What is the starting dose of injectable testosterone (T) for a patient with hypogonadism (low testosterone)?

Starting Dose of Injectable Testosterone for Hypogonadism

The recommended starting dose for injectable testosterone cypionate in patients with hypogonadism is 50-100 mg weekly or 100-200 mg every two weeks administered intramuscularly. 1, 2, 3

Dosing Considerations

• Injectable testosterone cypionate is FDA-approved for intramuscular administration only, with a recommended dose range of 50-400 mg every 2-4 weeks for hypogonadal males 1
• The typical clinical practice involves either:
  • 100-200 mg every 2 weeks (less frequent dosing) 2, 3
  • 50-100 mg weekly (more frequent dosing) 2
• Lower frequency dosing (every 2 weeks) may lead to greater fluctuations in testosterone levels with noticeable peaks and valleys, potentially affecting mood and sexual function 2, 4
• Weekly administration provides more stable serum testosterone levels but requires more frequent injections 2, 5

Target Testosterone Levels

• The goal of testosterone therapy is to achieve total testosterone levels in the mid-normal range (450-600 ng/dL) 6, 3
• Dosing should be adjusted to the minimal amount necessary to normalize testosterone levels and improve symptoms 6
• Testosterone levels should be measured 2-3 months after treatment initiation and after any dose adjustment 2, 3
• For patients on every-2-week dosing regimens, levels should be checked midway between injections 2

Administration Route Considerations

• Intramuscular injections should be administered deep in the gluteal muscle 1
• Subcutaneous administration is an emerging alternative that may provide more stable testosterone levels with less discomfort compared to intramuscular injections 7, 5
• Subcutaneous testosterone enanthate has been associated with lower post-therapy estradiol and hematocrit levels compared to intramuscular testosterone cypionate 5

Important Precautions

• Testosterone therapy should not be initiated in men who are currently trying to conceive due to suppression of spermatogenesis 6
• Therapy should not be commenced for a period of 3-6 months in patients with a history of cardiovascular events 6, 3
• Alkylated oral testosterone should not be prescribed due to risk of liver toxicity 6
• Regular monitoring for potential adverse effects is essential, including hematocrit/hemoglobin, PSA, and cardiovascular symptoms 2, 3

Clinical Approach to Dosing

• For most adult males with hypogonadism, start with 100 mg every 2 weeks or 50 mg weekly 2, 1
• Consider patient factors such as age, body mass index, and comorbidities when selecting the initial dose 3
• For older patients or those with cardiovascular risk factors, consider starting at the lower end of the dosing range 2, 3
• Adjust dose based on symptom response and testosterone levels, targeting the mid-normal range of 450-600 ng/dL 6, 3