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  • TESTOSTERONE REPLACEMENT THERAPIES
    • NOTE: This page is intended to be a quick reference for properties of commonly used testosterone products. It is NOT a comprehensive review of each medication. Other drug interactions, side effects, precautions, and contraindications may exist for each drug.

PATCH
GELS
SOLUTION
NASAL SPRAY
BUCCAL TABLET
IMPLANT
INJECTIONS

LOW TESTOSTERONE OTHER




Drug Dosage form Dosage Generic/Price Other Class/Mechanism of Action Indications
(FDA-approved)
Side Effects Drug/Lab interactions Precautions/
Contraindications
Testosterone patch

(Androderm®)
Androderm® patch
  • 2 mg/24 hr
  • 4 mg/24 hr
Primary and secondary hypogonadism
  • Starting: 4 mg/24 hr patch applied nightly
  • Maintenance: 2 - 6 mg/24 hr applied nightly to maintain testosterone levels between 400 - 930 ng/dl
  • Check morning testosterone level 2 weeks after initiating therapy and after dose changes. A new patch should be applied the evening before morning level is drawn.
  • Apply to to a clean, dry area of the skin on the back, abdomen, upper arms, or thighs
NO/$$$$
  • Remove old patch before applying new patch
  • Avoid applying to bony prominences or a part of the body that may be subject to prolonged pressure during sleep or sitting (ex. the outer shoulder)
  • Do not apply to the scrotum
  • Rotate application site. Allow an interval of 7 days before applying to the same site.
  • Do not shower, swim, or wash patch site for a minimum of 3 hours after applying
  • Triamcinolone acetonide 0.1% cream (not ointment) may be applied under the central drug reservoir prior to application to reduce skin irritation
  • Remove before MRI scan. Patch contains aluminum
  • Androderm is DEA Schedule III
  • Endogenous androgens, including testosterone and dihydrotestosterone (DHT), are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics.

  • See testosterone physiology for more

NOTE: Strength of association is unknown because there was no placebo arm in trials. Data are from men who were stable on other topical testosterone products and were switched to Androderm.

  • Application site itching - 17%
  • Application site vesicles - 6%
  • Back pain - 6%
Drug interactions
  • Insulin - testosterone may increase insulin sensitivity. Insulin doses may need to be lowered after starting testosterone.
  • Warfarin - testosterone may alter warfarin activity. More frequent INR monitoring may be required.
  • Corticosteroids - testosterone may increase the fluid retention seen with corticosteroids

Lab interactions
  • Thyroid labs - testosterone may decrease concentrations of thyroxine-binding globulins resulting in decreased total T4 serum concentration and increased resin uptake of T3 and T4. Free T3 and T4 levels remain unchanged.
  • Breast cancer - DO NOT USE
  • Prostate cancer - DO NOT USE
  • Pregnant women or women who may become pregnant - DO NOT USE
  • Breastfeeding - DO NOT USE
  • Benign Prostatic Hyperplasia (BPH) - testosterone may worsen symptoms. DO NOT USE in severe BPH.
  • Congestive heart failure (CHF) - testosterone may cause fluid retention that worsens CHF. DO NOT USE in uncontrolled CHF.
  • Obstructive sleep apnea (OSA) - testosterone may worsen symptoms of OSA. DO NOT USE in severe OSA.
  • Polycythemia - testosterone may increase red blood cells (hematocrit). DO NOT USE in men with hematocrit > 50%.
  • MRI scans - Androderm patch contains aluminum. It should be removed before MRI scans to avoid potential burns.
  • Risk of prostate cancer - testosterone may increase risk
  • Heart attack and stroke - testosterone products may increase the risk of heart attack and stroke
  • Venous thromboembolism (DVT and PE) - DVT and PE cases have been reported in men using testosterone
  • Decreased spermatogenesis (infertility) - exogenous testosterone suppresses spermatogenesis by inhibiting FSH
  • Edema and swelling - testosterone may promote sodium and water retention leading to swelling and edema
  • Liver abnormalities - oral methyltestosterone has been associated with liver peliosis. Long-term use of testosterone enanthate has been associated with hepatic adenomas. These conditions have not been associated with other forms of testosterone.
  • Abuse and dependence - some patients may abuse testosterone and develop physical dependence. Withdrawal symptoms in patients taking supratherapeutic doses include depression, fatigue, craving, restlessness, irritability, anorexia, insomnia, decreased libido and hypogonadotropic hypogonadism. Symptoms may last weeks to months.
  • Gynecomastia - testosterone may cause gynecomastia
  • Hypercalcemia - testosterone may worsen hypercalcemia
  • Kidney disease - has not been studied. Manufacturer makes no recommendation.
  • Liver disease - has not been studied. Manufacturer makes no recommendation.




Drug Dosage form Dosage Generic/Price Other Class/Mechanism of Action Indications
(FDA-approved)
Side Effects
P = % of patients on placebo who experienced side effect
Drug/Lab Interactions Precautions/
Contraindications
Testosterone gel

(Androgel®)
(Fortesta®)
(Testim®)
(Vogelxo®)
Androgel® pump
  • 1% gel pump - delivers 12.5 mg of testosterone per actuation. Each 88g pump delivers 60 actuations.
  • 1.62% gel pump - delivers 20.25 mg of testosterone per actuation. Each 88g pump delivers 60 actuations.

