TRT Treatment Options – Sustanon, Nebido, and Cypionate Compared

TRT Treatment Options

At Omniya Clinic, we understand that every man’s experience with testosterone deficiency is unique. That's why we offer a range of TRT options tailored to suit your individual needs. If you're a man aged 40+ experiencing symptoms such as low energy, reduced muscle mass, weight gain, or low libido, TRT can help restore your vitality. This page will guide you through the various TRT options available.

Understanding Testosterone Deficiency and Its Symptoms

As men age, natural testosterone levels begin to decline. For many, this process can lead to physical and emotional changes like fatigue, low mood, loss of concentration, and reduced sex drive. In some cases, this is more pronounced and can lead to a condition known as hypogonadism, which affects roughly 10% of men over 40, and up to 40% of men 45+ years are hypogonadal. It's critical to receive a proper diagnosis and personalised treatment plan to address these symptoms, and as hypogonadism increases the risk of heart disease and osteoporosis., it is important to replace the missing hormone to reduce these risks

Types of Testosterone Replacement Therapy

There are various TRT options, each offering its own set of advantages, depending on your lifestyle, preferences, and medical history. Let’s explore the most commonly used forms, backed by clinical research.

1. Testosterone Injections

Testosterone injections are one of the most popular methods of TRT due to their effectiveness in delivering predictable amounts of testosterone directly into the body. There are multiple ester formulations, each with distinct advantages.

Testosterone Cypionate & Enanthate

Cypionate and Enanthate are two closely related short acting testosterone esters that are injected just under the skin via a very small needle or into the muscle using a slightly larger needle. The frequency of injections is patient specific, taking into account individual preference and SHBG levels. They offer flexibility in dosing and are often interchangeable based on individual response.

Research: The Testosterone Trials by Snyder et al. (2016) in the New England Journal of Medicine found that both forms effectively increased muscle mass, improved sexual function, and had positive effects on bone health.

Advantages: Cypionate can be administered in a relatively pain free way through a very small gauge needle just under the skin, for example in the abdomen. Both esters are short acting and for many patients a preferred regime is one of frequent (for example twice weekly or more) injections of a short acting ester. Taken in this way stable testosterone levels can be achieved throughout the week to avoid any peaks and troughs.

Drawbacks: More frequent injecting is not suited to everyone.

Sustanon 250

Sustanon is a mixture of four different testosterone esters that provide a quick and sustained release. Administered intramuscularly every 3-4 weeks, Sustanon is designed to maintain stable testosterone levels with fewer injections.

• Research: A study by Behre et al. (2010) in Clinical Endocrinology found that Sustanon effectively improves sexual function, mood, and muscle mass.
• Advantages: Requires fewer injections than shorter-acting esters.
• Drawbacks: Not suitable for those with peanut allergies, as it contains peanut oil. Potential for inconsistent results as the different esters have different half lives and are therefore metabolised at different rates.

Nebido (Testosterone Undecanoate)

Nebido is a long-acting single-ester testosterone treatment, with injections needed only every 10-14 weeks. Its extended half-life offers theoretically consistent hormone levels with fewer injections.

• Research: A clinical trial reported by The Aging Male journal (Zitzmann et al., 2012) demonstrated that Nebido significantly improved bone density and lean muscle mass.
• Advantages: Fewer injections with only one injection every few months.
• Drawbacks: Highs and lows often experienced between doses Less frequent opportunities to adjust dosage; if a reaction occurs, it can take weeks before adjustments can be made.

2. Testosterone Creams & Testosterone Gels

Creams and gels offer a non-invasive alternative to injections. Applied daily to the skin, they provide a steady release of testosterone.

• Types of Creams and gels: Versabase, Testogel, Tostran, Testim, Androgel.
• Research: A meta-analysis by Arver et al. (2014) published in The Journal of Andrology found that testosterone gels improved sexual function, mood, and body composition in hypogonadal men.
• Advantages: Easy to apply and no need for needles. Creams have the potential to be almost as effective as injectables.
• Drawbacks: Gels have variable rates of absorption not just from one patient to the next, but also from one application to the next. Requires daily application and carries the risk of transference to others through skin contact. Care must be taken to avoid contact with children or partners. Topical testosterones are to be used extremely cautiously if there is regular contact with children

3. Testosterone Patches

Patches deliver testosterone transdermally and must be applied daily. They offer a consistent release without the risk of transference associated with gels.

• Types of Patches: Andropatch, Intrinsa (occasionally used off-label for men).
• Research: The Journal of Clinical Endocrinology & Metabolism (Bhasin et al., 2010) showed patches significantly improved sexual function and body composition in men with low testosterone.
• Advantages: Non-invasive and reduced risk of transference.
• Drawbacks: Daily application can be inconvenient, and some users experience skin irritation.

4. Testosterone Pellets

Pellets are small implants inserted under the skin, usually in the hip area, which slowly release testosterone over 3-6 months.

• Types of Pellets: Testopel.
• Research: A study by Pastuszak et al. (2015) in The Journal of Urology highlighted that testosterone pellets effectively maintained stable testosterone levels while improving sexual function and mood.
• Advantages: Long-lasting with minimal maintenance.
• Drawbacks: Involves minor surgery for insertion and offers less flexibility in adjusting doses. There is limited availability in the UK.

5. Oral Testosterone

Though less commonly used, oral testosterone formulations are available, offering convenience without injections or skin applications.

• Types of Oral Testosterone: Restandol, Andriol Testocaps.
• Research: Swerdloff et al. (2020) in The Journal of Clinical Endocrinology & Metabolism found that newer oral testosterone formulations effectively restored testosterone levels with minimal liver toxicity risks.
• Advantages: Easy administration.
• Drawbacks: Historically associated with liver toxicity, but newer formulations mitigate this concern. May provide better results than gels, but remain inferior to injectables

Discover different types of TRT

Natural Supplements to Support Testosterone Levels

While not a substitute for TRT, certain supplements may support natural testosterone production.

• Vitamin D: Research suggests vitamin D deficiency is linked to lower testosterone levels.
• Zinc: Important for testosterone production, with deficiency potentially leading to lower levels.
• Ashwagandha: There is weak evidence to suggest it may increase testosterone levels and improve sperm quality.

Choosing the Right TRT Method for You

At Omniya Clinic, we aim to provide a personalised TRT approach. Our experienced doctors will assess your symptoms, testosterone levels, and overall health to recommend the best treatment option for you. We take a comprehensive approach to men’s health, including:

• Detailed review of symptoms and medical history.
• Comprehensive blood tests.
• Physical examination.

Book a Consultation Today

To find out more about the best TRT method for your lifestyle and health, book a consultation at Omniya Clinic. We are here to guide you on your journey to better health and wellbeing.