Testosterone Enanthate vs Testosterone Cream

Injectable testosterone ester

Topical testosterone (compounded)

A long-acting injectable testosterone ester very similar to cypionate; one branded form (Xyosted) is a weekly subcutaneous auto-injector.

A daily testosterone cream, usually compounded, applied to the skin — needle-free with steady levels, but it can transfer to others by skin contact.

Testosterone replacement (TRT)

Testosterone replacement (TRT)

• Testosterone replacement in men with primary hypogonadism
• Testosterone replacement in men with hypogonadotropic (secondary) hypogonadism

• Testosterone replacement in men with hypogonadism (compounded creams are prepared by a pharmacy and are not FDA-approved finished products)

• Traditional intramuscular dosing: 50–200 mg every 1–2 weeks, individualized to levels
• Xyosted subcutaneous auto-injector: 75 mg once weekly, adjusted 50–100 mg based on levels
• Given by intramuscular or subcutaneous injection depending on the product

• Applied once daily to clean, dry skin (commonly inner arms, shoulders, or as directed), dose individualized to trough levels
• Concentration and volume vary by the compounding pharmacy's formulation
• Allow the site to dry and wash hands after application

• Injection-site reactions
• Acne
• Mood changes
• Fluid retention
• Increased red blood cell count

• Polycythemia (thickened blood) raising clot risk
• Worsening of untreated sleep apnea
• Increased blood pressure
• Edema in patients with heart, kidney, or liver disease

• Application-site irritation or redness
• Acne
• Increased red blood cell count
• Mood changes

• Transfer to partners or children through skin contact, causing virilization
• Polycythemia (thickened blood) raising clot risk
• Worsening of untreated sleep apnea
• Increased blood pressure

• Adult men with a confirmed low morning testosterone level and symptoms of hypogonadism
• Men who want a weekly subcutaneous option (Xyosted)

• Adult men with confirmed hypogonadism who prefer a needle-free daily option
• Men who want steadier day-to-day levels than intermittent injections

• Known or suspected prostate or breast cancer in men
• Pregnancy or breastfeeding
• Known hypersensitivity to the ingredients, including the sesame-oil vehicle

• Known or suspected prostate or breast cancer in men
• Households where secondary skin transfer to women or children cannot be avoided
• Known hypersensitivity to the formulation ingredients

• The Xyosted label warns testosterone can increase blood pressure, raising the risk of major cardiovascular events
• Monitor hematocrit; discontinue or reduce dose if it becomes elevated
• Not indicated for age-related 'low T' without documented hypogonadism
• Potential for abuse and dependence at supraphysiologic doses

• Secondary exposure: testosterone can transfer to others through skin contact — cover the site and wash hands; children exposed can develop signs of puberty
• Because it is compounded, potency and absorption are not FDA-verified and can vary between pharmacies
• Can raise blood pressure and hematocrit — monitor both
• Not indicated for age-related 'low T' without documented hypogonadism