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Testosterone Replacement Therapy: Every Option, Explained

How each form of testosterone is given, what its label warns about, and how we decide together which one fits your life.

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Medically reviewed by David A. Robbins, MD — Diplomate, American Board of Urology Last reviewed November 2026

At a glance

Every option on this page is an FDA-approved prescription medicine for men whose testosterone deficiency has a recognised cause; none is approved for age-related low testosterone specifically.
The forms prescribed here are injections into the muscle, testosterone cypionate injections under the skin, gels and solutions, nasal gel, oral capsules, and pellets inserted in this office.
Giving testosterone cypionate under the skin is an off-label use of an FDA-approved medicine, because its label directs injection into the muscle.
Every testosterone gel label carries a boxed warning for secondary exposure: virilization has been reported in children who came into contact with the skin where gel was applied.
A prescription starts with an evaluation, not a product: two early-morning testosterone measurements on separate occasions, then a fertility conversation before any prescription.

Overview

There is more than one way to take testosterone

There are several different methods for taking testosterone replacement therapy, and no single one is right for every man. The choice depends on your blood tests, on your routine and how often you can come in, on whether you are planning to have children, now or later, and on the other conditions you live with, including your blood pressure and your heart and prostate history, which the safety and follow-up page covers.

Every option below is an FDA-approved prescription medicine for men whose testosterone deficiency has a recognised cause. None of them is approved for age-related low testosterone specifically — see the note further down — and none of them is a shortcut past the evaluation.

You are reading a page written and reviewed by David Robbins, MD, a board-certified urologist (Diplomate, American Board of Urology) who has practiced in Miami since 2009 at a practice serving South Florida for more than four decades.

First

What can change before a prescription

Prior to considering TRT, patients may want to consider starting an exercise regimen as increased physical activity can result in improvements in testosterone levels. Exercise is not the only thing worth looking at.

Weight. In men who are carrying excess weight, low testosterone is common, and it is one of the causes that can reverse. Obesity turns down the signal from the brain that tells the testicles to make testosterone and raises estrogen; losing weight moves both back in the right direction.

The evidence is consistent. A 2013 analysis that pooled 24 studies found testosterone rose after weight loss, and rose more the more weight was lost: by about 83 ng/dL on average with a low-calorie diet, and by about 252 ng/dL after weight-loss surgery, which produces far larger weight loss. The gains were greatest in younger men and in men without diabetes. A 2025 review in the Journal of Clinical Endocrinology & Metabolism advises weight loss first, ahead of testosterone treatment, for men whose low level is driven by obesity rather than by a disease of the testicles or pituitary gland.

The newer weight-loss medicines are being studied for this as well. In a small two-month pilot study published in 2025, 83 men with obesity and low testosterone who took tirzepatide saw their testosterone rise more than men who changed diet and exercise alone, or who used testosterone gel. It is early evidence, and larger, longer trials are still needed.

The AUA guideline recommends that every man with testosterone deficiency be counselled on lifestyle changes as part of his treatment. How much your own level changes depends on how much weight you lose and on what else is going on, which is why it starts with a conversation and a blood test, not a promise.

Sources: Corona G, Rastrelli G, Monami M, et al. Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. Eur J Endocrinol 2013;168(6):829–43. · Muir CA, Wittert GA, Handelsman DJ. Approach to the patient: low testosterone concentrations in men with obesity. J Clin Endocrinol Metab 2025;110(9):e3125–30. · La Vignera S, Cannarella R, Garofalo V, et al. Short-term impact of tirzepatide on metabolic hypogonadism and body composition in patients with obesity: a controlled pilot study. Reprod Biol Endocrinol 2025;23(1):92. · American Urological Association. Evaluation and Management of Testosterone Deficiency, guideline statement 21.

Sleep. Short or disrupted sleep, including untreated sleep apnea, is associated with lower levels, so we ask how you sleep.

Alcohol. Heavy drinking can lower testosterone, so we ask about that too.

Medications. Some medicines, including opioid pain medicines and steroid (glucocorticoid) tablets, can suppress testosterone, so we go through everything you take.

We discuss it first. This conversation happens at the first visit, before any prescription.

Every option

Testosterone replacement, method by method

Forms of testosterone replacement therapy. Every row is summarised from the product’s FDA prescribing information; nothing here replaces the label or a consultation.
Method	How it’s taken	How often	What the label warns about	Offered here
Injections into the muscle (testosterone cypionate, enanthate)	Injection into a muscle, given in the office or at home after we teach you to self-inject	Every two to four weeks, per label	No boxed warning. Blood-pressure increases, a rise in red-cell count (hematocrit), blood clots in the veins, and worsening prostate-enlargement symptoms.	Yes
Injections under the skin (testosterone cypionate)	Injection under the skin; the first dose is taught in the office, then you continue at home	Set at the visit; the label covers injection into the muscle only	The same medicine and warnings as the row above. Its label directs injection into the muscle, so giving it under the skin is an off-label use.	Yes
Autoinjector under the skin (Xyosted, testosterone enanthate)	Self-injection under the skin with an autoinjector	Weekly, per label	No boxed warning in the current label. Warns of blood-pressure increases; hematocrit checks approximately every three months.	Not prescribed here
Gels and solutions (AndroGel, Testim, generics)	Applied to the skin at home	Daily	Boxed warning: secondary exposure. Virilization has been reported in children who came into contact with the application site.	Yes
Pellets (Testopel)	Small pellets placed under the skin in a short procedure, inserted in this office	Every three to six months, per label	No boxed warning. The warnings that apply to every form: blood pressure, red-cell count, blood clots, prostate symptoms.	Yes
Nasal gel (Natesto)	Applied inside the nose at home	Three times a day, per label	No boxed warning. Not recommended for men with chronic nasal conditions.	Yes
Oral capsules (Jatenzo, Tlando, Kyzatrex — testosterone undecanoate)	Swallowed with food at home	Twice a day, per label	No boxed warning in the current labels. Blood-pressure increases are a listed warning; Jatenzo and Kyzatrex call for hematocrit checks approximately every three months.	Yes

Injections

Injections into the muscle are one of the longest-used forms of testosterone, and the testosterone cypionate and enanthate labels give a dose every two to four weeks. Here, the injection can be given in the office, or we teach you to give it yourself at home.

