TRT delivery: A urologist discusses options and patient preferences

In this video, Robert Jansen, MD, a urologist with Atlantic Urology Specialists in South Carolina, discusses his approach to testosterone replacement therapy (TRT) and shares his thoughts on the rise of “low T” clinics. He emphasizes that all TRT delivery methods can be effective, but selection depends on patient preference, insurance coverage, and individual response. Short-acting injectables like testosterone cypionate and transdermal gels (eg, Androgel) are commonly covered by insurance, but cypionate often causes adverse events such as elevated red blood cell count, acne, and high blood pressure, whereas gels may not absorb well in hot, humid climates. Jansen prefers options like Xyosted (a prefilled pen injector) and oral therapies when feasible, citing ease of use and a more natural mimicry of the body’s testosterone rhythms. Long-acting injectables such as Aveed and Testopel are favored for patients needing convenience or those with compliance challenges.

On the topic of “low T” clinics, Jansen acknowledges they increase access to care for men who may avoid traditional medical settings. However, he stresses that testosterone therapy requires nuanced, long-term management that should ideally be overseen by urologists trained in male hormone health. He warns of risks like inadequate monitoring, inappropriate dosing, and failure to diagnose related health conditions such as sleep apnea, cardiovascular disease, or thyroid issues. Although he appreciates that these clinics help some men begin treatment, he argues that more education and outreach are needed from the urology community to ensure safe and effective care.