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A safe oral formulation called testosterone undecanoate is available in Canada and in Europe, but not in the United States.In fact, the FDA approved the use only of testosterone enanthate as a replacement for birth control pills only last year. Tested on animals, it appears to work best in the lab - that is, when administered in the womb or on the perineum.FDA officials say more studies are planned on how well testosterone undecanoate performs over time, as well as the dangers of mixing the hormone with any other medications.Tests last long enough to detect birth defects, according to the FDA. But experts say that's hard to know without more testing of the long-acting, non-hormone replacement hormone."We'll need a long-term study to see how well the replacement hormone reduces the risk of cancer and other reproductive diseases," says Dr. Michael Lauer, a fertility specialist at the University of Washington in Seattle.Treatment may be costlyThe cost of care may eventually outstrip the cost of the pills.The US Health Services and Medicaid programs each spent $28 million in 2014 on hormone replacement therapy, a 10% increase from 2013, according to a Government Accountability Office report.The amount is expected to grow every year through 2036, increasing to as much as $1.4 billion in 2040, according to the GAO. That's because men will almost certainly need hormone replacement, as well as blood tests to check their levels of sex hormones.Dr. David Gorski of Harvard Medical School says it is unclear how long doctors will have to prescribe hormone replacement therapy to help men's health, as he calls it "a complex and difficult problem."He says doctors must balance the need for treatments "where there is evidence of long-term benefit as well as the costs of caring for a patient," since the medications will also have to be monitored.This story is part of a reporting partnership with NPR, Kaiser Health News and Kaiser Health News Service.Related Article: