Testosterone
Brand names: AndroGel, Testim, Vogelxo, Xyosted, Aveed, Jatenzo, Tlando, Kyzatrex, Natesto, Testopel. Also called TRT, testosterone replacement therapy, testosterone cypionate, testosterone enanthate, testosterone undecanoate.
Androgen (testosterone and its esters) 7 graded human studies Last checked
The short answer
From 27 sourcesTestosterone is the main male sex hormone, made in the testes under signals from the pituitary. As a medicine it comes as injections, gels, oral capsules, a nasal gel and pellets, used for men whose testes or pituitary do not make enough. It is not established for low testosterone from ageing alone, and it suppresses sperm production.
Key facts
- Heart safety
- No rise in major heart events in TRAVERSE (7.0% vs 7.3%)15
Which testosterone products are approved, and for what?
Every testosterone product on this page is an FDA-approved prescription drug and a Schedule III controlled substance. Boxed warnings differ: the gels carry one for secondary exposure of children, Aveed one for oil microembolism and anaphylaxis, and the blood-pressure box was removed from Xyosted, Jatenzo, Tlando and Kyzatrex in 2025.
Status by form
7 forms| Form | Status | Approved for | Boxed warning |
|---|---|---|---|
| Intramuscular injection: cypionate and enanthategenerics | FDA-approved prescription drug; Schedule III controlled substance45 | Men with primary or hypogonadotropic hypogonadism; enanthate also delayed puberty in boys and palliation of some breast cancers in women | None on the current labels |
| Subcutaneous autoinjector: enanthateXyosted | FDA-approved prescription drug; Schedule III controlled substance6 | Adult men with primary or hypogonadotropic hypogonadism | None; the blood-pressure box was removed in March 2025 |
| Long-acting injection: undecanoateAveed | FDA-approved prescription drug; Schedule III controlled substance; given only in certified clinics (REMS)7 | Adult men with primary or hypogonadotropic hypogonadism | Yes: pulmonary oil microembolism (POME) reactions and anaphylaxis |
| GelsAndroGel, Testim, Vogelxo, generics | FDA-approved prescription drugs; Schedule III controlled substance123 | Adult men with primary or hypogonadotropic hypogonadism | Yes: secondary exposure (virilization in children who touch the application site) |
| Oral capsules: undecanoateJatenzo, Tlando, Kyzatrex | FDA-approved prescription drugs; Schedule III controlled substance8910 | Adult men with primary or hypogonadotropic hypogonadism | None; the blood-pressure box was removed in 2025 (Jatenzo March and July, Tlando and Kyzatrex July) |
| Nasal gelNatesto | FDA-approved prescription drug; Schedule III controlled substance11 | Adult men with primary or hypogonadotropic hypogonadism | None on the current label |
| Implanted pelletsTestopel | FDA-approved prescription drug; Schedule III controlled substance12 | Men with primary or hypogonadotropic hypogonadism; delayed puberty in boys | None on the current label |
What is testosterone and how does it work?
Testosterone and its two main active products, estradiol and dihydrotestosterone, drive male sexual development, body hair, voice, muscle and fat distribution. Labels cover men with primary hypogonadism (the testes fail) or hypogonadotropic hypogonadism (the pituitary or hypothalamus fails), confirmed by two low morning tests. Benefit in age-related low testosterone has not been established.
How it works
Androgen (testosterone and its esters)Testosterone acts on androgen receptors, and its main active metabolites, dihydrotestosterone and estradiol, carry part of its effects on the sex organs, body hair, voice, muscle and fat. Taking it from outside switches off the pituitary's LH and FSH, so the testes make less of their own testosterone and much less sperm.123
What doses are on the label and in studies?
Doses depend on the product. Cypionate and enanthate injections are labelled at 50 to 400 mg every 2 to 4 weeks; Xyosted starts at 75 mg weekly under the skin; AndroGel 1.62% starts at 40.5 mg daily; the oral undecanoate capsules are taken twice daily with food; Aveed is 750 mg given in a clinic.
Label and study amounts, not a dose for you. A prescriber decides whether and how much; these show what the labels print and what trials used.
Doses by use
13 rows| Use | Form | Amount and schedule | Basis |
|---|---|---|---|
| Male hypogonadism | Testosterone cypionate, intramuscular | 50 to 400 mg every 2 to 4 weeks, deep in the gluteal muscle4 | Label |
| Male hypogonadism | Testosterone enanthate, intramuscular | 50 to 400 mg every 2 to 4 weeks5 | Label |
| Delayed puberty (boys) | Testosterone enanthate, intramuscular | 50 to 200 mg every 2 to 4 weeks for a limited period, for example 4 to 6 months, with bone-age X-rays5 | Label |
| Male hypogonadism | Xyosted, subcutaneous autoinjector | Start 75 mg once weekly in the abdomen; adjust from a trough level 7 days after a dose, after 6 weeks6 | Label |
| Male hypogonadism | Aveed, intramuscular | 750 mg (3 mL) at the start, at 4 weeks, then every 10 weeks; 30 minutes of observation after each injection7 | Label |
| Male hypogonadism | AndroGel 1.62% | Start 40.5 mg once daily to the shoulders and upper arms; adjust between 20.25 and 81 mg to keep levels between 350 and 750 ng/dL1 | Label |
| Male hypogonadism | Testim or Vogelxo gel | Start 50 mg once daily23 | Label |
| Male hypogonadism | Jatenzo capsules | Start 237 mg twice daily with food; range 158 to 396 mg twice daily8 | Label |
| Male hypogonadism | Tlando capsules | 225 mg twice daily with food9 | Label |
| Male hypogonadism | Kyzatrex capsules | Start 200 mg twice daily with food; adjusted between 100 mg once in the morning and 400 mg twice daily10 | Label |
| Male hypogonadism | Natesto nasal gel | 11 mg (one pump in each nostril) three times daily11 | Label |
| Male hypogonadism | Testopel pellets | 150 to 450 mg under the skin every 3 to 6 months12 | Label |
| Low sexual desire (HSDD) after menopause | Approved male products at female doses | Doses that keep blood levels in the premenopausal female range, with regular level checks24 | Guideline |
What is testosterone combined with?
Testosterone shuts down the pituitary signals that drive sperm production, so hCG is sometimes added to keep testosterone inside the testes. Men with erectile dysfunction may also use a PDE5 inhibitor, though added benefit is uncertain. In postmenopausal women with low sexual desire, a consensus statement allows low doses alongside estrogen.
Testosterone with hCG
To keep testosterone high inside the testes while LH is suppressed.
Weekly testosterone enanthate cut testicular testosterone by 94% in healthy men; adding hCG every other day kept it near normal, rising with the hCG dose. Reviews describe hCG among the options used off-label to restore sperm production after testosterone.2327
Checked: Semen analysis when fertility matters.
Testosterone with a PDE5 inhibitor
Erectile dysfunction is often treated with sildenafil or tadalafil.
A meta-analysis of 41 trials found testosterone improved erectile function in hypogonadal men, and added to a PDE5 inhibitor it could improve the result, but that was not confirmed in placebo-controlled trials. In TRAVERSE, testosterone did not improve erectile function.2617
Low-dose testosterone with estrogen, after menopause
For postmenopausal women diagnosed with low sexual desire (HSDD).
The 2019 global consensus statement says the only evidence-based use in women is HSDD after menopause, with or without estrogen, at doses that keep levels in the premenopausal range. It advises against pharmacy-mixed testosterone and against pellets or injections that push levels higher.24
Checked: Blood testosterone checked regularly to stay in the female range.
How does testosterone relate to fertility and pregnancy?
Testosterone works as a contraceptive: in a WHO trial, weekly injections stopped sperm production in about two thirds of men within six months. Sperm usually returns within months of stopping, but not in everyone. The Endocrine Society advises against starting it in men who plan to father a child soon.