Androgel® packets
  • 1% gel packets - come in 25 mg and 50 mg doses
  • 1.62% gel packet - comes in 20.25 mg and 40.5 mg doses

Fortesta® pump
  • Delivers 10 mg of testosterone per actuation
  • Comes in 60 g canister that delivers 120 actuations

Testim® tube
  • 1 tube of gel contains 50 mg of testosterone

Vogelxo®
  • Tube - one tube of gel contains 50 mg of testosterone
  • Packet - one packet of gel contains 50 mg of of testosterone
  • Pump - 12.5 mg of testosterone per actuation. Each 88g pump has 60 actuations.
Primary and secondary hypogonadism

Androgel 1%
  • Starting: 50 mg of testosterone (4 pump actuations, two 25 mg packets, or one 50 mg packet) applied once daily in the morning
  • Maintenance: 25 - 100 mg a day to maintain testosterone levels between 350 - 750 ng/dl
  • Check morning testosterone level (predose) at 14 and 28 days after initiating therapy and after dose changes
  • Apply to the shoulders, upper arms, and/or abdomen. Evenly distribute dose between both sides of the body.

Androgel 1.62%
  • Starting: 40.5 mg of testosterone (2 pump actuations or a single 40.5 mg packet) applied once daily in the morning
  • Maintenance: 20.25 - 81 mg a day to maintain testosterone levels between 350 - 750 ng/dl
  • Check morning testosterone level (predose) at 14 and 28 days after initiating therapy and after dose changes
  • If level is > 750 ng/ml, decrease dose by 20.25 mg. If dose is < 350 ng/dl, increase dose by 20.25 mg.
  • Apply to clean, dry, intact skin of the upper arms and shoulders using palm of the hand. Apply to both sides of body if using more than 20.25 mg.

Fortesta
  • Starting: 40 mg applied once daily in the morning
  • Maintenance: 10 - 70 mg a day to maintain testosterone levels (drawn 2 hours after applying) between 500 - 1250 ng/dl
  • Check testosterone level 2 hours after applying at 14 and 35 days after initiating therapy and after dose changes
  • For levels > 2500 ng/dl, decrease dose by 20 mg. For levels 1250 - 2499 ng/dl, decrease dose by 10 mg. For levels 500 - 1250 ng/dl, leave dose same. For levels < 500 ng/dl, increase dose by 10 mg.
  • Apply to clean, dry, intact skin of the front and inner thighs using one finger. Split doses > 10 mg between the thighs.

Testim
  • Starting: 50 mg (one tube) applied once daily in the morning
  • Maintenance: 50 - 100 mg a day to maintain testosterone levels between 300 - 1000 ng/dl
  • Check morning testosterone level (predose) 14 days after initiating therapy and after dose changes
  • If level is < 300 ng/ml, increase dose to 100 mg once daily. Maximum recommended dose is 100 mg per day.
  • Apply to clean, dry, intact skin of the upper arms and shoulders using the palm of the hand

Vogelxo
  • Starting: 50 mg of testosterone (one tube, one packet, or 4 pump actuations) applied once daily at the same time each day
  • Maintenance: 50 - 100 mg a day to maintain testosterone levels between 300 - 1000 ng/dl
  • Check morning testosterone level (predose) 14 days after initiating therapy and after dose changes
  • If level is < 300 ng/ml, increase dose to 100 mg once daily. Maximum recommended dose is 100 mg per day.
  • Apply to clean, dry, intact skin of the upper arms and shoulders. If using 100 mg, apply to both sides of body.
Androgel 1% gel and packet
YES/$$$$

Androgel 1.62% gel and packet
NO/$$$$

Fortesta
YES/$$$$

Testim
NO/$$$$

Vogelxo
NO/$$$$

  • Do not apply to other parts of the body
  • After drying, area of application should be covered by clothing
  • Wash hands after applying
  • Avoid swimming, showering, or washing the application site for a minimum of 2 hours
  • Pumps should be primed before first use
  • Gels contain alcohol and are flammable
  • Testosterone gels are DEA schedule III
  • Endogenous androgens, including testosterone and dihydrotestosterone (DHT), are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics.
  • See testosterone physiology for more

NOTE: Data from Androgel PI in a study lasting 182 days

  • PSA increase* - 11%, P - 0%
  • Emotional lability - 2.6%, P - 0%
  • Hypertension - 2.1%, P - 0%
  • Hematocrit increase - 2.1%, P - 0%
  • Contact dermatitis - 2.1%, P - 0%

*defined as average change from baseline > 0.75 ng/ml and/or an average PSA value > 4.0 ng/ml based on two measurements
Drug interactions
  • Insulin - testosterone may increase insulin sensitivity. Insulin doses may need to be lowered after starting testosterone.
  • Warfarin - testosterone may alter warfarin activity. More frequent INR monitoring may be required.
  • Corticosteroids - testosterone may increase the fluid retention seen with corticosteroids

