| The Testicular Cancer Resource Center |
This page is for men who already know they need testosterone replacement therapy (TRT), or who are already using it and want to understand the choices, blood testing, dose adjustment and safety monitoring.
If you are still trying to determine whether low testosterone is actually causing symptoms, start with Testosterone: Symptoms & Testing.
When the last functioning testicle is removed, testosterone replacement should generally begin immediately after surgery or very soon afterward unless there is a specific medical reason to delay it. Ideally, the prescription and follow-up plan have already been arranged before the operation.
After that, the practical question is not whether testosterone is needed. It is which method works best for you and whether the dose is producing good symptom control without excessive levels or side effects.
There is no single best method for everyone. Cost, insurance, convenience, absorption, travel, side effects and personal preference all matter. Product availability also differs by country and changes over time.
| Method | Examples and availability | Advantages | Practical issues |
|---|---|---|---|
| Testosterone cypionate injections | Widely used in the U.S.; generic testosterone cypionate is readily available. Depo-Testosterone is a familiar brand name. | Usually inexpensive, easy to adjust, and can be self-injected after instruction. | Levels rise after the injection and fall before the next one. Larger doses given farther apart can produce obvious peaks and troughs. Some men feel better with smaller, more frequent doses. |
| Testosterone enanthate injections | Generic injectable testosterone enanthate is available. Xyosted is a U.S. weekly subcutaneous autoinjector. | Similar flexibility to cypionate; the autoinjector avoids drawing medication from a vial. | Standard injections can still produce peaks and troughs. Xyosted has its own dosing and monitoring instructions and can be more expensive. |
| Mixed testosterone ester injections | Sustanon 250 is widely used in the U.K. and some other countries. It is not an FDA-approved U.S. product. | Long-established option with less frequent dosing than some short-acting injections. | Testosterone still changes across the injection cycle. Availability and recommended intervals differ by country. |
| Long-acting testosterone undecanoate injections | Aveed is the U.S. product. Nebido and other testosterone-undecanoate products are used in the U.K. and elsewhere. | Much less frequent injections and relatively steady levels once the regimen is established. | Harder to adjust quickly. Aveed has special administration and post-injection observation requirements because of rare serious reactions. |
| Gels and topical preparations | AndroGel and several generic testosterone gels are available in the U.S.; Testavan and other gels are used in some other countries. | Daily dosing usually produces smoother levels and is easy to adjust or stop. | Absorption varies among men. Medication can transfer to another person through skin contact unless application and washing/covering instructions are followed carefully. |
| Oral testosterone undecanoate | Jatenzo, Tlando and Kyzatrex are U.S. oral products. Oral testosterone undecanoate is also used internationally. | No needles or skin application. | Food requirements, dose-adjustment rules and the correct timing of blood tests differ by product. Blood pressure requires attention. |
| Subcutaneous testosterone pellets | Testopel is a U.S. example. Small testosterone pellets are implanted under the skin during an office procedure. | Can provide testosterone for months without daily or weekly dosing. | Insertion is a minor procedure. Pellets can occasionally be expelled or the site can become infected, and the dose cannot be quickly changed once the pellets are in place. |
| Nasal testosterone | Natesto is available in the U.S. | Avoids injections and skin-transfer concerns. | Requires dosing several times a day and can cause nasal irritation. It is not a good fit for everyone with chronic nasal problems. |
| Testosterone patches | Androderm was the U.S. testosterone patch. It has been discontinued, and there is no current routine testosterone patch option in the United States. Availability in other countries varies. | Provided steady transdermal delivery without injections. | Skin irritation was common, and the major practical issue now is simple availability. |
The first method you try does not have to be the one you use forever.
The goal is to restore testosterone to an appropriate physiologic range and relieve the symptoms caused by deficiency without repeatedly pushing the level too high. A pre-treatment testosterone baseline can be useful when it exists, but it is evidence, not a rigid target.
The right dose is judged by a combination of:
Once you are taking testosterone, blood testing is used to judge how well the regimen is working. The result depends heavily on the preparation, the dose and where the blood draw falls in the dosing cycle.
When results are being compared over time, they are far more useful if they are drawn at comparable points in the dosing cycle. Write down when the last dose was taken or injected.
Testosterone normally feeds back on the brain and pituitary and lowers LH. If LH remains clearly elevated while a man is receiving testosterone, the pituitary is still signaling that the androgen feedback is not fully adequate. This can be particularly useful in a man with no functioning testicular tissue, because there is no remaining testicle that can respond to that LH signal by making more testosterone.
If the testosterone level is technically within the laboratory range but is near the low end, LH remains elevated, and the man is having symptoms, the combination can support the conclusion that the dose, dosing interval or absorption is inadequate. With injections, this may be especially apparent late in the dosing cycle. Studies of men with primary hypogonadism and men treated after bilateral orchiectomy show that effective testosterone replacement generally lowers elevated LH, while inadequate or widely spaced replacement can leave LH elevated.
LH should be interpreted together with symptoms, a properly timed testosterone level, free testosterone when relevant, the formulation and dosing pattern, and safety measures such as hematocrit and blood pressure. The goal is adequate replacement, not simply forcing LH into range by pushing testosterone excessively high.
More testosterone is not necessarily better. Problems can come from persistently excessive levels, very high peaks, or large swings between doses.
True aggressive or hypomanic reactions are much better documented with testosterone doses far above normal replacement levels than with properly adjusted TRT. Still, a major personality or mood change after a dose increase should not be ignored.
Testosterone can stimulate red blood cell production enough to make the hematocrit too high. If that happens, the dose or formulation may need to change, treatment may need to be paused, or a unit of blood may be removed to lower the red-cell concentration. That procedure is called therapeutic phlebotomy and is similar to donating blood. Current guidelines generally require action when hematocrit rises above 54%.
Current FDA labeling recognizes that testosterone products can raise blood pressure, so blood pressure should be followed. Testosterone products also carry warnings about venous blood clots such as deep-vein thrombosis and pulmonary embolism.
Testosterone has not been proven to cause prostate cancer, but prostate tissue is responsive to androgens and long-term prostate-cancer safety remains an area of active study. Men who still have a prostate should have age- and risk-appropriate prostate monitoring. Active or advanced prostate cancer requires specialist guidance before TRT, and a man with a history of treated prostate cancer should discuss the decision and PSA monitoring with the clinician managing that cancer history.
Longstanding testosterone deficiency can contribute to osteopenia, osteoporosis and fractures. Adequate replacement helps protect bone, but bone health also depends on resistance and weight-bearing exercise, adequate calcium and vitamin D, smoking, alcohol use and other medical risks.
A DEXA bone-density scan is especially worth discussing if there has been prolonged hypogonadism, an unexpected fracture, known osteopenia or osteoporosis, or other major risk factors.
There are two different possibilities, and simply increasing the dose can make the wrong one worse.
The sensible response is to review the symptoms, the exact preparation and dose, the timing of the blood test and the safety labs before deciding whether the answer is more testosterone, a different formulation, or evaluation for something else.