Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
6.4.2 Male sex hormones and antagonists
Testosterone
First-line:Sustanon 250®250mg/ml amp: £2.45 (1ml)Sustanon 250® is the testosterone injection of choice on grounds of cost-effectiveness
Second-line:Testosterone Enantate250mg/ml amp: £72.50 (3)
Second line is Testosterone Enantate 250mg given every 4 weeks. Trough testosterone should be measured on the day of the 3rd Enantate injection to make sure patients are not being overdosed – target is a testosterone in the lower quartile of reference range, 8-13 nmol/l.
The Enantate dosing interval range of 3-6 weekly is longer than that for Sustanon®, which is usually 3-4 weekly.
Third-line:Nebido®250mg/ml amp: £87.11 (4ml)If neither first- or second-line choices are available Nebido® injection lasts for 10-14 weeks - measuring trough testosterone weekly from 10 weeks will enable the dosing interval to be determined using the target range above.
Nebido® should be given with the patient lying in prone position
Fourth-line:
(Temporary formulary inclusion)
Testogel®16.2mg/g 88g pump: £31.11ALL Testosterone products are included in the formulary for the duration of the national shortage of injectable formulations.
For non-injectable alternatives please see BNF 62 6.4.2 or Choosing a Testosterone Preparation information sheet for details.
Tostran®2% gel (10mg per application): £28.67 (60g)
Striant SR®30mg Mucoadhesive buccal tablets: £28.00 (60)
Restandol®40mg capsules: £8.55 (30)
5-Alpha Reductase Inhibitors (5-ARIs)Cross refer to section 7.4.1 for further details on the management of Lower Urinary Tract Symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), for which 5-ARIs are indicated.
Finasteride5mg tablets: £1.12 (28)Finasteride is the only recommended 5-ARI, due to the weight of clinical evidence and cost-effectiveness.
Dutasteride (Avodart®) is non-formulary following rejection by the T&ST D&TC

 

NHS England Gender Dysphoria Protocol and Flowchart