There is no single best TRT method for everyone. The right choice depends on your priorities: how stable you want your testosterone levels, whether you’re concerned about cost, how often you’re willing to dose, and whether you live with women or children who could be exposed to topical testosterone. Each delivery method has real tradeoffs in effectiveness, side effects, convenience, and price.
Injectable Testosterone
Injections are the most widely chosen form of TRT, selected by about 53% of patients in satisfaction surveys. The two most common formulations are testosterone cypionate and testosterone enanthate, which work nearly identically. Injected into the muscle every one to two weeks, or subcutaneously (just under the skin) once a week, they reliably raise testosterone into the normal range.
The main drawback is the roller coaster effect. A standard 200 mg intramuscular dose produces supraphysiologic levels in the first week after injection, then drops back down before the next dose. That peak-to-trough swing can cause mood fluctuations, energy dips toward the end of the cycle, and changes in libido that track with the dosing schedule. Switching to smaller, more frequent subcutaneous injections (such as 50 to 100 mg weekly) significantly smooths out those swings, keeping levels more consistent throughout the week.
Injections also carry the highest risk of erythrocytosis, a condition where your body produces too many red blood cells and thickens the blood. In studies, roughly 44% to 67% of men on weekly intramuscular injections developed elevated hematocrit levels above 50%, compared to about 13% of men using gels. This means more frequent blood monitoring is necessary, and some men need to reduce their dose or take breaks if their levels climb too high. On the plus side, injections are by far the cheapest option, typically running $30 to $150 per month.
Testosterone Gels and Creams
Topical gels are the second most popular option, chosen by about 31% of patients. You apply them once daily, usually to the shoulders, upper arms, or abdomen in the morning. The testosterone absorbs through your skin into a reservoir in the outer layer, then slowly releases into your bloodstream over 24 hours. This produces the most stable day-to-day testosterone levels of any method. Levels typically reach the normal range within 30 minutes of the first application and stay steady as long as you keep applying daily.
Only about 10% to 15% of the testosterone you apply actually makes it into your blood, so the doses look large on paper. Skin irritation is far less common than with older testosterone patches: about 5.5% of gel users report irritation compared to 66% of patch users. The bigger concern is secondary transfer. If someone touches the area where you applied the gel, they can absorb testosterone through their own skin. This is especially dangerous for women and children, who can develop virilization or early puberty from repeated exposure. Studies have shown that even wearing a shirt over the application site doesn’t fully prevent transfer. You need to wash the area thoroughly before any skin-to-skin contact.
Gels cost significantly more than injections, typically $200 to $500 per month, and require daily application without exception. Missing a day means your levels drop. Some men find this routine inconvenient, but the tradeoff is the most physiologically stable hormone levels and a much lower risk of erythrocytosis compared to injections.
Subcutaneous Pellets
Pellets are small, rice-grain-sized implants placed under the skin of the hip or buttock in a quick office procedure. They slowly dissolve over three to six months, releasing a steady supply of testosterone without any daily or weekly effort on your part. In surveys, pellet users rated ease of use (64%) and convenience (58%) higher than any other method, and satisfaction was highest within the first 12 months of treatment.
Complications are rare. A review of over one million pellet insertions found that extrusion (the pellet working its way back out), infection, and bleeding occurred in fewer than 1% of cases. However, the erythrocytosis risk falls between injections and gels, with about 35% of pellet users developing elevated hematocrit in one study. Another practical downside: if you don’t respond well or experience side effects, you can’t simply stop. The pellets are already in your body and will continue releasing testosterone until they dissolve.
Cost runs $500 to $1,500 per insertion, which you’ll need every three to six months. That works out to roughly $80 to $500 per month depending on your dose and how long each insertion lasts.
Nasal Testosterone
Nasal testosterone gel is applied inside the nostrils three times daily, roughly six to eight hours apart, delivering a total of 33 mg of testosterone per day. It’s the newest approved delivery route and occupies a specific niche: because the testosterone is absorbed quickly and cleared quickly, it may have less suppressive effect on your body’s own hormone production compared to other methods. This could make it a consideration for men who want to preserve some degree of natural function.
The three-times-daily dosing schedule is the most demanding of any TRT method, which limits its appeal. Nasal irritation and changes in sense of smell are possible. It’s a reasonable option for men who want to avoid both needles and the transfer risk of gels, but adherence to three daily doses is a genuine challenge for most people.
Oral Testosterone
Older oral testosterone formulations (specifically methyltestosterone) were linked to liver toxicity and are no longer recommended. The American Urological Association explicitly advises against prescribing alkylated oral testosterone. However, newer oral testosterone undecanoate formulations work through a different absorption pathway that largely bypasses the liver. Clinical trials of these newer formulations showed no clinically significant liver toxicity, and elevated liver function tests were uncommon.
Oral testosterone undecanoate also had the lowest rate of erythrocytosis of any method in comparative data, at just 0.003%. It’s taken as a capsule twice daily with food, making it more convenient than nasal gel but less convenient than pellets or weekly injections. Availability and insurance coverage can vary.
How to Choose Based on Your Situation
If cost is your primary concern, injectable testosterone cypionate or enanthate is the clear winner at $30 to $150 per month. Weekly subcutaneous injections offer better level stability than the traditional every-two-week intramuscular approach, with less of the mood and energy fluctuation.
If you live with a partner, children, or pets and want to eliminate any risk of accidental hormone exposure, injections, pellets, nasal gel, or oral formulations are safer choices than topical gels or creams.
If you want the least day-to-day hassle, pellets require attention only two to four times per year. Satisfaction surveys confirm that pellet users value this convenience above all else.
If you’re concerned about blood thickening, gels and oral testosterone undecanoate carry the lowest erythrocytosis risk. Men with already elevated hematocrit levels (above 50%) are typically advised to investigate the cause before starting any form of TRT, and injectable testosterone would be the riskiest choice in that scenario.
If you’re trying to have children, exogenous testosterone in any form suppresses sperm production and should not be used. Alternative treatments exist that raise testosterone without shutting down fertility.
Satisfaction Is Similar Across Methods
Perhaps the most reassuring finding from patient research: satisfaction rates are nearly identical regardless of which method you choose. About 68% of gel users, 70% of pellet users, and 73% of injection users reported being satisfied with their treatment. The reasons for choosing differ (cost drives injection preference, doctor recommendation drives gel preference, convenience drives pellet preference), but the end result is that most men are happy once they find a method that fits their lifestyle. The “best” method is the one you’ll actually use consistently.