Oral vs. Injectable Testosterone: 5 Differences to Keep in Mind
Key takeaways:
Oral testosterone medications are taken twice a day: once in the morning and once in the evening. You should take them with meals, preferably fatty meals, to help improve their absorption.
Testosterone injections are administered less frequently than testosterone pills. Many people can go several weeks between injections, depending on the medication. However, injection-related side effects are common.
Speak to your healthcare professional to learn about the testosterone formulation that is best for you. It’s important to make regular appointments with them, regardless of your dosage form, to ensure optimal testosterone levels over time.
Table of contents
If you’re interested in testosterone replacement, you have several options to consider.
You may have heard of — or might already be receiving — testosterone injections. These are some of the most popular choices for testosterone replacement. They’re available in many forms, including Depo-Testosterone (testosterone cypionate), testosterone enanthate, and Aveed (testosterone undecanoate). But these injections aren’t one and the same. There are several differences between them.
Oral testosterone is another option to consider. Capsules such as Jatenzo (testosterone undecanoate), Tlando (testosterone undecanoate), and Kyzatrex (testosterone undecanoate) are all available. But these forms of testosterone aren’t identical to each other either.
Let’s explore five points to keep in mind when considering oral and injectable forms of testosterone.
1. There are many forms of oral and injectable testosterone
Testosterone replacement therapy (TRT) comes in many formulations. Injectable and oral forms of testosterone are most common, but nasal or skin gels, skin patches, and pellets are also available.
TRT addresses low testosterone levels, whether due to a health condition you were born with or an issue you encountered later in life. This could include reasons such as chemotherapy, heavy metal poisoning, or genetic conditions like Klinefelter syndrome. Testicular trauma or pituitary tumors are also potential causes.
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TRT can also be prescribed for masculinizing hormone therapy. But TRT is rarely used to treat low testosterone levels caused by the natural aging process. The risks of TRT generally outweigh the benefits in that case.
Oral testosterone formulations
Methyltestosterone was one of the first FDA-approved oral testosterone medications. However, healthcare professionals rarely prescribe it today due to liver risks. The three newer oral testosterone medications are more typically recommended. Jatenzo was FDA approved in 2019, while Tlando and Kyzatrex were approved in 2022.
All three medications are taken by mouth twice daily. They’re available as oral capsules, and they each contain the same form of testosterone. Jatenzo and Kyzatrex capsules also come in several different strengths, so your prescriber can adjust your dosage to help you reach and maintain your target testosterone levels. Tlando capsules only come in a single strength.
Injectable testosterone formulations
Testosterone cypionate, testosterone enanthate, and testosterone undecanoate are three different testosterone injections.
Testosterone cypionate and testosterone enanthate are shorter-acting forms of testosterone that are available as generic medications. They’re typically administered into your buttocks by a healthcare professional or caregiver, with one notable exception: Xyosted (testosterone enanthate). Xyosted is a newer form of testosterone enanthate that you can give yourself as an under-the-skin injection.
Aveed (testosterone undecanoate) is a longer-acting, brand-name-only form of testosterone that can only be administered by a healthcare professional into your buttocks.
Low testosterone symptoms: Learn about the important symptoms that may indicate you have low testosterone levels.
Testosterone replacement therapy (TRT) at a glance: Discover the benefits, risks, and side effects of TRT.
Testosterone injections: Learn about the differences between the types of testosterone injections.
2. Injectable testosterone tends to last longer than oral testosterone
Oral testosterone pills are typically taken twice daily. This is because they’re relatively fast acting.
By comparison, injectable forms of testosterone are not administered daily. They stay in your body for longer periods of time. They can be given as frequently as every week or as infrequently as every 10 weeks (2.5 months). The specific time frame depends on your prescribed product.
Testosterone enanthate is the shortest-acting form of injectable testosterone. It’s administered once a week. Testosterone cypionate is a longer-acting form that’s given every 2 to 4 weeks. Testosterone undecanoate is the longest-acting form of injectable testosterone. It’s typically injected once every 10 weeks after your initial starting doses.
3. Oral testosterone should be taken with food
Jatenzo, Kyzatrex, and Tlando should all be taken with food. This will help your body absorb as much of the medication as possible.
Not all foods are created equally, though. The amount of fat in your meals may affect your testosterone levels. Consuming higher-fat meals with Jatenzo and Kyzatrex increased people’s testosterone levels in clinical studies. So consuming higher-fat meals may be beneficial in getting your testosterone levels to target.
This isn’t the case for Tlando. While you should still take Tlando with meals, you don’t need to be as mindful of the fat content in your food. In clinical studies, the fat content in meals didn’t impact Tlando’s effectiveness.
Testosterone injections may be a better choice if you have trouble remembering to take your twice-daily doses or don’t want to time oral testosterone with your meals. Testosterone injections aren’t affected by the timing or contents of your food.