Lab interactions
  • Thyroid labs - testosterone may decrease concentrations of thyroxine-binding globulins resulting in decreased total T4 serum concentration and increased resin uptake of T3 and T4. Free T3 and T4 levels remain unchanged.
  • Secondary exposure - children and women should avoid contact with application sites. Virilization has been reported in exposed children.
  • Breast cancer - DO NOT USE
  • Prostate cancer - DO NOT USE
  • Pregnant women or women who may become pregnant - DO NOT USE
  • Breastfeeding - DO NOT USE
  • Benign Prostatic Hyperplasia (BPH) - testosterone may worsen symptoms. DO NOT USE in severe BPH.
  • Congestive heart failure (CHF) - testosterone may cause fluid retention that worsens CHF. DO NOT USE in uncontrolled CHF.
  • Obstructive sleep apnea (OSA) - testosterone may worsen symptoms of OSA. DO NOT USE in severe OSA.
  • Polycythemia - testosterone may increase red blood cells (hematocrit). DO NOT USE in men with hematocrit > 50%.
  • Risk of prostate cancer - testosterone may increase risk
  • Heart attack and stroke - testosterone products may increase the risk of heart attack and stroke
  • Venous thromboembolism (DVT and PE) - DVT and PE cases have been reported in men using testosterone
  • Decreased spermatogenesis (infertility) - exogenous testosterone suppresses spermatogenesis by inhibiting FSH
  • Edema and swelling - testosterone may promote sodium and water retention leading to swelling and edema
  • Liver abnormalities - oral methyltestosterone has been associated with liver peliosis. Long-term use of testosterone enanthate has been associated with hepatic adenomas. These conditions have not been associated with other forms of testosterone.
  • Abuse and dependence - some patients may abuse testosterone and develop physical dependence. Withdrawal symptoms in patients taking supratherapeutic doses include depression, fatigue, craving, restlessness, irritability, anorexia, insomnia, decreased libido and hypogonadotropic hypogonadism. Symptoms may last weeks to months.
  • Gynecomastia - testosterone may cause gynecomastia
  • Hypercalcemia - testosterone may worsen hypercalcemia
  • Kidney disease - has not been studied. Manufacturer makes no recommendation.
  • Liver disease - has not been studied. Manufacturer makes no recommendation.




Drug Dosage form Dosage Generic/Price Other Class/Mechanism of Action Indications
(FDA-approved)
Side Effects Drug/Lab Interactions Precautions/
Contraindications
Testosterone solution

(Axiron®)
Axiron® pump
  • Pump delivers 30 mg of testosterone in 1.5 ml of solution per actuation

  • Pump comes in 90 ml size that delivers 60 actuations
Primary and secondary hypogonadism
  • Starting: 60 mg of testosterone (2 pump actuations) applied once daily
  • Maintenance: 30 - 120 mg once daily to maintain testosterone levels between 300 - 1050 ng/dl
  • Check testosterone level 14 days after initiating therapy and after dose changes. Level should be drawn 2 - 8 hours after applying Axiron.
  • If level is < 300 ng/dl, increase dose by 30 mg. If level is > 1050 ng/dl, decrease dose by 30 mg.
  • Axiron is applied to the axilla (armpit) using included applicator
  • Doses > 30 mg should be split between both axilla, allowing product to dry between application
NO/$$$$
  • Pump should be primed with 3 actuations before very first use
  • Apply deodorant before Axiron
  • Wash hands after applying
  • Cover application site with clothing
  • Avoid swimming or washing the application site for a minimum of 2 hours after application
  • Axiron contains alcohol and is flammable
  • Axiron is DEA schedule III
  • Endogenous androgens, including testosterone and dihydrotestosterone (DHT), are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics.
  • See testosterone physiology for more

NOTE: Strength of association is unknown because there was no placebo arm in trials

  • Application site irritation - 7%
  • Application site redness - 5%
  • Headache - 5%
  • Hematocrit increase - 4%
  • Diarrhea - 3%
  • Vomiting - 3%
  • PSA increase* - 1%

*average increase in PSA over 120 days was 0.13 ng/ml
Drug interactions
  • Insulin - testosterone may increase insulin sensitivity. Insulin doses may need to be lowered after starting testosterone.
  • Warfarin - testosterone may alter warfarin activity. More frequent INR monitoring may be required.
  • Corticosteroids - testosterone may increase the fluid retention seen with corticosteroids

Lab interactions
  • Thyroid labs - testosterone may decrease concentrations of thyroxine-binding globulins resulting in decreased total T4 serum concentration and increased resin uptake of T3 and T4. Free T3 and T4 levels remain unchanged.
  • Secondary exposure - children and women should avoid contact with application sites. Virilization has been reported in exposed children.
  • Breast cancer - DO NOT USE
  • Prostate cancer - DO NOT USE
  • Pregnant women or women who may become pregnant - DO NOT USE
  • Breastfeeding - DO NOT USE
  • Benign Prostatic Hyperplasia (BPH) - testosterone may worsen symptoms. DO NOT USE in severe BPH.
  • Congestive heart failure (CHF) - testosterone may cause fluid retention that worsens CHF. DO NOT USE in uncontrolled CHF.
  • Obstructive sleep apnea (OSA) - testosterone may worsen symptoms of OSA. DO NOT USE in severe OSA.
  • Polycythemia - testosterone may increase red blood cells (hematocrit). DO NOT USE in men with hematocrit > 50%.
  • Risk of prostate cancer - testosterone may increase risk
  • Heart attack and stroke - testosterone products may increase the risk of heart attack and stroke
  • Venous thromboembolism (DVT and PE) - DVT and PE cases have been reported in men using testosterone
  • Decreased spermatogenesis (infertility) - exogenous testosterone suppresses spermatogenesis by inhibiting FSH
  • Edema and swelling - testosterone may promote sodium and water retention leading to swelling and edema
  • Liver abnormalities - oral methyltestosterone has been associated with liver peliosis. Long-term use of testosterone enanthate has been associated with hepatic adenomas. These conditions have not been associated with other forms of testosterone.
  • Abuse and dependence - some patients may abuse testosterone and develop physical dependence. Withdrawal symptoms in patients taking supratherapeutic doses include depression, fatigue, craving, restlessness, irritability, anorexia, insomnia, decreased libido and hypogonadotropic hypogonadism. Symptoms may last weeks to months.
  • Gynecomastia - testosterone may cause gynecomastia
  • Hypercalcemia - testosterone may worsen hypercalcemia
  • Kidney disease - has not been studied. Manufacturer makes no recommendation.
  • Liver disease - has not been studied. Manufacturer makes no recommendation.