Fertility, pregnancy and breastfeeding
- Sperm production stops
- In a WHO trial of 271 fertile men, weekly 200 mg testosterone enanthate made 65% azoospermic by 6 months (mean 120 days); sperm returned to 20 million/mL a median 3.7 months after stopping.22
- Planning a pregnancy
- The Endocrine Society advises against starting testosterone in men planning fertility in the near term; labels warn that it can cause azoospermia.131
- Recovery after stopping
- Sperm often recovers after testosterone or anabolic steroids stop, but not in every man; hCG, SERMs such as clomiphene and aromatase inhibitors are used off-label to help.27
- Pregnancy exposure
- Testosterone can virilize a female fetus; gel labels warn pregnant women to avoid contact with application sites.1
What gets checked during treatment?
Before starting, two morning testosterone tests confirm the diagnosis and the hematocrit and prostate are checked. Labels advise rechecking hematocrit 3 to 6 months after starting and then yearly, and stopping if it rises too high. Testosterone levels are checked to adjust the dose, and blood pressure is monitored periodically.
Monitoring
6 checks| Check | When | Why |
|---|---|---|
| Morning testosterone, twice | Before starting, on separate days113 | To confirm the diagnosis |
| Hematocrit | Before starting, 3 to 6 months after, then yearly113 | Testosterone raises red blood cells; therapy stops if it is too high |
| Prostate (PSA and exam) | Before starting and during the first year113 | Prostate cancer and BPH can worsen on testosterone |
| Testosterone level on treatment | Timed to the product (for example 6 hours after the morning Jatenzo dose; Xyosted trough at day 7)6813 | To adjust the dose toward the mid-normal range |
| Blood pressure | Periodically, especially with hypertension61 | Labels report rises (TRAVERSE: about 1.5 mm Hg systolic vs placebo) |
| Symptoms and side effects | At follow-up visits1413 | The AUA and Endocrine Society guidelines base continued treatment on symptom response and on-treatment levels |
What does the research show?
In TRAVERSE, a placebo-controlled trial in 5,246 men with heart disease or risk factors, testosterone gel did not raise major heart events over about three years. It improved sexual activity, desire, mood, energy and anemia, but not erectile function, and fractures were slightly more frequent. Earlier T Trials found moderate sexual benefit and no gain in vitality.
Every graded row
7 rows from 7 studiesShowing 7 of 7 outcomes. Human trials only.
AGrade AMajor heart events (heart death, heart attack, stroke)Heart safetyNo effectRCT
n 5,246 · 2023
7.0% vs 7.3% on placebo (HR 0.96, 95% CI 0.78 to 1.17); more atrial fibrillation, acute kidney injury and pulmonary embolism on testosterone.
- Design
- RCT, n = 5,246, 2023
- Population
- Men 45 to 80 with low testosterone and heart disease or high risk
- Form
- Testosterone gel 1.62%
- Dose
- Adjusted to 350 to 750 ng/dL
- Duration
- Mean 22 months of treatment, 33 months follow-up
- Source
- Reference 15 · PubMed 37326322 (opens PubMed)
BGrade BMood and energyMoodImprovedRCT
n 5,204 · 2024
Small improvements in mood and energy; no change in cognition or sleep quality.
- Design
- RCT, n = 5,204, 2024
- Population
- All TRAVERSE men; 2,643 with depressive symptoms
- Form
- Testosterone gel 1.62%
- Dose
- Adjusted to target range
- Duration
- Up to 3 years
- Source
- Reference 19 · PubMed 38205962 (opens PubMed)
BGrade BClinical fracturesFracturesWorsenedRCT
n 5,204 · 2024
Fractures 3.50% vs 2.46% on placebo (HR 1.43, 95% CI 1.04 to 1.97): no reduction, numerically more.
