From the Guidelines
Testosterone injections are generally more effective than gels for raising testosterone levels, and clinicians should consider intramuscular rather than transdermal formulations when initiating testosterone treatment due to lower costs and similar clinical effectiveness and harms. According to a clinical guideline from the American College of Physicians 1, intramuscular formulations, such as injections, are recommended over transdermal formulations, like gels, for improving sexual function in men with age-related low testosterone. This recommendation is based on the lower costs of intramuscular formulations, with an annual cost of $156.24 compared to $2135.32 for transdermal formulations, as well as similar clinical effectiveness and harms 1.
Some key points to consider when choosing between testosterone injections and gels include:
- Injections typically provide higher and more consistent testosterone levels in the bloodstream compared to topical gels 1
- Injectable testosterone is usually administered every 1-2 weeks and delivers a more immediate impact on hormone levels
- Testosterone gel must be applied daily and has variable absorption rates depending on skin condition, application technique, and potential transfer risks
- Injections also tend to be more cost-effective over time, with a significant difference in annual cost between intramuscular and transdermal formulations 1
- Side effects are similar between both forms, including potential acne, mood changes, and cardiovascular risks, though gels carry the additional risk of transferring testosterone to others through skin contact
Ultimately, the choice between testosterone injections and gels should be based on individual patient preferences and needs, and clinicians should discuss the potential benefits, harms, costs, and patient's preferences when initiating testosterone treatment 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Comparison of Testosterone Shot and Gel
- The provided studies do not directly compare the effectiveness of testosterone shots and gels 2, 3, 4, 5, 6.
- However, study 4 evaluates the efficacy and safety of a new topical testosterone replacement gel therapy for the treatment of male hypogonadism, showing that approximately three-quarters (76.1%) of subjects met the average testosterone concentration criteria on Day 90.
- Study 5 assesses the efficacy and safety of testosterone gel treatment in hypogonadal men with liver cirrhosis, finding that testosterone replacement resulted in an increase in muscle strength and amelioration of gynecomastia.
- There is no direct evidence to suggest that testosterone shots are more effective than gels, as the studies focus on the efficacy and safety of gel treatments or discuss guidelines for testosterone replacement therapy in general 2, 3, 6.
Efficacy and Safety of Testosterone Gel
- Testosterone gel has been shown to be effective in improving symptoms of testosterone deficiency, with few safety concerns 4, 5.
- Study 5 found that testosterone gel treatment raised free testosterone to values below supraphysiological levels in cirrhotic men, improving muscle strength and ameliorating gynecomastia.
- The safety profile of testosterone gel is favorable, with most adverse events being mild to moderate 4.
Guidelines for Testosterone Replacement Therapy
- The Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism emphasize the importance of diagnosing men who are androgen deficient due to organic hypogonadism 2.
- The US Endocrine Society and Endocrine Society of Australia provide guidelines for testosterone therapy, highlighting the importance of identifying pre-existing prostate and cardiovascular disease prior to initiating therapy 3.