Drug Dosage form Dosage Generic/Price Other Class/Mechanism of Action Indications
(FDA-approved)
Side Effects Drug/Lab Interactions Precautions/
Contraindications
Testosterone nasal gel

(Natesto®)
Natesto® pump
  • One actuation delivers 5.5 mg of testosterone nasal gel

  • Each pump has 60 actuations
Primary and secondary hypogonadism
  • Dosing: 11 mg of testosterone (2 pump actuations; 1 actuation per nostril) intranasally 3 times daily for a total daily dose of 33 mg
  • Check morning testosterone level 1 month after initiating therapy
  • If testosterone level does not stay consistently between 300 - 1050 ng/dl, discontinue Natesto

NO/$$$$
  • Pump should be primed with 10 actuations before very first use
  • Blow nose before administering dose
  • Gel is deposited on inside wall of nostril and then massaged in
  • Patients should discontinue during episodes of severe rhinitis (runny nose)
  • Natesto is DEA schedule III
  • Endogenous androgens, including testosterone and dihydrotestosterone (DHT), are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics.
  • See testosterone physiology for more

NOTE: Strength of association is unknown because there was no placebo arm in trials

  • PSA increase* - 5.1%
  • Headache - 3.8%
  • Runny nose - 3.8%
  • Nosebleeds - 3.8%
  • Nasal discomfort - 3.8%
  • Nasopharyngitis - 3.8%
  • Bronchitis - 3.8%
  • Upper respiratory infection - 3.8%
  • Sinusitis - 3.8%
  • Nasal scab - 3.8%

*average increase in PSA over 90 days was 0.2 ng/ml
Drug interactions
  • Insulin - testosterone may increase insulin sensitivity. Insulin doses may need to be lowered after starting testosterone.
  • Warfarin - testosterone may alter warfarin activity. More frequent INR monitoring may be required.
  • Corticosteroids - testosterone may increase the fluid retention seen with corticosteroids
  • Oxymetazoline (Afrin®) nasal spray - oxymetazoline does not affect the absorption of Natesto
  • Nasal sprays - the effect of nasal sprays on Natesto (besides oxymetazoline) has not been studied

Lab interactions
  • Thyroid labs - testosterone may decrease concentrations of thyroxine-binding globulins resulting in decreased total T4 serum concentration and increased resin uptake of T3 and T4. Free T3 and T4 levels remain unchanged.
  • Nasal abnormalities - DO NOT USE in patients with a history of nasal or sinus surgery, nasal fracture within the previous 6 months or nasal fracture that caused a deviated anterior nasal septum, mucosal inflammatory disorders (e.g, Sjogren’s syndrome), or sinus disease
  • Long-term nasal safety - there is limited data on the long-term nasal safety of Natesto
  • Breast cancer - DO NOT USE
  • Prostate cancer - DO NOT USE
  • Pregnant women or women who may become pregnant - DO NOT USE
  • Breastfeeding - DO NOT USE
  • Allergic rhinitis - absorption may be decreased by up to 24%
  • Benign Prostatic Hyperplasia (BPH) - testosterone may worsen symptoms. DO NOT USE in severe BPH.
  • Congestive heart failure (CHF) - testosterone may cause fluid retention that worsens CHF. DO NOT USE in uncontrolled CHF.
  • Obstructive sleep apnea (OSA) - testosterone may worsen symptoms of OSA. DO NOT USE in severe OSA.
  • Polycythemia - testosterone may increase red blood cells (hematocrit). DO NOT USE in men with hematocrit > 50%.
  • Risk of prostate cancer - testosterone may increase risk
  • Heart attack and stroke - testosterone products may increase the risk of heart attack and stroke
  • Venous thromboembolism (DVT and PE) - DVT and PE cases have been reported in men using testosterone
  • Decreased spermatogenesis (infertility) - exogenous testosterone suppresses spermatogenesis by inhibiting FSH
  • Edema and swelling - testosterone may promote sodium and water retention leading to swelling and edema
  • Liver abnormalities - oral methyltestosterone has been associated with liver peliosis. Long-term use of testosterone enanthate has been associated with hepatic adenomas. These conditions have not been associated with other forms of testosterone.
  • Abuse and dependence - some patients may abuse testosterone and develop physical dependence. Withdrawal symptoms in patients taking supratherapeutic doses include depression, fatigue, craving, restlessness, irritability, anorexia, insomnia, decreased libido and hypogonadotropic hypogonadism. Symptoms may last weeks to months.
  • Gynecomastia - testosterone may cause gynecomastia
  • Hypercalcemia - testosterone may worsen hypercalcemia
  • Kidney disease - has not been studied. Manufacturer makes no recommendation.
  • Liver disease - has not been studied. Manufacturer makes no recommendation.