- Design
- RCT, n = 5,204, 2024
- Population
- TRAVERSE men
- Form
- Testosterone gel 1.62%
- Dose
- Adjusted to target range
- Duration
- Median 3.2 years
- Source
- Reference 21 · PubMed 38231621 (opens PubMed)
BGrade BHigh-grade prostate cancerProstate safetyNo effectRCT
n 5,204 · 2023
0.19% vs 0.12% (HR 1.62, 95% CI 0.39 to 6.77), not significantly different.
- Design
- RCT, n = 5,204, 2023
- Population
- TRAVERSE men with PSA 3.0 or less
- Form
- Testosterone gel 1.62%
- Dose
- Adjusted to target range
- Duration
- 14,304 person-years
- Source
- Reference 20 · PubMed 38150256 (opens PubMed)
BGrade BSexual activity and desireSexual functionImprovedRCT
n 1,161 · 2023
About 0.5 more sexual acts per day than placebo at 6 and 12 months, sustained at 24; desire and symptoms improved, erectile function did not.
- Design
- RCT, n = 1,161, 2023
- Population
- TRAVERSE men with low libido
- Form
- Testosterone gel 1.62%
- Dose
- Adjusted to target range
- Duration
- 24 months
- Source
- Reference 17 · PubMed 37589949 (opens PubMed)
BGrade BAnemia correctionAnemiaImprovedRCT
n 815 · 2023
Anemia corrected in 45.0% vs 33.9% on placebo at 12 months.
- Design
- RCT, n = 815, 2023
- Population
- TRAVERSE men with anemia
- Form
- Testosterone gel 1.62%
- Dose
- Adjusted to target range
- Duration
- Up to 36 months
- Source
- Reference 18 · PubMed 37889486 (opens PubMed)
BGrade BSexual function in older menSexual functionImprovedRCT
n 790 · 2016
Sexual activity, desire and erectile function improved moderately; no benefit for vitality; walking benefit only across all three trials.
- Design
- RCT, n = 790, 2016
- Population
- Men 65 and older with testosterone under 275 ng/dL and symptoms
- Form
- Testosterone gel
- Dose
- To mid-normal young-man levels
- Duration
- 1 year
- Source
- Reference 16 · PubMed 26886521 (opens PubMed)
What are the side effects and risks?
The main risks on the labels are a rise in red blood cells, blood clots, higher blood pressure, worsening prostate enlargement and suppressed sperm production. Gels can virilize children who touch the skin. Men with breast or prostate cancer should not use it, and it can harm a pregnancy through skin contact.
Regulatory status. All products here are FDA-approved prescription drugs and Schedule III controlled substances; the gels keep a boxed warning for secondary exposure and Aveed one for POME and anaphylaxis, while Xyosted and the oral capsules lost their blood-pressure box in 2025.1678910
Side effects reported more often than placebo
From the label's trialWarnings on the label
- Red blood cell rise (polycythemia)
- Hematocrit can rise enough to need a lower dose or a pause; more red cells may raise clot risk.1
- Blood clots
- Deep vein thrombosis and pulmonary embolism are reported; in TRAVERSE, clots were numerically more frequent on gel (1.7% vs 1.2%).615
- Blood pressure
- Testosterone can raise blood pressure: Xyosted by 3.9/1.5 mm Hg on ambulatory monitoring; in TRAVERSE, systolic pressure was 1.5 mm Hg higher than placebo.6
- Prostate
- BPH symptoms can worsen; men are checked for prostate cancer before and during treatment.1
- Secondary exposure (gels)
- Children who touched application sites have shown virilization; hands are washed and sites covered.12
- Oil microembolism (Aveed)
- Cough, breathlessness, throat tightening or fainting can follow the injection, so patients are observed for 30 minutes.7
- Misuse
- Testosterone is misused at high doses, often with other anabolic steroids, which can cause serious heart and psychiatric problems.1
Who should not use it (label contraindications)
What does testosterone interact with?
