What are alternative testosterone therapies to the 1.62% gel?

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Last updated: September 28, 2026 • View editorial policy

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Alternative Testosterone Therapies to 1.62% Gel

Multiple testosterone formulations are available as alternatives to the 1.62% gel, including other transdermal gels at different concentrations, transdermal patches, intramuscular injections (testosterone enanthate or cypionate), injectable testosterone undecanoate, buccal tablets, and testosterone pellets—all of which are recognized by Endocrine Society guidelines as appropriate options for testosterone replacement therapy. 1

Available Testosterone Formulations

The Endocrine Society guidelines explicitly recognize multiple delivery systems for testosterone replacement, each with distinct monitoring requirements and side effect profiles 1:

Transdermal Options

  • Other gel concentrations: Different testosterone gel formulations are available and can be assessed after at least 1 week of treatment to achieve mid-normal testosterone levels 1. The 2% testosterone gel (Testavan) represents a newer option with potentially improved convenience 2
  • Transdermal patches: Applied daily (nonscrotal patches in the evening), with testosterone levels assessed 3-12 hours after application. Common side effect is skin irritation at application site (up to 66% of users) 1, 3

Injectable Formulations

  • Testosterone enanthate or cypionate: Standard intramuscular injections every 2-4 weeks (typically 200-300 mg). Measure testosterone levels midway between injections; adjust if levels are >700 ng/dL or <400 ng/dL. Patients may experience mood or libido fluctuations 1, 4
  • Injectable testosterone undecanoate: Longer-acting formulation with less frequent dosing. Measure levels just prior to each injection to adjust dosing interval 1

Other Delivery Systems

  • Buccal testosterone tablets: Applied to gums with assessment immediately before or after fresh system application. Monitor for taste alterations and oral mucosa irritation 1
  • Testosterone pellets: Subcutaneous implants with extended duration. Measure levels at end of dosing interval. Monitor for infection, fibrosis, or pellet extrusion 1

Key Considerations for Selection

Practical Factors

Cost varies dramatically: Annual costs range from approximately $156 for intramuscular formulations to over $2,135 for transdermal options 5. Patient preference studies show 53% prefer injectable testosterone primarily due to lower cost, while 71% of those who tried multiple formulations preferred topical gels for convenience and ease of use 5.

Safety Profile Differences

All formulations require the same monitoring protocol 1:

  • Testosterone levels at 3-6 months, targeting mid-normal range
  • Hematocrit at baseline, 3-6 months, then annually (stop if >54%)
  • PSA and digital rectal exam at baseline, 3-6 months, then per screening guidelines
  • Annual symptom assessment

Critical caveat: Transdermal gels carry a unique risk of testosterone transfer to women and children through skin contact. Patients must cover application sites and wash skin with soap and water before contact. This transfer risk is eliminated 4-6 hours after application 1, 6.

Formulation-Specific Advantages

  • Intramuscular injections: Most cost-effective, proven efficacy, but require office visits or self-injection comfort 7, 4
  • Transdermal gels: Convenient daily application, stable levels, but higher cost and transfer risk 1
  • Patches: Stable levels without transfer risk, but high skin irritation rates 1, 3
  • Pellets: Least frequent administration (months between doses), but require minor surgical procedure 1

Clinical Algorithm for Selection

  1. Assess patient priorities: Cost sensitivity, convenience preference, comfort with injections, household contact concerns
  2. Evaluate contraindications: Skin conditions may preclude patches/gels; bleeding disorders may complicate injections
  3. Consider starting options:
    • Cost-conscious patients or those comfortable with injections → testosterone enanthate/cypionate IM
    • Patients prioritizing convenience without household transfer concerns → alternative gel concentration or patches
    • Patients wanting minimal administration frequency → testosterone pellets or long-acting injectable undecanoate
  4. Monitor response at 3-6 months and adjust formulation if inadequate symptom relief, intolerable side effects, or inability to achieve mid-normal testosterone levels

Important pitfall: Oral testosterone preparations (except testosterone undecanoate, not available in the US) are associated with hepatotoxicity and should be avoided 3. The goal across all formulations remains achieving mid-normal testosterone levels with symptom improvement while monitoring for adverse effects, particularly erythrocytosis and prostate changes 1.

References

7
Guideline

american association of clinical endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple's problem--2003 update.

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologist, 2003

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.