Drug Dosage form Dosage Generic/Price Other Class/Mechanism of Action Indications
(FDA-approved)
Side Effects Drug/Lab Interactions Precautions/
Contraindications
Testosterone buccal tablet

(Striant®)
Striant® buccal tablet
  • Each buccal tablet contains 30 mg of testosterone
Primary and secondary hypogonadism
  • Dosing: 1 buccal system (30 mg) to the gum region twice a day (about 12 hours apart)
  • Tablet is placed just above the incisor tooth on either side of the mouth. Rotate sides of the mouth with each application.
  • Check morning (predose) testosterone level 4 - 12 weeks after initiating therapy
  • If testosterone level does not stay consistently between 300 - 1050 ng/dl, discontinue Striant

NO/$$$$
  • The rounded surface of the tablet goes against the gum and is held firmly in place with a finger over the lip and against the product for 30 seconds to ensure adhesion
  • If tablet dislodges during use, throw away and replace with a new tablet
  • Remove before oral care (brushing teeth, mouthwash, etc.)
  • Striant is DEA schedule III
  • Endogenous androgens, including testosterone and dihydrotestosterone (DHT), are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics.
  • See testosterone physiology for more

NOTE: Strength of association is unknown because there was no placebo arm in trials

  • Gum or mouth irritation - 9.2%
  • Bitter taste - 4.1%
  • Gum pain - 3.1%
  • Gum tenderness - 3.1%
  • Headache - 3.1%
  • Gum edema - 2.0%
  • Taste perversion - 2.0%
Drug interactions
  • Insulin - testosterone may increase insulin sensitivity. Insulin doses may need to be lowered after starting testosterone.
  • Warfarin - testosterone may alter warfarin activity. More frequent INR monitoring may be required.
  • Corticosteroids - testosterone may increase the fluid retention seen with corticosteroids

Lab interactions
  • Thyroid labs - testosterone may decrease concentrations of thyroxine-binding globulins resulting in decreased total T4 serum concentration and increased resin uptake of T3 and T4. Free T3 and T4 levels remain unchanged.
  • Long-term gum safety - there is limited data on the long-term gum safety of Striant
  • Breast cancer - DO NOT USE
  • Prostate cancer - DO NOT USE
  • Pregnant women or women who may become pregnant - DO NOT USE
  • Breastfeeding - DO NOT USE
  • Benign Prostatic Hyperplasia (BPH) - testosterone may worsen symptoms. DO NOT USE in severe BPH.
  • Congestive heart failure (CHF) - testosterone may cause fluid retention that worsens CHF. DO NOT USE in uncontrolled CHF.
  • Obstructive sleep apnea (OSA) - testosterone may worsen symptoms of OSA. DO NOT USE in severe OSA.
  • Polycythemia - testosterone may increase red blood cells (hematocrit). DO NOT USE in men with hematocrit > 50%.
  • Risk of prostate cancer - testosterone may increase risk
  • Heart attack and stroke - testosterone products may increase the risk of heart attack and stroke
  • Venous thromboembolism (DVT and PE) - DVT and PE cases have been reported in men using testosterone
  • Decreased spermatogenesis (infertility) - exogenous testosterone suppresses spermatogenesis by inhibiting FSH
  • Edema and swelling - testosterone may promote sodium and water retention leading to swelling and edema
  • Liver abnormalities - oral methyltestosterone has been associated with liver peliosis. Long-term use of testosterone enanthate has been associated with hepatic adenomas. These conditions have not been associated with other forms of testosterone.
  • Abuse and dependence - some patients may abuse testosterone and develop physical dependence. Withdrawal symptoms in patients taking supratherapeutic doses include depression, fatigue, craving, restlessness, irritability, anorexia, insomnia, decreased libido and hypogonadotropic hypogonadism. Symptoms may last weeks to months.
  • Gynecomastia - testosterone may cause gynecomastia
  • Hypercalcemia - testosterone may worsen hypercalcemia
  • Kidney disease - has not been studied. Manufacturer makes no recommendation.
  • Liver disease - has not been studied. Manufacturer makes no recommendation.




Drug Dosage form Dosage Generic/Price Other Class/Mechanism of Action Indications
(FDA-approved)
Side Effects Drug/Lab Interactions Precautions/
Contraindications
Testosterone pellet

(Testopel®)
Testopel® pellet
  • Each pellet contains 75 mg of testosterone
Primary and secondary hypogonadism
  • Dosing: 150 - 450 mg subcutaneously every 3 - 6 months
  • Pellet is implanted in the hip area or other fatty area
  • With testosterone pellets, the Endocrine Society recommends checking testosterone levels at the end of the dosing interval [2]

NO/$$$$
  • Testosterone levels peak at 1 month, then are sustained in the normal range for 3 - 6 months [2]
  • Pellets are inserted in a doctor's office
  • Pellets are typically reinserted every 3 - 4 months
  • Testopel is DEA schedule III
  • Endogenous androgens, including testosterone and dihydrotestosterone (DHT), are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics.
  • See testosterone physiology for more

