I've been on HRT now for over six years and it has been quite the uphill battle at times. Initially, I tried Androgel, compounded creams, Testopel pellets and intramuscular testosterone cypionate injections in that order. Androgel did nothing for me, but all of the other options brought improvements to my life and health. However, it was unquestionably subQ testosterone cypionate that seemed to solve all of my problems, i.e. provide nice, steady levels of testosterone and estradiol with no side effects or the necessity of taking an aromatase inhibitor such as Arimidex (anastrazole).
For those who don't know, subQ means subcutaneous, i.e. injecting into the subcutanteous fat layer. It is commonly used for a number of medicines including insulin and so docs are generally well familiar and even comfortable with it. My current protocol is 50 mg twice weekly into the abdominals. Of course, if you try this protocol, your doctor will give you instructions as to how he or she wants you to do it. Here is some starter info in this thread How to Do Different Kinds of Testosterone Cypionate Injections if you want more information.
But, before I to into more detail as to why I think subQ is so the best protocol out there for most guys, let me cover the significant disadvantages that I see with the other delivery systems. Please keep in mind that these are just my opinion and what works for me: you and your doc have to decide what is best for you.
1. Topicals. First of all, I have kids and a wife and I was always concerned they might be getting some exposure. I always washed myself and covered the area, so I doubt it was ever an issue. But it was just a nagging doubt that seemed to linger. However, a more realistic concern is one uncovered by ZRT Labs - thanks Sam for the rec! - that showed that the topical testosterones create a non-physiological and unnatrual distribution of testosterone within the body - something I cover in link on Potential Risks Associated with Testosterone Therapy - where very high testosterone and estradiol levels exist in the capillaries. Assuming this is true, I figured it cannot be a good thing. (Besides, Androgel never boosted my T a ng!)
In addition, topicals tend to jack up DHT levels to supraphysiological levels. I have seen many time on the Peak Testosterone Forum, men with 2, 3 or even 4 times the upper value of the lab range for DHT in men that are on topical (transdermal) testosterone. This is essentially a "steroid" level of DHT, and I cannot see any good coming out of that long term. Time will tell I guess.
2. Longer Term Solutions (Pellets and Undecanoate). Both testosterone pellets (implants) and testosterone undecanoate (Nebido / Aveed) are solutions that do not need to be done weekly or daily but rather every 2-3 months (roughly). As such, they are very convenient for some men. However, the problem is that these delivery systems give a fairly slow ride up to peaking levels and then a slow ramp down. Some men are not going to feel as good during the pretty quick ramp up and down. I basically had a few good weeks out of 3 months and that was about it. It gave me a taste as to what HRT could do for me, but did not give me reliable results. Plus, some men will find that, when the pellets or undecanoate hits peaking levels that they are too high in estradiol.. And it will be difficult for a doctor to prescribe Arimidex or maybe DIM / chrysin, because the levels change significantly from week-to-week. There are other issues, but I'll let you read my page on Testosterone Pellets for more information if you are interested.
3. Intramuscular Cypionate. I am very thankful that I was put on intramuscular cypionate by my former HRT clinic: it restored my morning erections for the first time in my life and got rid of three decades of mild depression virtually overnight. That said, even weekly cypionate give you a pretty wild ride with your testosterone and estradiol. I ended up with a little gyno because of it and, for awhile I was on Arimidex as well.
While each of the above provided improvement over the former, I did not like the battle with even mild gynecomastia, nor swings that I felt weekly. And this is where subQ stepped in. Look at what subQ testosterone cypionate injections did for me:
For all these reasons, I think that I can make a compelling case for subQ testosterone cypionate being the best overall choice out there. Men who are Low SHBG may feel better using a shorter ester such as propionate. However, we have had at least one low SHBG man who has successfully used cypionate.
I also like the fact that I seem to feel better with each passing month that goes by. This might just be coincidence, but I feel that, as time has gone on, morning erections are coming more steadily and more strongly and the body is almost "healing" itself from the years of either low or unsteady testosterone levels.