Comparison of the steady-state pharmacokinetics, metabolism, and variability of a transdermal testosterone patch versus a transdermal testosterone gel in hypogonadal men
Abstract
Aim: To compare the pharmacokinetics (PK), metabolism, intra- and inter-subject variability of a permeation-enhanced testosterone patch versus a topical testosterone gel. Methods: 28 hypogonadal men were treated with a testosterone patch (5 mg/day applied at 2200 h) and a 1% testosterone gel (5 g/day applied at 0800 h; nominal delivery 5 mg/day), each for 14 days, in an open-label crossover design. PK profiles of total testosterone (TT) and calculated free testosterone (cFT) were measured on day 7 and day 14 of each treatment, with patches or gel applied to the abdomen; dihydrotestosterone (DHT) and estradiol (E2) profiles were measured on day 14. The time-average (Cavg), maximum (Cmax), time of maximum (Tmax) and minimum concentrations (Cmin) were derived from each profile. The intra- and inter-subject coefficients of variation (CVintra and CVinter) of the TT and cFT parameters were computed by ANOVA. Results: Nightly applications of the patch produced a mean TT profile that mimicked the circadian pattern of healthy men. Morning applications of the gel produced a flatter mean profile; though individual subjects exhibited significant peaks at variable times. For TT, the mean and 90% confidence intervals of the patch/gel ratio of Cavg (1.030; 0.936–1.133; P > 0.05) and Cmax (1.086; 0.974–1.211; P > 0.05) met the criteria for bioequivalence. Cmin was lower for the patch. DHT levels and DHT/T ratios were 2 to 3-fold higher for the gel (P < 0.0001). E2 levels and E2/T ratios were comparable. CVintra and CVinter for Tmax approached 100% for the gel and were 23% and 42%, respectively, for the patch (P < 0.0001). Other variability parameters were generally comparable. Both products were well tolerated, and the patches adhered well. Conclusions: These findings reflect the different mechanisms of transdermal absorption from the patch and gel and provide new considerations for selecting testosterone replacement therapies in hypogonadal men.
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Common testosterone therapies normalize total testosterone to eugonadal levels in approximately 75-85% of men, indicating a 15-25% rate of suboptimal response.
“Common T therapies result in normalization of TT to eugonadal levels in approximately 75–85% of men, indicating a 15–25% rate of suboptimal response.138, 139”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [139]
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- Authors
- Mazer, N., Bell, D., Wu, J., Fischer, J., Cosgrove, M., & Eilers, B.
- Affiliations
- University of Utah (US)
- Watson Laboratories, Inc., Clinical R&D, Salt Lake City,
- Diabetes & Glandular Disease Clinic (US)
- Clinical Research Services (DE)
- Corresponding author
- Mazer, Norman
- ORCID
- Mazer, Norman
- Venue
- The Journal of Sexual Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-03-01
- Volume
- 2
- Issue
- 2
- Pages
- 213-226
- ISSN
- 1743-6095 (ISSN-L)
- 1743-6109
- OpenAlex
- W2168964163
- Cited by
- 44
- References
- 23
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 1 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 5 · 2013: 1 · 2012: 1
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Sexual Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Advancements in Transdermal Drug Delivery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- testosterone gel, testosterone replacement therapy, hypogonadism, steady-state pharmacokinetics, free testosterone, dihydrotestosterone, estradiol, bioequivalence, percutaneous absorption, interindividual variability, crossover comparison
- MeSH terms
- Administration, Cutaneous, Adult, Aged, Androgens, Estradiol, Gels, Humans, Hypogonadism, Male, Middle Aged, Dihydrotestosterone, Testosterone, Therapeutic Equivalency, Cross-Over Studies
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