Look over some of the older oral TU (Andriol) studies.
Although it is still prescribed in Canada most doctors in the know would offer it as a last resort.
Gels let alone injections dominate.
The use of sub-q injections has skyrocketed.
Very few would waste their time with Andriol.
Definitely not a go-to drug!
A practical guide to diagnosis, management and treatment of testosterone deficiency for Canadian physicians (2010)
*Testosterone undecanoate is formulated in Canada in the convenience of an oral preparation (Andriol or pms-Testosterone). These products may induce supraphysiologic levels of dihydrotestosterone.32 To permit absorption, testosterone undecanoate must be taken with a high-fat meal. Absorption issues may lead to poor responses.
Table 2. Common testosterone formulations available in Canada
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Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline (2015)
In Canada, the available products for testosterone therapy include short-acting injectable testosterone (testosterone enanthate, testosterone cypionate, and testosterone propionate), oral testosterone undecanoate, transdermal testosterone patches, transdermal testosterone gel 1% (hydroalcoholic gel, and hydroalcoholic gel with pentadecalactone), and axillary transdermal testosterone solution 2%. Intramuscular injection of testosterone propionate is used infrequently. Compounded testosterone products are available at many compounding pharmacies in Canada, but there are no published data on the safety and efficacy of these products.
The choice of product for testosterone replacement therapy should be a topic of discussion between the physician, the patient, and the patient’s caregiver, if appropriate. Factors affecting this choice include safety, efficacy, tolerability, availability, preference, and cost. More information on the advantages and disadvantages of available products, including costs, is outlined in Tables 7 and 8 of Appendix 1.
TREATMENT OPTIONS
Table 7. Testosterone Products for the Treatment of TDS
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Canadian Urological Association guideline on testosterone deficiency in men: Evidence-based Q&A (2021)
Ethan D. Grober, MD; Yonah Krakowsky, MD; Mohit Khera, MD; Daniel T. Holmes, MD; Jay C. Lee, MD; John E. Grantmyre, MD; Premal Patel, MD; Richard A. Bebb, MD; Ryan Fitzpatrick, MD; Jeffrey D. Campbell, MD; Serge Carrier, MD; Abraham Morgentaler, MD
13. What are the current treatment options for TD in Canada?
Table 3 summarizes the testosterone treatment formulations currently approved by Health Canada.
Compounded testosterone products are available at many compounding and online pharmacies in Canada, however, published data have demonstrated significant variability of testosterone concentrations within such products, leading to concerns regarding the efficacy and safety.30
The choice of testosterone therapy and route of administration should be a topic of discussion between the physician and the patient using a shared decision-making approach. Factors influencing this choice include safety, efficacy, tolerability, availability, preference, and cost/insurance coverage.
Table 3. Testosterone treatment formulations currently approved by Health Canada
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A new oral testosterone undecanoate therapy comes of age for the treatment of hypogonadal men (2020)
*Historically, efforts to administer oral T have taken two primary paths: alkylation of T at the C-17 position to create T analogs that are resistant to first-pass hepatic metabolism (exemplified by methyltestosterone);2 or fatty-acid esterification of T to create a T-ester (exemplified by TU) that is absorbed via the intestinal lymphatic system thus bypassing the portal circulation.3 Oral methyltestosterone, originally discovered and used clinically in the mid-1930s,1 is the only
oral TRT ever approved for use in the US, but has been associated with serious hepatotoxicity such as cholestasis, peliosis hepatis, and hepatic adenocarcinoma4–6 and therefore is not recommended for clinical management of male hypogonadism.
Conversely, while oral TU has not been associated with liver toxicity, an early oral TU formulation approved for use in many countries but never in the US (Andriol®) was highly influenced by dietary fat, thus leading to significant intra- and inter-patient variability in T response and questionable clinical utility.7,8 Reformulation of this product to reduce the effect of dietary fat did not address the low TU content of the capsules, thus resulting in the need to dose hypogonadal men with several capsules three or more times daily. Even then, reported serum T response would not result in average serum T levels in the normal range9 and therefore would not pass current-day regulatory scrutiny for efficacy. Consequently, these oral TU formulations have never been widely used to treat T deficiency although they remain available in many countries.
