Injectable medicines commonly used in primary care during COVID-19: testosterone

General guidance on medicines management for endocrinology conditions during COVID-19 is available from the Society for Endocrinology.

Advice on other injectable medicines commonly used in primary care is available here.

This page gives advice on the administration and monitoring of testosterone injections during COVID-19 for androgen deficiency. The objective is to protect patients from unnecessary health care visits, to help preserve NHS capacity, and to provide options for the management of patients who are self-isolating or have symptoms of COVID-19.

The most commonly prescribed testosterone injections for androgen deficiency in the UK are either a long acting intramuscular depot testosterone, Nebido®, or short-acting mixed testosterone esters, Sustanon®.

Administration

Normal administration can be summarised as:

The administration interval of testosterone injections varies from 3 weeks to 14 weeks depending on the preparation used.

During the COVID-19 pandemic, options to manage administration include:

1) Temporarily interrupt administration

For most formulations and most patients, a temporary interruption of their testosterone replacement therapy (TRT) is unlikely to cause harm. It is unlikely that bone or muscle mass will be affected by a 3-4 month interruption of treatment.

2) Self-administration

It is not common for patients to self-inject. However, where patients or their partners/family members are already undertaking the injections as one of them may be a healthcare professional, this can continue uninterrupted.

3) Switch to testosterone based gel

Empirical dose (Tostran 50mg daily; Testogel Pump 40.5 mg daily; or Testovance 46mg daily). The testosterone gel should be commenced  from the date the next injection would have been due. The intramuscular preparation could be recommenced once non-urgent services resume

For patients with COVID-19 symptoms, recommendations are:

The goal of TRT is to return serum testosterone levels to within physiologic range. Therefore, TRT administration can continue uninterrupted.

Monitoring

Normal monitoring can be summarised as:

Haematocrit, haemoglobulin; and PSA must be monitored before treatment, at 3-6 months, 12 months, and yearly thereafter. Testosterone level and Sex Hormone-Binding Globulin (SHBG) should also be monitored at baseline and at regular intervals during treatment.

During the COVID-19 pandemic, monitoring options include:

Routine monitoring blood tests may be delayed unless a safety issue is suspected. Patients should be advised to report any side effects from testosterone therapy such as mood changes; fatigue and loss of sexual function which might suggest testosterone levels are low. Blood tests should be arranged when it is reasonably possible.

This page was developed in conjunction with Dr Robert D Murray, Clinical Committee member, Society for Endocrinology and Professor Stephanie E Baldeweg, Chair of the Clinical Committee, Society for Endocrinology. We are hugely grateful for their input.