neil.burman@gmail.com
the important report on testosterone replacement for men is wrong on one account: such replacement with injection need not cost almost R6000pa for the ideal 3monthly German Schering AG ultralongacting brand.
as this column has repeatedly pointed out, physiological depot injection has been available in South Africa for almost 70 years. Currently it retails at perhaps R350 per gram as depotestosterone, the equivalent dose to the 3monthly 1gm injection being 160mg 1.6ml every 2 weeks ie a cost of about R1400 per year.
This is easily and safely self-injected subcutaneously with a tiny (insulin) 25g needle, and gives physiological blood levels to most men – as with all chronic drugs, the dose and interval simply needs to be titrated to individual metabolism and response, always under periodic medical screening. Eldrely men usually need and tolerate perhaps 20% less than younger men, who may well tolerate 200mg/fortnight.
It is blatantly wrong to give the shortacting Sustanon monthly- this brand has been banned by authorities- and unphysiological to give monthly the gold standard depotestosterone cypionate / enanthate- with a life of about 3 weeks, since it is well known that the irrationally marketed higher dose for less frequent injection will give the adverse peaks and troughs that Dr Hafferjee notes. Its like banning spirits or wine when 4% beer provides far less alcohol- but common sense tells us they are equally good (or bad!), just the dose and interval needs to be proportionate.
Authoritative data on rational dose and interval of old depotestosterone has been freely available since at least 1991, so there is no justification whatsoever for proclaiming the costly Nebido or other costly forms of testosterone replacement as the necessary gold standard.
Nebido and depotestosterone cypionate/enanthate are equally, superbly physiological if used rationally eg subcutaneously, to avoid the unnecessary multiple risks of intramuscular injection. It can be questioned whether any patient who refuses to be taught his own injection warrants such costly replacement- the same natural selection applies to millions of insulin-dependent diabetics. And replacement of testosterone often relieves type 2 diabetics of the need to use costly and risky insulin, when appropriate testosterone and metformin reduce all-cause mortality by perhaps half, whereas insulin in type 2 diabetics does not.
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