Most physical changes occur over the course of a few years regardless of the method used. Gel and injections are comparable in efficacy. The method of administration impacts the way in which hormone levels peak. Injections are associated with a fast peak in blood hormone levels and as such there may be some fluctuations in hormone levels between injections. Gels are slowly absorbed and so they provide a more consistent dosage and therefore stable hormone levels, avoiding the highs and lows which can be experienced with injections. Our preference is to start with gel over injections. However, if patients prefer, with a clear plan for administration in place and having ruled out any allergies, injections are an option.