What is the recommended dosage and administration of testosterone injections, such as testosterone cypionate (intramuscular) or testosterone enanthate (intramuscular), for treating hypogonadism?

From the Guidelines

For treating male hypogonadism, testosterone cypionate or enanthate is typically administered at 100-200 mg intramuscularly every 2 weeks or 50 mg weekly. The dosage should be adjusted based on serum testosterone levels, aiming for mid-normal range (400-700 ng/dL) when measured midway between injections, as suggested in the study by Bhasin et al. 1. Injections are given deep into the gluteal muscle or thighs for intramuscular self-injection. Patients may experience fluctuations in testosterone levels with these formulations, with higher levels shortly after injection and lower levels before the next dose.

Key Considerations

• Regular monitoring is essential, including testosterone levels, hematocrit, PSA, and liver function tests.
• Treatment should be individualized based on patient response and side effect profile.
• Some patients prefer more frequent injections at lower doses to minimize mood and energy fluctuations.
• Testosterone therapy addresses symptoms of hypogonadism by restoring physiological hormone levels, improving libido, energy, muscle mass, and bone density while potentially reducing fat mass and improving mood.

Administration and Dosage

• The typical dose range for testosterone enanthate and cypionate is 100-200 mg every 2 weeks or 50 mg weekly, as outlined in the study 1.
• The preparation name and dosage supplied can vary, with testosterone cypionate available in 100 mg/mL and 200 mg/mL concentrations.
• The advantages of long-acting injections include relatively inexpensive options, flexible and infrequent dosing, and no risk of transference, although they require intramuscular injection and can result in fluctuating serum testosterone levels.

From the Research

Testosterone Injections for Hypogonadism

• Testosterone therapy has been used for over 60 years to treat male hypogonadism, with intramuscular injections of esters like testosterone enanthate being the mainstay of treatment 2.
• The recommended dosage and administration of testosterone injections, such as testosterone cypionate or testosterone enanthate, vary depending on the individual patient's needs and response to treatment.
• Studies have shown that doses of 50-400 mg of testosterone enanthate administered every 1-4 weeks can effectively suppress serum LH and FSH concentrations and produce serum testosterone concentrations within the normal range 3.
• Testosterone undecanoate injections have also been shown to be effective in maintaining serum testosterone concentrations within the normal range for at least 7 weeks, with a terminal elimination half-life of 18-24 days 4.
• The frequency of injections can vary, with some studies suggesting that injections every 6-8 weeks or longer may be sufficient to maintain normal testosterone levels 4.

Administration Routes

• Intramuscular injections are the most common route of administration for testosterone injections, but subcutaneous injections have also been shown to be effective and may be preferred by some patients 5.
• Testosterone undecanoate depot injections have been shown to be effective and well-tolerated, with a low incidence of adverse effects and a high level of patient satisfaction 6.

Dosage and Efficacy

• The optimal dosage of testosterone injections varies depending on the individual patient's needs and response to treatment, but doses of 50-100 mg of testosterone cypionate or enanthate per week have been shown to be effective in achieving normal testosterone levels 5.
• Testosterone undecanoate injections have been shown to be effective in achieving normal testosterone levels, with a dose of 500-1000 mg administered every 6-8 weeks or longer 4.
• The efficacy of testosterone injections can be monitored by measuring serum testosterone concentrations, as well as LH and FSH levels, to ensure that the patient is receiving an adequate dose 3, 4.