What is the initial dose of testosterone (intramuscular injection) to start with?

From the Guidelines

The initial dose of testosterone for intramuscular injection should be 100-200 mg every 2 weeks or 50 mg weekly, as indicated by the typical dose range for testosterone enanthate and cypionate 1. When considering testosterone replacement therapy, it's crucial to start with a dose that balances efficacy with potential side effects.

• The dose may be adjusted based on individual patient needs and response to treatment.
• Testosterone levels should be monitored 4-6 weeks after initiating therapy to ensure levels are within the mid-normal range (approximately 500-600 ng/dL).
• Baseline blood tests, including total testosterone, free testosterone, estradiol, complete blood count, and prostate-specific antigen (PSA), are essential before starting treatment.
• Regular follow-up monitoring is necessary to check for potential side effects such as elevated red blood cell count, increased PSA, or estrogen conversion.
• Testosterone therapy can improve energy, libido, muscle mass, and overall well-being in those with true deficiency, but it should only be administered under medical supervision to avoid serious health complications. The goal of testosterone replacement therapy is to alleviate symptoms of testosterone deficiency while minimizing adverse effects, and the chosen dose should reflect this balance, as supported by the practical use of pharmacotherapy for obesity 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION ... Male hypogonadism: As replacement therapy, i.e., for eunuchism, the suggested dosage is 50 to 400 mg every 2 to 4 weeks. The initial dose of testosterone (intramuscular injection) to start with is 50 to 400 mg every 2 to 4 weeks for male hypogonadism.

• The dose may vary depending on the patient's condition and response to treatment.
• The chronological and skeletal ages must be taken into consideration when determining the initial dose and adjusting the dose 2.

From the Research

Initial Dose of Testosterone

The initial dose of testosterone for intramuscular injection can vary depending on the specific formulation and the individual patient's needs.

• According to the study 3, the initial dose of testosterone cypionate or enanthate for subcutaneous injection was 50 mg weekly.
• The study 4 compared two different intramuscular testosterone therapy regimens: 100 mg IM weekly or 200 mg IM biweekly, but did not specify an initial dose.
• The study 5 used an initial dose of 200 mg of intramuscular testosterone enanthate every 3 weeks.

Factors Influencing the Initial Dose

The initial dose of testosterone may be influenced by several factors, including:

• The patient's age and medical history
• The severity of their hypogonadism or low testosterone levels
• The specific formulation of testosterone being used
• The patient's response to treatment and any potential side effects

Administration and Monitoring

It is essential to monitor the patient's response to treatment and adjust the dose as needed to achieve optimal testosterone levels.

• The study 6 suggests that subcutaneous administration of testosterone esters can be an effective and safe alternative to intramuscular injections, with comparable pharmacokinetics and mean serum testosterone levels.
• The study 3 found that subcutaneous injections of testosterone were well-tolerated and effective in achieving normal male testosterone levels in female-to-male transgender patients.