4. Different side effects are possible between the formulations
You may experience different side effects if you’re taking oral or injectable forms of testosterone. These side effects are associated with the different routes of medication delivery.
For example, injectable testosterone products are more likely to cause side effects at the injection site, such as:
Redness
Bleeding
Bruising
Pain
You’re more likely to experience the following side effects with oral testosterone, but they’re unlikely to occur overall:
Nausea
Diarrhea
Constipation
Other side effects — such as high blood pressure, mood changes, and fluid retention — are related to testosterone levels in your blood, not the dosage form. You aren’t more or less likely to experience these side effects whether you’re taking oral or injectable testosterone.
All testosterone medications are considered schedule 3 controlled substances. This is related to their risk of misuse and dependence.
Boxed warnings
Oral and injectable testosterone medications each carry boxed warnings, the most serious type of warning that the FDA gives medications. These warnings are related to the medication in general — not the dosage form.
Heart risks
Oral and injectable testosterone both have a boxed warning about the medication’s effects on your cardiovascular system. Testosterone can raise your blood pressure to unhealthy levels. Testosterone can also increase your body’s production of red blood cells.
People taking testosterone have an increased risk of experiencing serious heart-related health problems, such as strokes, heart attacks, and blood clots. It’s important to regularly see your prescriber for monitoring purposes and lab work. They can help manage potential problems before they become serious.
Heart attack symptoms include chest pain, shortness of breath, and lightheadedness. Stroke symptoms include numbness and weakness on one side of the body, an intense headache, and difficulty speaking. Blood clot symptoms may include shortness of breath, chest pain, or sudden leg swelling. Call 911 or go to the nearest ER if you experience any of these symptoms.
Lung risks
Aveed, the longer-acting injectable form of testosterone undecanoate, has a boxed warning for pulmonary oil microembolism (POME) and anaphylaxis, a severe allergic reaction.
POME is a unique, rare side effect that may be life-threatening. It occurs when oil from the medication enters the lungs. This can result in symptoms such as chest pain, fainting, and shortness of breath. Anaphylaxis symptoms include tightness of the throat, swelling, and others.
Due to these rare but serious risks, Aveed should only be administered by specially trained medical personnel. They’ll be able to observe you after your injections to make sure everything is going as expected.
5. You may be more likely to experience symptom fluctuations with testosterone injections
Testosterone is a hormone that affects your physical and mental health in many ways. This includes your emotional state, energy levels, and sexual health. You may experience variability in your symptoms if your testosterone levels aren’t the same every day.
This is sometimes an issue with the long-acting testosterone injections. These injections are able to keep your testosterone levels within a target range over a long period of time. But that doesn’t mean that your testosterone levels will always be the same between doses. Typically, your levels will increase slowly after your injection until they peak. Then, they will start to taper off until your next dose. By comparison, oral testosterone pills cause daily testosterone fluctuations that may more closely mimic a natural testosterone rhythm.
If you’re receiving a testosterone injection, you might notice changes in your symptoms between doses due to fluctuating testosterone levels. Your prescriber can adjust your TRT regimen if you’re experiencing any troublesome symptoms.
Other forms of testosterone are also available
As mentioned, TRT can be administered in many ways. These include:
Androgel, a gel applied to the skin
Androderm, a patch applied to the skin
Axiron, a topical solution applied to the armpits
Natesto, a nasal gel
Testopel, an implantable pellet
It’s important to review your options with a healthcare professional to figure out which is right for you.
The bottom line
Oral and injectable forms of testosterone each have their pros and cons. Oral testosterone medications offer convenience, and they don’t have injection-related side effects. However, they should be taken twice a day with meals: once in the morning and once in the evening. Testosterone injections are given less frequently, but many should be given by a healthcare professional or caregiver. It’s important to talk to your prescriber about the testosterone formulation that is best for you.
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References
Antares Pharma, Inc. (2023). Tlando [package insert].
Antares Pharma, Inc. (2024). Xyosted [package insert].
Endo Pharmaceuticals Inc. (2021). Aveed [package insert].
Eugia US LLC. (2023). Testosterone cypionate [package insert].
Eugia US LLC. (2024). Testosterone enanthate [package insert].
National Human Genome Research Institute. (2019). About Klinefelter syndrome.
Papangkorn, K., et al. (2021). MP36-04 clinical experience with Tlando in hypogonadal men. Journal of Urology.
Pastuszak, A. W., et al. (2020). Occurrence of pulmonary oil microembolism after testosterone undecanoate injection: A postmarketing safety analysis. Sexual Medicine.
U.S. Food and Drug Administration. (2016). FDA approves new changes to testosterone labeling regarding the risks associated with abuse and dependence of testosterone and other anabolic androgenic steroids (AAS).
Westaby, D., et al. (1977). Liver damage from long-term methyltestosterone. Lancet.
