health/low-testosterone-symptoms-questionnaire/

Alternatively, you may read this article for more information on testosterone deficiency.

Duration of Testosterone Injection Treatment

The recommended injection regime consists of one loading dose 6 weeks after the initial injection followed by intervals of 10 to 14 weeks (usually 3 months).

What Are The Side Effects of Testosterone Injections?

Side effects of testosterone injections include:

  • High red blood cell count

  • Reduced sperm count

  • Acne (particularly at the beginning of treatment and generally for a short time only)

  • Enlarged prostate or increased PSA

  • Irritation at the injection site

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