Testosterone Enanthate vs Testosterone Gel

Injectable testosterone ester

Topical testosterone (FDA-approved gel)

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

An FDA-approved daily testosterone gel applied to the skin — convenient and needle-free, but it carries a boxed warning about transfer to children.

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

• 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 in the morning to clean, dry, intact skin of the shoulders and upper arms (site varies by product)
• Starting dose is product-specific and titrated to trough testosterone levels
• Allow to dry, cover the area with clothing, 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 reactions
• Acne
• Increased red blood cell count
• Headache
• Mood changes

• Transfer to children or partners 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 FDA-approved 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
• Pregnancy or breastfeeding (women should avoid contact with application sites)
• 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

• Can raise blood pressure and hematocrit — monitor both
• Flammable until dry — avoid fire, flame, or smoking during application
• Not indicated for age-related 'low T' without documented hypogonadism
• Potential for abuse and dependence at supraphysiologic doses