NOTE: Incidence of side effects is not well-defined

  • Inflammation and pain at the implantation site
  • Anaphylactoid reactions
  • Pellets may extrude spontaneously
  • Infection at implantation site
  • Fibrosis at implantation site
Drug Interactions
  • Insulin - testosterone may increase insulin sensitivity. Insulin doses may need to be lowered after starting testosterone.
  • Warfarin - testosterone may alter warfarin activity. More frequent INR monitoring may be required.
  • Corticosteroids - testosterone may increase the fluid retention seen with corticosteroids

Lab Interactions
  • Thyroid labs - testosterone may decrease concentrations of thyroxine-binding globulins resulting in decreased total T4 serum concentration and increased resin uptake of T3 and T4. Free T3 and T4 levels remain unchanged.
  • Breast cancer - DO NOT USE
  • Prostate cancer - DO NOT USE
  • Pregnant women or women who may become pregnant - DO NOT USE
  • Breastfeeding - DO NOT USE
  • Benign Prostatic Hyperplasia (BPH) - testosterone may worsen symptoms. DO NOT USE in severe BPH.
  • Congestive heart failure (CHF) - testosterone may cause fluid retention that worsens CHF. DO NOT USE in uncontrolled CHF.
  • Obstructive sleep apnea (OSA) - testosterone may worsen symptoms of OSA. DO NOT USE in severe OSA.
  • Polycythemia - testosterone may increase red blood cells (hematocrit). DO NOT USE in men with hematocrit > 50%.
  • Risk of prostate cancer - testosterone may increase risk
  • Heart attack and stroke - testosterone products may increase the risk of heart attack and stroke
  • Venous thromboembolism (DVT and PE) - DVT and PE cases have been reported in men using testosterone
  • Decreased spermatogenesis (infertility) - exogenous testosterone suppresses spermatogenesis by inhibiting FSH
  • Edema and swelling - testosterone may promote sodium and water retention leading to swelling and edema
  • Liver abnormalities - oral methyltestosterone has been associated with liver peliosis. Long-term use of testosterone enanthate has been associated with hepatic adenomas. These conditions have not been associated with other forms of testosterone.
  • Abuse and dependence - some patients may abuse testosterone and develop physical dependence. Withdrawal symptoms in patients taking supratherapeutic doses include depression, fatigue, craving, restlessness, irritability, anorexia, insomnia, decreased libido and hypogonadotropic hypogonadism. Symptoms may last weeks to months.
  • Gynecomastia - testosterone may cause gynecomastia
  • Hypercalcemia - testosterone may worsen hypercalcemia
  • Kidney disease - has not been studied. Manufacturer makes no recommendation.
  • Liver disease - has not been studied. Manufacturer makes no recommendation.




Drug Dosage form Dosage Generic/Price Other Class/Mechanism of Action Indications
(FDA-approved)
Side Effects Drug/Lab Interactions Precautions/
Contraindications
Testosterone cypionate

(Depo®-testosterone)
Testosterone cypionate vial
  • 100 mg/ml - 10 ml vial
  • 200 mg/ml - 1 ml and 10 ml vial
Primary and secondary hypogonadism
  • Dosing: 50 - 400 mg IM every 2 - 4 weeks
  • In trials, dosing of 200 mg IM every 2 - 3 weeks was often used [1]
  • The Endocrine Society recommends 75 - 100 mg IM every week or 150 - 200 mg IM every 2 weeks when initiating therapy [2]
  • The Endocrine Society recommends a target testosterone level of 400 - 700 ng/dl one week after injection [2]
  • Inject into the gluteal muscle

YES/$
  • After injection, testosterone levels rise into the supraphysiological range and then decline gradually
  • Store vials at room temperature
  • Testosterone cypionate is DEA schedule III
  • Endogenous androgens, including testosterone and dihydrotestosterone (DHT), are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics.
  • See testosterone physiology for more

NOTE: Incidence of side effects is not well-defined

  • Inflammation and pain at the injection site

  • Fluctuations in mood and libido - secondary to peaks and valleys in testosterone levels

  • Cough after injection - rare. Possibly due to oil embolization.
Drug interactions
  • Insulin - testosterone may increase insulin sensitivity. Insulin doses may need to be lowered after starting testosterone.
  • Warfarin - testosterone may alter warfarin activity. More frequent INR monitoring may be required.
  • Corticosteroids - testosterone may increase the fluid retention seen with corticosteroids

