Abstract
Testosterone substitution and replacement therapy is effective for managing testosterone deficiency. Traditional routes of administration include oral, nasal, transdermal, and intramuscular. Scrotal application of testosterone cream has been made recently available. Physician’s choice of one preparation over another is based on testosterone bioavailability, side effect profile and ability to achieve therapeutic levels. Patient’s choice is influenced by comfort, ease of use and product acceptability. This is important for compliance and achievement of good outcomes. Testosterone substitution can be overused and associated with adverse effects. Individuals at risk are older, obese with chronic cardiorespiratory disorders, and lower urinary tract symptoms. Therapeutic monitoring is vital and is achieved through measuring serum total testosterone levels and clinical follow-up. Decision on therapy outcomes should be individualised, based on symptom control and testosterone effects on organ function. Supra-therapeutic testosterone levels should be avoided as adverse outcomes such as worsening obstructive sleep apnoea, polycythaemia, and prostatic growth stimulation are more likely.