Testosterone is available in several forms: injections, topical gels, skin patches, oral capsules, nasal gels, and implanted pellets. The method you use depends on your lifestyle, how often you want to deal with dosing, and how your body responds. Each option reliably restores testosterone to a normal range (300 to 1,050 ng/dL in men), but the daily experience of using them varies significantly.
Injections: The Most Common Method
Injectable testosterone is the most widely prescribed form. The two standard options, testosterone cypionate and testosterone enanthate, are typically dosed at 75 to 100 mg weekly or 150 to 200 mg every two weeks. At these doses, most men maintain levels within the therapeutic range through the end of each dosing cycle. Your prescriber will determine your starting dose and adjust based on blood work.
You can inject into muscle (intramuscular) or into the fat layer just beneath the skin (subcutaneous). Subcutaneous injections have gained popularity because they use smaller needles, typically a 23- or 25-gauge needle that’s only 5/8 of an inch long, and are less painful. For subcutaneous shots, the recommended sites are the belly fat about two inches to either side of your navel, or the fatty tissue of the thigh. Intramuscular injections traditionally go into the outer thigh or the upper-outer quadrant of the glute.
Most people learn to self-inject at home after receiving training from a nurse or medical assistant. A locking syringe (called Luer-Lok) is preferred because the oil-based testosterone solution is thick, and a standard syringe can sometimes separate from the needle during injection. Many people use a larger-gauge needle to draw the testosterone out of the vial, then swap to a thinner needle for the actual injection to reduce discomfort.
A longer-acting injectable option, testosterone undecanoate, requires dosing only at the start of treatment, again four weeks later, and then every 10 weeks after that. In clinical studies, 94% of men maintained normal testosterone levels on this schedule. The tradeoff is that it must be administered in a medical office due to a small risk of a reaction after injection, so it isn’t something you do at home.
Topical Gels: Daily but Painless
Testosterone gel is applied once a day, ideally in the morning after a shower. Applying it at the same time each day keeps your levels steady. The FDA-approved application areas are the shoulders, upper arms, and abdomen. You should not apply it to the genitals.
After rubbing the gel in, wash your hands immediately with soap and water. Let the area dry completely, then cover it with clothing, like a regular t-shirt. The gel absorbs through the skin over several hours, and during that time it can transfer to anyone who touches the application site. If you expect skin-to-skin contact with a partner or child, wash the area thoroughly with soap and water first. If accidental contact does occur, the other person should wash the affected skin right away.
Gels achieve normal testosterone levels in roughly 74% to 87% of men. Absorption varies from person to person, so dose adjustments are common in the first few months. Some men find that their skin simply doesn’t absorb the gel well enough, which is one reason your prescriber will check your levels after starting treatment.
Patches, Pills, and Nasal Gels
Transdermal patches stick to the skin and deliver testosterone over 24 to 48 hours. They achieve normal levels in 77% to 100% of users, with over 85% reaching levels above 300 ng/dL. The amount absorbed depends on the patch size and where it’s placed. Skin irritation at the patch site is the most common complaint.
Oral testosterone capsules are absorbed through the lining of the mouth rather than the stomach, which avoids the liver damage associated with older oral formulations. Levels rise quickly and reach their peak by the second dose of the day (they’re taken twice daily, 12 hours apart). One important note: alkylated oral testosterone, an older formulation, is linked to liver toxicity and should not be used.
Nasal testosterone gel is applied inside the nostrils three times daily. It reaches peak levels in about 40 minutes and clears quickly, with a short duration of action. In a 90-day trial, 90% of men using it maintained normal testosterone levels. The frequent dosing schedule makes it less convenient, but its short-acting nature may better preserve fertility compared to longer-acting options.
Pellets: The Longest-Lasting Option
Testosterone pellets are small, rice-grain-sized implants placed under the skin by a healthcare provider during a brief in-office procedure. They dissolve slowly over several months, and in clinical studies 100% of men had therapeutic levels at four weeks, with levels remaining above 300 ng/dL at four months. After the pellets are spent, you return for a new set.
The main appeal is not having to think about daily or weekly dosing. The downsides include the need for a minor procedure each time, the possibility that a pellet can work its way out of the skin, and the inability to quickly adjust your dose if levels run too high or too low. You’re essentially locked into a dose until the pellets dissolve.
Short-Acting vs. Long-Acting Options and Fertility
All forms of testosterone therapy suppress your body’s own production of the hormone by signaling the brain that there’s already enough in the bloodstream. This suppression also reduces sperm production. If you’re trying to conceive, exogenous testosterone should not be used.
That said, short-acting formulations (gels, patches, nasal gel, oral capsules) have less impact on the hormonal feedback loop that controls sperm production. For men who may want children in the future, these options are generally considered less disruptive to fertility than long-acting injections or pellets, though none should be treated as fertility-safe.
Blood Work and Monitoring
Starting testosterone isn’t just about choosing a delivery method. Your levels and several safety markers need to be tracked on a schedule. The standard recommendation is to check your testosterone at 3 to 6 months after starting treatment, with the goal of reaching the mid-normal range for a healthy young man.
Hematocrit, a measure of red blood cell concentration, is one of the most important things to watch. Testosterone stimulates red blood cell production, and if your hematocrit climbs above 54%, therapy needs to be paused until it drops back down. This is checked at baseline, again at 3 to 6 months, and then yearly. Excessively thick blood raises the risk of clots, so this isn’t optional monitoring.
For men between 55 and 69, or those at higher risk for prostate cancer, a PSA level and prostate exam are recommended before starting treatment and again within the first year. After that, screening follows standard age-based guidelines.
Who Should Not Start Testosterone
Testosterone product labels list a history of prostate cancer as a contraindication. In practice, some specialists will consider therapy for prostate cancer survivors on a case-by-case basis when the potential benefits are significant, but this remains a carefully weighed decision rather than a routine one.
If you’ve had a heart attack, stroke, or other cardiovascular event, guidelines recommend waiting at least three to six months before starting therapy. If your hematocrit is already above 50% before treatment, the underlying cause should be identified before adding testosterone to the mix. And as noted above, men actively trying to have children should avoid all forms of exogenous testosterone.