Safety
No boxed warning on the cypionate label. Testosterone can raise blood pressure and red blood cell counts, and blood clots in the legs and lungs have been reported. It can lower sperm counts, and it is not for men with breast cancer or known or suspected prostate cancer. The label calls for periodic hemoglobin and hematocrit checks. Testosterone is a Schedule III controlled substance with a risk of abuse and dependence at high doses.
Talk to a licensed clinician about your health history and every medication you take before you start.
Legal status
Prescription only; FDA-approved. Testosterone is a Schedule III controlled substance. Prescribing it by telemedicine without an in-person exam relies on the DEA and HHS temporary extension that runs through Dec 31, 2026 (90 FR 61301); without a further extension or a final rule, the in-person requirement returns on Jan 1, 2027. Compounded testosterone cypionate is lawful under section 503A, but it is not FDA-approved. Online prescribing needs a live video visit with the prescriber under the DEA’s temporary telemedicine rule, which runs through December 31, 2026.
What testosterone injection is
Testosterone injection is made by Pharmacia & Upjohn (Depo-Testosterone), Antares Pharma (Xyosted) and generic makers. Depo-Testosterone, Xyosted and generic cypionate and enanthate are FDA-approved. Their labels say safety and efficacy in “age-related hypogonadism” have not been established. Many online programs prescribe compounded cypionate, which is not FDA-approved.
FDA-approved for
- Primary hypogonadism (congenital or acquired) in adult males
- Hypogonadotropic hypogonadism (congenital or acquired) in adult males
Dosing
Injection into muscle (cypionate and enanthate) or under the skin (Xyosted), or weekly for Xyosted; some online programs prescribe smaller weekly or twice-weekly doses. 50 to 400 mg every 2 to 4 weeks on the cypionate and enanthate labels. Xyosted starts at 75 mg under the skin once a week, adjusted by trough levels after 6 weeks. Before starting, the labels require two morning testosterone tests, on separate days, below the normal range. Your clinician sets the dose for you.
How well it works
In TRAVERSE (5,246 men aged 45 to 80 with low testosterone and heart disease or high heart risk, treated with testosterone gel), major heart events occurred in 7.0% of men on testosterone and 7.3% on placebo. Atrial fibrillation, acute kidney injury and pulmonary embolism were more common on testosterone. In the Xyosted label study, 135 of 150 men (90%) had average levels in the normal range at week 12. Individual results vary.
Testosterone injection cost
Some of the lowest prices need a membership or a 6- to 12-month plan paid upfront, and first labs can cost extra. For a full breakdown, read How much does TRT cost online?. For the steps, read How to get TRT online.