Lab interactions
  • Thyroid labs - testosterone may decrease concentrations of thyroxine-binding globulins resulting in decreased total T4 serum concentration and increased resin uptake of T3 and T4. Free T3 and T4 levels remain unchanged.
  • Breast cancer - DO NOT USE
  • Prostate cancer - DO NOT USE
  • Pregnant women or women who may become pregnant - DO NOT USE
  • Breastfeeding - DO NOT USE
  • Benign Prostatic Hyperplasia (BPH) - testosterone may worsen symptoms. DO NOT USE in severe BPH.
  • Congestive heart failure (CHF) - testosterone may cause fluid retention that worsens CHF. DO NOT USE in uncontrolled CHF.
  • Obstructive sleep apnea (OSA) - testosterone may worsen symptoms of OSA. DO NOT USE in severe OSA.
  • Polycythemia - testosterone may increase red blood cells (hematocrit). DO NOT USE in men with hematocrit > 50%.
  • Risk of prostate cancer - testosterone may increase risk
  • Heart attack and stroke - testosterone products may increase the risk of heart attack and stroke
  • Venous thromboembolism (DVT and PE) - DVT and PE cases have been reported in men using testosterone
  • Decreased spermatogenesis (infertility) - exogenous testosterone suppresses spermatogenesis by inhibiting FSH
  • Edema and swelling - testosterone may promote sodium and water retention leading to swelling and edema
  • Liver abnormalities - oral methyltestosterone has been associated with liver peliosis. Long-term use of testosterone enanthate has been associated with hepatic adenomas. These conditions have not been associated with other forms of testosterone.
  • Abuse and dependence - some patients may abuse testosterone and develop physical dependence. Withdrawal symptoms in patients taking supratherapeutic doses include depression, fatigue, craving, restlessness, irritability, anorexia, insomnia, decreased libido and hypogonadotropic hypogonadism. Symptoms may last weeks to months.
  • Gynecomastia - testosterone may cause gynecomastia
  • Hypercalcemia - testosterone may worsen hypercalcemia
  • Kidney disease - has not been studied. Manufacturer makes no recommendation.
  • Liver disease - has not been studied. Manufacturer makes no recommendation.

Drug Dosage form Dosage Generic/Price Other Class/Mechanism of Action Indications
(FDA-approved)
Side Effects Drug/Lab Interactions Precautions/
Contraindications
Testosterone enanthate

(Delatestryl®)
Testosterone enanthate vial
  • 200 mg/ml - 5 ml vial
Primary and secondary hypogonadism
  • Dosing: 50 - 400 mg IM every 2 - 4 weeks
  • In trials, dosing of 200 mg IM every 2 weeks was often used [1]
  • The Endocrine Society recommends 75 - 100 mg IM every week or 150 - 200 mg IM every 2 weeks when initiating therapy [2]
  • The Endocrine Society recommends a target testosterone level of 400 - 700 ng/dl one week after injection [2]
  • Inject into the gluteal muscle

Delayed puberty
  • Dosing: 50 - 200 mg IM every 2 - 4 weeks

Palliation of inoperable mammary cancer in women
  • Dosing: 200 - 400 mg IM every 2 - 4 weeks
YES/$
  • After injection, testosterone levels rise into the supraphysiological range and then decline gradually
  • Store vials at room temperature
  • If stored at lower temperatures, crystals may develop. Warming and rotating vial should redissolve crystals.
  • Testosterone enanthate is DEA schedule III
  • Endogenous androgens, including testosterone and dihydrotestosterone (DHT), are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics.
  • See testosterone physiology for more

NOTE: Incidence of side effects is not well-defined

  • Inflammation and pain at the injection site

  • Fluctuations in mood and libido - secondary to peaks and valleys in testosterone levels

  • Cough after injection - rare. Possibly due to oil embolization.

  • Anaphylactoid reactions - rare
Drug interactions
  • Insulin - testosterone may increase insulin sensitivity. Insulin doses may need to be lowered after starting testosterone.
  • Warfarin - testosterone may alter warfarin activity. More frequent INR monitoring may be required.
  • Corticosteroids - testosterone may increase the fluid retention seen with corticosteroids

Lab interactions
  • Thyroid labs - testosterone may decrease concentrations of thyroxine-binding globulins resulting in decreased total T4 serum concentration and increased resin uptake of T3 and T4. Free T3 and T4 levels remain unchanged.
  • Breast cancer - DO NOT USE
  • Prostate cancer - DO NOT USE
  • Pregnant women or women who may become pregnant - DO NOT USE
  • Breastfeeding - DO NOT USE
  • Benign Prostatic Hyperplasia (BPH) - testosterone may worsen symptoms. DO NOT USE in severe BPH.
  • Congestive heart failure (CHF) - testosterone may cause fluid retention that worsens CHF. DO NOT USE in uncontrolled CHF.
  • Obstructive sleep apnea (OSA) - testosterone may worsen symptoms of OSA. DO NOT USE in severe OSA.
  • Polycythemia - testosterone may increase red blood cells (hematocrit). DO NOT USE in men with hematocrit > 50%.
  • Risk of prostate cancer - testosterone may increase risk
  • Heart attack and stroke - testosterone products may increase the risk of heart attack and stroke
  • Venous thromboembolism (DVT and PE) - DVT and PE cases have been reported in men using testosterone
  • Decreased spermatogenesis (infertility) - exogenous testosterone suppresses spermatogenesis by inhibiting FSH
  • Edema and swelling - testosterone may promote sodium and water retention leading to swelling and edema
  • Liver abnormalities - oral methyltestosterone has been associated with liver peliosis. Long-term use of testosterone enanthate has been associated with hepatic adenomas. These conditions have not been associated with other forms of testosterone.
  • Abuse and dependence - some patients may abuse testosterone and develop physical dependence. Withdrawal symptoms in patients taking supratherapeutic doses include depression, fatigue, craving, restlessness, irritability, anorexia, insomnia, decreased libido and hypogonadotropic hypogonadism. Symptoms may last weeks to months.
  • Gynecomastia - testosterone may cause gynecomastia
  • Hypercalcemia - testosterone may worsen hypercalcemia
  • Kidney disease - has not been studied. Manufacturer makes no recommendation.
  • Liver disease - has not been studied. Manufacturer makes no recommendation.

