Doctors prescribe testosterone in several forms: injectable solutions, topical gels, skin patches, implantable pellets, oral capsules, and even a nasal gel. The right choice depends on your lifestyle, how often you want to deal with dosing, your comfort with needles, and how your body responds. Most prescriptions in the United States fall into two categories: injections and topical gels. Here’s what each option actually looks like in practice.
Why Testosterone Gets Prescribed
Testosterone replacement therapy is prescribed for hypogonadism, a condition where the body doesn’t produce enough testosterone on its own. Diagnosis typically requires both symptoms (low sex drive, fatigue, erectile dysfunction, mood changes) and blood work confirming low levels. The Endocrine Society uses a threshold of about 264 to 300 ng/dL on a morning blood draw, though some guidelines point to 320 ng/dL as the level below which sexual symptoms become clearly linked to low testosterone. You’ll usually need at least two separate blood tests showing low levels before a doctor starts treatment.
Injectable Testosterone
Injections are the most widely prescribed and least expensive form. The two standard options are testosterone cypionate (brand name Depo-Testosterone) and testosterone enanthate (brand name Delatestryl). They’re nearly identical in how they work, with a half-life of roughly 173 hours, or about seven days. You inject once every one to two weeks, either into muscle tissue or subcutaneously into the fat of the abdomen or thigh using a small needle.
Subcutaneous injections have gained popularity because they use a shorter, thinner needle and are easier to self-administer at home. The abdomen (a few inches to the side of the belly button) and the outer thigh are the most common sites. Many patients prefer weekly smaller doses over biweekly larger ones because it keeps blood levels more stable and reduces the “roller coaster” effect of peaks and valleys.
There’s also a long-acting injectable called testosterone undecanoate (brand name Aveed). This one works on a completely different schedule: you get an injection at the start, another four weeks later, and then one every 10 weeks after that. It must be given in a doctor’s office because of a small risk of a serious reaction at the injection site. It’s a good fit if you want to think about your testosterone as rarely as possible, but it does mean regular office visits.
Topical Gels
Gels are the main alternative to injections and appeal to people who don’t want needles. Several FDA-approved brands are available: AndroGel (in 1% and 1.62% concentrations), Testim (1%), Fortesta (2%), and Vogelxo (1%). Generic versions exist as well. You apply the gel once daily to clean, dry skin, typically on the upper arms, shoulders, or abdomen. It dries within minutes, and testosterone absorbs steadily through the skin over the course of the day.
The biggest practical concern with gels is transfer risk. Until the gel fully dries and the skin is covered or washed, direct skin contact can transfer testosterone to partners, children, or pets. This means being careful about when you apply it, covering the area with clothing, and washing your hands thoroughly afterward. Gels also tend to cost more than injectable testosterone, particularly without insurance.
Skin Patches
Testosterone patches (brand name Androderm) deliver a steady dose through the skin over 24 hours. They come in strengths of 2, 2.5, 4, and 5 mg per day, and you apply a new patch each night to the back, abdomen, upper arms, or thighs. You rotate the application site to avoid irritation.
Skin reactions are the main drawback. Many users develop redness, itching, or irritation at the patch site, and for some people this is bothersome enough to switch to another form. Patches also don’t stick well during heavy sweating or physical activity, which can be frustrating. They do provide the most consistent daily testosterone levels of any formulation, though, since absorption is continuous.
Implantable Pellets
Testosterone pellets (brand name Testopel) are small, rice-grain-sized implants placed under the skin, usually in the hip or buttock area, during a quick in-office procedure with local numbing. The pellets dissolve slowly over two to six months, with most people coming back for replacement every three months. The number of pellets inserted varies based on your blood levels and how your body metabolizes them.
The appeal is obvious: once the pellets are in, you don’t think about testosterone for months. There’s no daily routine and no weekly injections. The downsides are that you need an office visit each time, there’s a small risk of pellet extrusion (where one works its way back out through the skin), and if you have side effects, you can’t simply stop taking a pill or skip an injection. The pellets are already in your body and will continue releasing testosterone until they dissolve.
Oral Capsules
Oral testosterone was long considered impractical because older formulations were hard on the liver. A newer oral form, testosterone undecanoate (brand name Jatenzo), was FDA-approved in 2019 and bypasses that liver toxicity issue. The starting dose is 237 mg taken twice daily, morning and evening, with food. Your doctor can adjust the dose anywhere from 158 mg to 396 mg twice daily based on follow-up blood work.
The trade-off is blood pressure. In clinical trials, patients on Jatenzo saw an average increase of about 5 points in systolic blood pressure, and roughly 7% of patients needed to start or increase blood pressure medication during the study. Other common side effects included elevated red blood cell counts, headaches, nausea, and digestive issues. Because of the cardiovascular concerns, this option works best for people whose blood pressure is well controlled before starting.
Nasal Gel
The most unusual option is Natesto, a testosterone gel applied inside the nostrils. You use a metered pump to deliver 5.5 mg of testosterone into each nostril, three times a day (morning, afternoon, and evening, spaced six to eight hours apart). The total daily dose is 33 mg.
Natesto’s main advantage is that it may have less impact on fertility than other testosterone forms, since the short bursts of absorption don’t suppress the body’s own hormone signals as heavily. The downside is the dosing frequency. Three times daily is a lot to keep up with, and nasal irritation or runny nose can be bothersome. It’s a niche choice, but it fills a real gap for younger men who want testosterone therapy without fully shutting down sperm production.
Monitoring While on Therapy
Regardless of which form you use, your doctor will check bloodwork on a regular schedule. The key numbers are your testosterone level (to make sure the dose is actually working), your hematocrit (a measure of red blood cell concentration), and your PSA (a prostate screening marker). Hematocrit is checked at baseline, again at three to six months, and then yearly. If it climbs above 54%, therapy is paused until it drops, because thickened blood raises the risk of clots. PSA gets flagged if it jumps more than 1.4 ng/mL in the first year or exceeds 4 ng/mL at any point, which triggers a urology referral.
Most men settle into a routine within the first few months. It’s common to try one formulation, find it doesn’t fit your life or produces side effects, and switch to another. The testosterone itself is the same hormone regardless of how it enters your body. The differences are all about convenience, cost, and how steadily your levels stay in range.