Testosterone cypionate can also be given under the skin. We give and teach the first dose in the office, and you continue at home. Its label describes injection into the muscle only, so this is an off-label use of an FDA-approved medicine, and we explain what that means before you choose it. Xyosted, a weekly autoinjector approved for use under the skin, is not one we prescribe.

Gels and solutions

Gels and solutions are applied to the skin once a day, at home. Every testosterone gel label carries a boxed warning for secondary exposure: virilization has been reported in children who came into contact with the skin where gel was applied. Wash your hands after applying, cover the site, and keep it away from partners and children. Patients additionally must be careful as the medication can be absorbed with skin-to-skin contact which is especially concerning with young women and children.

Pellets

Testopel is the long-acting form: small pellets placed under the skin, which are inserted in this office in a short procedure. Its label gives an interval of every three to six months between insertions. It carries no boxed warning; the warnings that apply to every form of testosterone apply to pellets too.

Nasal gel

Natesto is a testosterone gel applied inside the nose, three times a day according to its label. The label says it is not recommended for men with chronic nasal conditions or changes in nasal anatomy, and asks patients to report any nasal symptoms. It carries no boxed warning.

Oral capsules

Jatenzo, Tlando and Kyzatrex are capsules of testosterone undecanoate, swallowed with food twice a day according to their labels. Their current labels carry no boxed warning. Each lists blood-pressure increases among its warnings, and the Jatenzo and Kyzatrex labels call for hematocrit checks approximately every three months.

Read this

The limitation every testosterone product carries

What the FDA label says

Every FDA-approved testosterone product is approved for testosterone replacement in men with a deficiency that has a recognised cause — a problem in the testicles, or in the pituitary gland or hypothalamus. Every label also carries the same limitation of use: safety and efficacy in men with “age-related hypogonadism” (also called “late-onset hypogonadism”) have not been established. In February 2025 the FDA revised the labeling of the whole class: it added the results of a large cardiovascular safety trial, removed the earlier boxed-warning language about cardiovascular risk, kept the age-related limitation, and added a warning that testosterone can raise blood pressure. We tell you this because it changes how the decision is made: for a man whose only finding is age, the evaluation matters more, not less.

Sources: FDA, “FDA issues class-wide labeling changes for testosterone products,” 28 Feb 2025; prescribing information for Testim, AndroGel, Depo-Testosterone, Xyosted, Testopel, Natesto, Jatenzo, Tlando, Kyzatrex, Aveed (openFDA, label versions dated 2024–2026).

In practice

How a prescription actually starts here

It starts with an evaluation, not a product. We go through your symptoms and history and confirm the number: the AUA guideline asks for two early-morning testosterone measurements on separate occasions before the diagnosis is made, and the symptoms and testing page explains why. Your blood is drawn at an outside laboratory, not in our office.

Before any prescription, we have the fertility conversation. It is important for a doctor to check baseline levels of your hematocrit, PSA, liver function tests, and pituitary hormone panel prior to starting TRT.

Then we choose the method together. The forms prescribed here are injections into the muscle (given in the office, or at home after we teach you), testosterone cypionate injections under the skin (first dose taught in the office, then at home), gels and solutions, nasal gel and oral capsules, all used at home, and pellets, which are inserted in this office.

After you start, follow-up blood tests and visits follow the intervals that guidelines and product labels call for, set out on the safety and follow-up page.

PLACEHOLDER: office exam room, 3:2 — owner-supplied

The practical part

Cost and insurance

Whether evaluation and treatment are covered depends on your plan; our office will tell you before anything is billed.

Common Questions

Frequently Asked Questions

Which form of testosterone works best?

None is “best” for everyone. All of them can restore a level; they differ in how steady the level is, how often you take them, side effects specific to the form (skin transfer with gels, injection-site reactions, nasal irritation), and what fits your routine. The choice is made with you, after the evaluation.

Can I inject at home?

Yes, if it suits you. Injections into the muscle can be given here in the office, or we teach you to give them yourself at home. Injections of testosterone cypionate under the skin start with a first dose taught in the office; after that you give them at home.

Do gels really transfer to other people?

Yes — it is a boxed warning on every testosterone gel. Virilization has been reported in children secondarily exposed. Wash your hands after applying, cover the site, and keep it away from partners and children.

How long before I notice a difference?

It varies by symptom and by man, and the guideline is explicit that if your level normalizes but your symptoms don’t improve within three to six months, stopping therapy should be discussed. We would rather say that up front.

Are testosterone boosters or supplements an alternative?

Over-the-counter “boosters” are not FDA-approved medicines and are not a treatment for testosterone deficiency. Our page on natural approaches discusses what the evidence does and does not show.

We’re here to help. Schedule your visit or ask a question today.

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