Drug Dosage form Dosage Generic/Price Other Class/Mechanism of Action Indications
(FDA-approved)
Side Effects Drug/Lab Interactions Precautions/
Contraindications
Testosterone undecanoate

(Aveed®)
Aveed® vial
  • 750 mg/3 ml (250 mg/ml)
  • Comes in 3 ml single use vial
Primary and secondary hypogonadism
  • Dosing: 3 ml (750 mg) IM initially, followed by 3 ml (750 mg) IM in 4 weeks, then 3 ml (750 mg) IM every 10 weeks thereafter
  • The Endocrine Society recommends checking a testosterone level just prior to the subsequent injection [2]
  • Inject into the gluteal muscle
  • After injection, patients should be observed in a healthcare setting for 30 minutes to monitor for POME reaction
NO/$$$$
  • In most men, testosterone levels stay in the normal range
  • In order to prescribe Aveed, healthcare professionals must complete an online training program and become enrolled in the Aveed REMS program Aveed REMS program
  • Store vials at room temperature
  • Aveed contains castor oil and benzyl benzoate
  • Aveed is DEA schedule III
  • Endogenous androgens, including testosterone and dihydrotestosterone (DHT), are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics.
  • See testosterone physiology for more

NOTE: Strength of association is unknown because there was no placebo arm in trials.

  • Acne - 5.2%
  • Injection site pain - 4.6%
  • PSA increase* - 4.6%
  • Estradiol increase - 2.6%
  • Hypogonadism - 2.6%
  • Fatigue - 2%
  • Irritability - 2%
  • Hemoglobin increase - 2%
  • Insomnia - 2%
  • Mood swings - 2%

*average PSA increased from 1.0 ng/ml to 1.5 ng/ml in an 84-week trial
Drug interactions
  • Insulin - testosterone may increase insulin sensitivity. Insulin doses may need to be lowered after starting testosterone.
  • Warfarin - testosterone may alter warfarin activity. More frequent INR monitoring may be required.
  • Corticosteroids - testosterone may increase the fluid retention seen with corticosteroids

Lab interactions
  • Thyroid labs - testosterone may decrease concentrations of thyroxine-binding globulins resulting in decreased total T4 serum concentration and increased resin uptake of T3 and T4. Free T3 and T4 levels remain unchanged.
  • Pulmonary Oil Microembolism (POME) - reaction causing cough, urge to cough, shortness of breath, sweating, throat tightening, chest pain, dizziness, and syncope has occurred after injection of testosterone undecanoate. Some reactions have required hospitalization. In one study, 9 POME events occurred among 3,556 patients treated with testosterone undecanoate.
  • Anaphylaxis after injection - has been reported. Rare.
  • Breast cancer - DO NOT USE
  • Prostate cancer - DO NOT USE
  • Pregnant women or women who may become pregnant - DO NOT USE
  • Breastfeeding - DO NOT USE
  • Benign Prostatic Hyperplasia (BPH) - testosterone may worsen symptoms. DO NOT USE in severe BPH.
  • Congestive heart failure (CHF) - testosterone may cause fluid retention that worsens CHF. DO NOT USE in uncontrolled CHF.
  • Obstructive sleep apnea (OSA) - testosterone may worsen symptoms of OSA. DO NOT USE in severe OSA.
  • Polycythemia - testosterone may increase red blood cells (hematocrit). DO NOT USE in men with hematocrit > 50%.
  • Risk of prostate cancer - testosterone may increase risk
  • Heart attack and stroke - testosterone products may increase the risk of heart attack and stroke
  • Venous thromboembolism (DVT and PE) - DVT and PE cases have been reported in men using testosterone
  • Decreased spermatogenesis (infertility) - exogenous testosterone suppresses spermatogenesis by inhibiting FSH
  • Edema and swelling - testosterone may promote sodium and water retention leading to swelling and edema
  • Liver abnormalities - oral methyltestosterone has been associated with liver peliosis. Long-term use of testosterone enanthate has been associated with hepatic adenomas. These conditions have not been associated with other forms of testosterone.
  • Abuse and dependence - some patients may abuse testosterone and develop physical dependence. Withdrawal symptoms in patients taking supratherapeutic doses include depression, fatigue, craving, restlessness, irritability, anorexia, insomnia, decreased libido and hypogonadotropic hypogonadism. Symptoms may last weeks to months.
  • Gynecomastia - testosterone may cause gynecomastia
  • Hypercalcemia - testosterone may worsen hypercalcemia
  • Kidney disease - has not been studied. Manufacturer makes no recommendation.
  • Liver disease - has not been studied. Manufacturer makes no recommendation.



  • PRICING

    • $ = 0 - $50
    • $$ = $51 - $100
    • $$$ = $101 - $150
    • $$$$ = > $151

    • Pricing based on 6 standard doses
    • Pricing based on survey of GoodRX.com® [accessed 2/2015]
    • Pricing may vary by region and availability



  • References

    • 1 - PMID 25621688 - PSA effects MA
    • 2 - PMID 20525905 - Endocrine Soc recs