Recommended Dosage of Sustanon for Adult Hypogonadal Men
For adult hypogonadal men, Sustanon (testosterone) should be administered at a dose of 50 to 400 mg intramuscularly every 2 to 4 weeks, with most effective regimens being 200 mg every 2 weeks or 300 mg every 3 weeks. 1, 2
Dosing Recommendations
- The FDA-approved dosage for testosterone replacement in hypogonadal men is 50 to 400 mg intramuscularly every 2 to 4 weeks, with adjustments based on patient response and adverse effects 1
- Clinical evidence suggests that 200 mg every 2 weeks or 300 mg every 3 weeks are the most effective regimens for normalizing testosterone levels and suppressing elevated gonadotropins 2
- Lower doses (100 mg weekly) provide higher average testosterone concentrations but require more frequent injections 2
- Higher doses (400 mg every 4 weeks) may not adequately suppress elevated LH levels throughout the dosing interval 2
Administration Considerations
- Sustanon injections should be administered deep in the gluteal muscle and should never be given intravenously 1
- Intramuscular formulations are recommended over transdermal options due to lower cost with similar effectiveness and safety profile 3
- Injectable testosterone provides effective treatment but results in fluctuating testosterone levels compared to transdermal preparations 3
- Before administration, inspect the solution for particulate matter and discoloration; warming and shaking the vial can redissolve any crystals that may have formed during storage 1
Monitoring Parameters
- Confirm hypogonadism with at least two separate morning testosterone measurements showing low levels before initiating therapy 3
- Check testosterone levels 2-3 months after treatment initiation or dose adjustment 3
- Once stable levels are achieved, monitor testosterone levels every 6-12 months 3
- Monitor hematocrit/hemoglobin regularly as testosterone therapy commonly causes erythrocytosis, particularly with injectable formulations 4
- Perform prostate monitoring through digital rectal examination and PSA measurement before initiating therapy, with regular PSA monitoring during treatment 4
Treatment Efficacy and Adjustment
- Aim for mid-normal range testosterone levels when adjusting dosage 4
- Evaluate symptom improvement within 12 months of starting treatment; if no improvement in sexual function or other targeted symptoms occurs, consider discontinuation 3
- Treatment should be individualized based on symptom response, not just testosterone levels 3
- No specific endpoint for discontinuation exists for men with confirmed hypogonadism; treatment should continue as long as clinical benefits persist without significant adverse effects 3
Safety Considerations
- Injectable testosterone therapy is associated with a higher risk of erythrocytosis compared to topical preparations 4
- If hematocrit rises above the reference range, consider temporarily withholding therapy, reducing the dose, or performing phlebotomy 4
- Evidence from observational studies shows no increased risk for mortality, cardiovascular events, prostate cancer, or venous thromboembolism with testosterone therapy, but long-term safety data beyond 10 years is limited 5, 3
- Most clinical trials excluded men with recent cardiovascular disease, so caution is warranted in this population 5
Common Pitfalls to Avoid
- Failing to confirm hypogonadism with multiple morning testosterone measurements before initiating therapy 3
- Not monitoring both efficacy and safety parameters regularly 3
- Continuing treatment despite lack of symptom improvement 3
- Ignoring cardiovascular risk factors in patients with pre-existing conditions 3