Men's health & testosterone
Types of Testosterone Replacement Therapy: Injections, Gels, Oral, Pellets and Nasal
TRT comes in five main forms. Here is how injections, gels, oral capsules, pellets and nasal gel differ, how often each is used and what to watch for.
- TRT comes in five main forms: injections, gels, oral capsules, pellets and nasal gel.
- Injections and topical gels are the most commonly prescribed forms in the United States.
- Every form needs a confirmed diagnosis first and regular monitoring of blood levels, red blood cells and blood pressure.
- All forms can lower sperm production, so tell your clinician if you may want children.
- The right form depends on your labs, health history, fertility plans, routine and preference.
Testosterone replacement therapy (TRT) is not one treatment. It comes in five main forms, and each delivers testosterone in a different way, on a different schedule, with its own practical pros and cons. Injections and topical gels are the most commonly prescribed in the United States. Oral capsules, implanted pellets and nasal gel are other FDA-approved options.
Whatever the form, TRT should only start after low testosterone is confirmed with symptoms and blood tests, and it needs regular monitoring once you begin.
1. Testosterone Injections
- Testosterone cypionate and testosterone enanthate. The most familiar injectable forms. They are given into a muscle on a schedule your clinician sets, often every one to two weeks.
- Xyosted. A testosterone enanthate autoinjector used under the skin once a week.
- Testosterone undecanoate (Aveed). A long-acting injection given in a clinic, every 10 weeks after two starting doses. Because of a rare risk of serious lung and allergic reactions, it is given only in certified settings, with 30 minutes of observation afterward.
Injections avoid the skin-transfer concerns of gels. With shorter-acting injections, levels can rise after a dose and fall before the next one, which some men notice.
2. Testosterone Gels and Topical Solutions
Gels are applied to the skin once a day. Examples include AndroGel and generic testosterone gels. They give steadier day-to-day levels than shorter-acting injections.
The main precaution is transfer: testosterone on your skin can pass to a partner or child through contact. Wash your hands after applying, let the gel dry and keep the area covered.
3. Oral Testosterone Capsules
FDA-approved testosterone undecanoate capsules include Jatenzo, Tlando and Kyzatrex. They are usually taken twice a day with meals. Their labels warn that they can raise blood pressure, so blood pressure is checked before and during treatment.
An older oral form, methyltestosterone, is not used for routine TRT because of liver safety concerns.
4. Testosterone Pellets
Pellets such as Testopel are small implants placed under the skin, usually near the hip, during a short in-office procedure. They release testosterone over about three to six months, so there is nothing to remember day to day.
The trade-offs: each placement is a minor procedure, a pellet can occasionally work its way out or the site can become infected, and the dose cannot be adjusted quickly once the pellets are in.
5. Nasal Testosterone Gel
Natesto is a testosterone gel pumped into each nostril three times a day. It avoids skin-to-skin transfer, but the frequent dosing does not suit everyone, and it can cause a runny nose, nasal discomfort or nosebleeds.
What Every Form Has in Common
- A confirmed diagnosis first. Symptoms plus low testosterone on two separate early-morning blood tests. See what an evaluation can and cannot tell you.
- Ongoing monitoring. Testosterone levels, red blood cell count (hematocrit), blood pressure and, for many men, PSA. See what monitoring may involve.
- Fertility. Every form of TRT can lower sperm production. See testosterone therapy and fertility.
- Current FDA labeling. In February 2025, the FDA required class-wide label changes for testosterone products: it added the results of the TRAVERSE heart-safety trial, removed cardiovascular-risk language from the boxed warning, and added a warning that testosterone can raise blood pressure. Labels still state that testosterone is not approved for low testosterone caused by aging alone.
Which Form Is Right for You?
There is no single best form. The choice depends on your symptoms and lab results, your health history, whether you may want children, how you feel about injections or daily routines, and cost or insurance coverage. The products named here are examples of FDA-approved options; availability and coverage vary.
At a testosterone consultation, Dr. Ewals reviews your labs and history first, then explains which options are appropriate for you, along with their risks and the monitoring each one needs.