The labels list three: testosterone can lower blood sugar and so reduce insulin needs; it can change warfarin's effect, so INR is checked more often when starting or stopping; and with corticosteroids it can increase fluid retention, a concern with heart, kidney or liver disease. The Interaction map covers testosterone.
Interactions
3 agents| With | What happens | Evidence |
|---|---|---|
| Insulin and diabetes medicinesInsulin | Testosterone may lower blood glucose and reduce insulin needs.1 | Drug label |
| Oral anticoagulantsWarfarin | Anticoagulant effect can change; INR is checked more often when testosterone starts or stops.1 | Drug label |
| Corticosteroids and ACTHPrednisone | More fluid retention, a concern with heart, kidney or liver disease.1 | Drug label |
Check your own medicines and supplements in the Interaction map: every edge is sourced, and nothing you enter leaves your browser.
How do the options compare?
Injections need a shot every two to four weeks, or weekly with Xyosted. Gels and the nasal gel are used every day and gels can transfer to others by touch. Oral undecanoate capsules avoid needles and skin transfer but are taken twice daily with food. Aveed lasts ten weeks between clinic injections, pellets three to six months.
Testosterone by form
| Injections (cypionate, enanthate, Xyosted) | Gels and nasal gel | Oral capsules (undecanoate) | Long-acting (Aveed, pellets) | |
|---|---|---|---|---|
| How often | Every 2 to 4 weeks (Xyosted weekly) | Daily (nasal gel three times daily) | Twice daily with food | Aveed every 10 weeks; pellets every 3 to 6 months |
| Dose is adjusted by | Symptoms and testosterone levels (Xyosted: trough 7 days after a dose) | AndroGel 1.62%: levels kept between 350 and 750 ng/dL | A blood test hours after the morning dose | Symptoms and levels between doses |
| Main practical issue | Needles; injection technique | Skin transfer to children and partners (gels) | Taken with meals; blood pressure monitored | Aveed in certified clinics with 30-minute observation; pellets need a minor procedure |
Which tools and services help with this?
Free tools
2 toolsGetting a prescription
Frequently asked questions
Common questions
7 answersIs testosterone approved for low testosterone from ageing?
Does testosterone cause heart attacks?
In TRAVERSE, 5,246 men with heart disease or high risk had the same rate of heart death, heart attack and stroke on testosterone gel as on placebo (7.0% vs 7.3%). Atrial fibrillation, kidney injury and pulmonary embolism were more common.15
Will testosterone make me infertile?
Why is hCG used with testosterone?
Testosterone switches off the LH signal to the testes. Low-dose hCG stands in for LH and kept testosterone inside the testes near normal in a controlled study, which matters for sperm production.23
How is low testosterone diagnosed?
Does testosterone raise blood pressure?
It can. Xyosted raised blood pressure by 3.9/1.5 mm Hg on 24-hour monitoring, and in TRAVERSE systolic pressure ended 1.5 mm Hg higher on gel than on placebo. Labels advise periodic checks.6
Can women use testosterone?
