Recommended Dosage of Testosterone Cypionate for Hypogonadism
For replacement therapy in hypogonadal males, testosterone cypionate should be administered at a dose of 50-400 mg intramuscularly every 2-4 weeks, with most patients requiring 100-200 mg every 2 weeks or 50 mg weekly to maintain mid-normal testosterone levels. 1
Dosing Guidelines and Administration
Initial Dosing
- Start with 100-200 mg every 2 weeks or 50 mg weekly intramuscularly 2, 1
- Injections should be given deep in the gluteal muscle 1
- For patients new to testosterone therapy, starting at the lower end of the range may help minimize side effects
Dose Adjustments
- Target mid-normal testosterone levels (450-600 ng/dL) 3
- Measure testosterone levels 2-3 months after treatment initiation and after any dose changes 3
- For injectable testosterone, measure levels midway between injections 2
- Adjust dose according to the following parameters:
- If testosterone >750 ng/dL: Decrease dose
- If testosterone 350-750 ng/dL: Maintain dose
- If testosterone <350 ng/dL: Increase dose 3
Administration Considerations
Injection Technique
- Intramuscular injections should be administered deep in the gluteal muscle 1
- Subcutaneous administration is an emerging alternative that some patients may prefer due to less discomfort 4
- Inspect solution visually for particulate matter before administration 1
- If crystals form during storage, warming and shaking the vial should redissolve them 1
Dosing Schedule Options
- 100-200 mg every 2 weeks (standard approach) 2, 3
- 50 mg weekly (provides more stable levels) 2, 3
- 300 mg every 3 weeks (less frequent administration) 5
Monitoring and Safety Considerations
Monitoring Parameters
- Check testosterone levels midway between injections, targeting 500-600 ng/dL 2
- Monitor for erythrocytosis (dose-dependent risk 2.8-17.9%) 3
- Monitor prostate health with PSA and digital rectal examination 3
- Follow-up every 6-12 months once stable 3
Important Adverse Effects
- Fluctuating testosterone levels with peaks and valleys (disadvantage of injections) 2, 6
- Levels peak 2-5 days post-injection and decline to baseline by days 13-14 6
- Intramuscular injections may cause higher estradiol and hematocrit elevations compared to other formulations 7
- Potential cardiovascular effects (though high-quality evidence suggests TRT does not increase stroke or heart attack risk in men 45-80 years old) 3
Clinical Pearls and Pitfalls
Common Pitfalls
- Underdosing: May not achieve symptom relief or physiological benefits
- Overdosing: Can lead to supraphysiological testosterone levels with increased risk of adverse effects
- Improper monitoring: Failure to check levels at appropriate times relative to injection schedule
- Ignoring contraindications: Including prostate cancer, male breast cancer, desire for near-term fertility, severe sleep apnea, uncontrolled heart failure, and hematocrit >54% 3
Alternative Formulations
- Consider transdermal preparations (gels, patches) for patients who prefer stable day-to-day testosterone levels 3
- Subcutaneous testosterone may provide more stable levels with less discomfort than intramuscular injections 4, 7
Remember that the goal of therapy is to achieve physiologic testosterone levels that alleviate symptoms while minimizing adverse effects. Regular monitoring is essential to ensure optimal outcomes.