Do you have a fear of needles? You indeed aren’t alone. Did you know that once you’ve gotten your blood work collected and your symptoms adequately identified, you get to decide the method of delivery for testosterone? And yes, there are non-injectable options. There are many approved strategies for Testosterone Optimization Therapy (TOT) that differ from one another. Often, doctors prescribe transdermals (topicals) over injectables to maintain patient adherence, due to the patient who has a case of needle phobia. Testosterone Creams and Gels The term ‘bioidentical’ is often misconstrued, even by physicians who often claim that bioidentical testosterone is “better” or more “natural” than pharmaceutical-grade testosterone. The reality is that all testosterone utilized in TOT possesses an identical molecular structure to your body’s naturally produced testosterone. Pharmaceutical-grade testosterone is bio-identical to ‘natural’ testosterone because it is an “esterified” form of testosterone. Esterified testosterone means that the testosterone is attached to a carrier molecule known as an ester, which is then enzymatically cleaved into the bloodstream leaving you with the ‘identical’ testosterone molecule that your gonads produce. Creams offer superior penetration compared to gels. Testosterone creams compound in a base that provides a much higher penetration of the testosterone through the skin (40-50%) compared to the 10% penetration of most water-based gels. Since five times the amount of drug is being delivered into circulation by using a transdermal cream, versus a gel, a lower amount needs to be applied to achieve optimal testosterone levels. Creams also moisten the skin, while alcohol-based gels dry it out. Higher active ingredient loads can be accommodated with creams compared to gels, as most hormones (mainly testosterone) are not water soluble and require a lipophilic vehicle to get through the dermis (skin) into systemic circulation. Androgel Androgel is the most prescribed TOT protocol in the world, and millions of men use it. Many doctors believe in its therapeutic value for raising low testosterone levels. The gels come in either 1%, 2%, 5% or 10% testosterone concentrations. In our opinion, it’s suboptimal for several reasons. Some compounds work incredibly well. For example, Androgel is 1.62% testosterone by weight. Compounded testosterone cream can be up to 20% testosterone by weight. While both branded and compounded products allow testosterone to be dosed transdermally, transdermal creams are recommended over gels for several reasons. The Drawbacks The primary drawback of creams and gels is that their testosterone concentration is too low, and it is also difficult to control the delivery of the dosage. Absorption through the skin is inefficient due to food consumption, sweat glands, and other factors. Often, this inconsistent absorption rate produces a variance in DHT levels and potentially harmful side effects like puffy nipples, water retention, and mood swings. There’s also the genuine risk of accidentally transferring the cream to children, women, and pets. Many find it a nuisance to apply creams or gels throughout the day always. On top of that, patients must avoid swimming, bathing, showering, and excess sweating for hours after application. Many men choose this method of TOT simply because it is the path of least resistance, both from pain from injections and because many doctors dispense this form of TOT liberally. Given that TOT must be administered for life, patient adherence is a primary focus of the treating physician. Some men ultimately prefer to apply the cream, rather than inject themselves. Finally, it all boils down to the choice of the patient. To find out much more about Testosterone and its role in helping us achieve optimal mental health and physical performance, purchase The TOT Bible.