What is the recommended dose for testosterone injection?

Testosterone Injection Dosing

For testosterone enanthate or cypionate, start with 100-200 mg every 2 weeks or 50-100 mg weekly via intramuscular injection, with weekly dosing providing more stable testosterone levels and fewer adverse effects. 1

Standard Dosing Regimens

Testosterone Enanthate/Cypionate

• Initial dose: 100-200 mg every 2 weeks OR 50-100 mg weekly, administered intramuscularly 1
• Weekly dosing (50-100 mg) is superior to biweekly administration because it provides more stable testosterone levels and reduces adverse effects including erythrocytosis and potentially cardiovascular risk 1
• The FDA label indicates a broader range of 50-400 mg every 2-4 weeks for hypogonadal males, with dosing adjusted based on patient response 2
• Research supports that 200 mg every 2 weeks and 300 mg every 3 weeks are most effective for suppressing LH to normal levels while maintaining testosterone in the normal range 3

Testosterone Undecanoate (Long-Acting)

• Dosing schedule: 750 mg initially, then 750 mg at 4 weeks, followed by 750 mg every 10 weeks 1
• Must be administered as gluteal intramuscular injection only 1
• Provides fewer yearly injections with less fluctuation in testosterone levels compared to enanthate/cypionate 1
• Research demonstrates this regimen maintains serum testosterone in the normal range (300-1,000 ng/dL) in 94% of patients during the 10-week dosing interval 4

Administration Techniques

Injection Sites and Methods

• Self-administration: Inject into the anterolateral thigh 1
• Administration by another person: Gluteal intramuscular injection 1
• The FDA recommends deep gluteal muscle injection for testosterone cypionate 2
• Subcutaneous injection is an effective alternative: 50-150 mg weekly (median 75-80 mg) achieves normal male testosterone levels across a wide BMI range (19.0-49.9 kg/m²), with patients showing marked preference over intramuscular injections 5

Required Supplies

• 18-gauge needles for drawing from vial 1
• 21-23 gauge, 1-1.5 inch needles for intramuscular injection 1
• 1-3 mL syringes (3 mL most common for typical 100-200 mg doses) 1
• Longer needles (1.5 inch) for gluteal injections; shorter needles (1 inch) for thigh injections in leaner patients 1
• Alcohol prep pads, gauze pads, adhesive bandages, and sharps container 1

Monitoring Protocol

Initial Monitoring

• Measure testosterone levels 2-3 months after treatment initiation or any dose change 1, 6
• For injectable formulations, check levels midway between injections, targeting mid-normal values (450-600 ng/dL) 1, 6

Maintenance Monitoring

• Once stable levels are achieved, monitor every 6-12 months 1, 6
• Monitor hematocrit and hemoglobin (research shows increases from baseline: hematocrit 43.3% to 45.7%, hemoglobin 14.6 to 15.5 g/dL over 24 weeks) 4
• Monitor prostate-specific antigen (research shows increases from 1.0 to 1.3 ng/mL over 24 weeks) 4

Safety Considerations and Pitfalls

Cardiovascular Risk

• Injectable testosterone may carry greater cardiovascular risk compared to transdermal preparations, possibly due to fluctuating testosterone levels 1, 6
• Assess cardiovascular risk factors before initiating therapy 1, 6

Hematologic Effects

• Erythrocytosis occurs more frequently with injectable formulations compared to transdermal 1
• Weekly dosing reduces this risk compared to biweekly dosing due to more stable testosterone levels 1

Common Pitfalls to Avoid

• Avoid biweekly dosing when weekly is feasible: The greater fluctuation in testosterone levels with biweekly dosing increases adverse effects 1
• Do not forget sharps disposal: Provide patients with a safe disposal method from the start of therapy 1
• Avoid intravenous administration: Testosterone cypionate is for intramuscular use only 2
• Warm and shake the vial if crystals form during storage at lower temperatures 2