The 2019 global consensus statement supports it only for postmenopausal women with low sexual desire (HSDD), at doses that keep levels in the female range; there is not enough evidence for mood, energy, bones or cognition.24
Sources
Sources cited on this page
27 sources- 1AndroGel 1.62% (testosterone) gel: prescribing information (DailyMed, version effective 2025-10-22)Label Ascend Therapeutics, 2025
- 2Testim (testosterone) gel: prescribing information (DailyMed, version effective 2025-07-15)Label Endo USA, 2025
- 3Vogelxo (testosterone) gel: prescribing information (DailyMed, version effective 2025-07-14)Label Upsher-Smith, 2025
- 4Testosterone cypionate injection: prescribing information (DailyMed, version effective 2026-09-09)Label BPI Labs, 2026
- 5Testosterone enanthate injection: prescribing information (DailyMed, version effective 2026-05-08)Label Hikma, 2026
- 6Xyosted (testosterone enanthate) injection: prescribing information (DailyMed, version effective 2025-07-01)Label Antares Pharma, 2025
- 7Aveed (testosterone undecanoate) injection: prescribing information (DailyMed, version effective 2025-07-15)Label Endo USA, 2025
- 8Jatenzo (testosterone undecanoate) capsules: prescribing information (DailyMed, version effective 2026-10-13)Label Tolmar, 2026
- 9Tlando (testosterone undecanoate) capsules: prescribing information (DailyMed, version effective 2026-02-25)Label Verity Pharmaceuticals, 2026
- 10Kyzatrex (testosterone undecanoate) capsules: prescribing information (DailyMed, version effective 2026-10-05)Label Marius Pharmaceuticals, 2026
- 11Natesto (testosterone) nasal gel: prescribing information (DailyMed, version effective 2025-07-22)Label Acerus Pharmaceuticals, 2025
- 12Testopel (testosterone) pellets: prescribing information (DailyMed, version effective 2025-07-17)Label Endo USA, 2025
- 13Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice GuidelineGuideline J Clin Endocrinol Metab, 2018 · PMID 29562364
- 14Evaluation and Management of Testosterone Deficiency: AUA GuidelineGuideline J Urol, 2018 · PMID 29601923
- 15Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE)RCT N Engl J Med, 2023 · PMID 37326322
- 16Effects of Testosterone Treatment in Older Men (T Trials)RCT N Engl J Med, 2016 · PMID 26886521
- 17Effect of Testosterone Replacement Therapy on Sexual Function and Hypogonadal Symptoms in Men with HypogonadismRCT J Clin Endocrinol Metab, 2023 · PMID 37589949
- 18Efficacy of Testosterone Replacement Therapy in Correcting Anemia in Men With Hypogonadism: A Randomized Clinical TrialRCT JAMA Netw Open, 2023 · PMID 37889486
- 19Depressive Syndromes in Men With Hypogonadism in the TRAVERSE Trial: Response to Testosterone-Replacement TherapyRCT J Clin Endocrinol Metab, 2024 · PMID 38205962
- 20Prostate Safety Events During Testosterone Replacement Therapy in Men With Hypogonadism: A Randomized Clinical TrialRCT JAMA Netw Open, 2023 · PMID 38150256
- 21Testosterone Treatment and Fractures in Men with HypogonadismRCT N Engl J Med, 2024 · PMID 38231621
- 22Contraceptive efficacy of testosterone-induced azoospermia in normal men (WHO Task Force)Open-label trial Lancet, 1990 · PMID 1977002
- 23Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppressionRCT J Clin Endocrinol Metab, 2005 · PMID 15713727
- 24Global Consensus Position Statement on the Use of Testosterone Therapy for WomenGuideline J Clin Endocrinol Metab, 2019 · PMID 31498871
- 25Identification of late-onset hypogonadism in middle-aged and elderly men (European Male Ageing Study)Observational N Engl J Med, 2010 · PMID 20554979
- 26Testosterone supplementation and sexual function: a meta-analysis studyMeta-analysis J Sex Med, 2014 · PMID 24697970
- 27Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid useReview Asian J Androl, 2016 · PMID 26908067
What changed
Change log
2 entries| Date | Change | Who and why |
|---|---|---|
| The dose row for women no longer carries an "off-label" tag. | Writer: Kymata Health EditorialTrigger: Growth review (2026-10-23): status once or twice per page | |
| Page created: status by product after the 2025 relabeling, label doses for every form, combinations, fertility, monitoring, seven graded rows (TRAVERSE and its substudies, T Trials), safety, interactions and a comparison by form. | Writer: Kymata Health EditorialTrigger: Owner request (2026-10-22): hormone library |
Kymata Health hormone library. Educational information only; it is not medical advice and does not replace a clinician. Doses are shown as labels and studies print them; a prescriber decides whether and how any hormone is used.