Testosterone replacement therapy is not a single treatment — it is a category of treatments delivered in fundamentally different ways. Injections, topical creams and gels, pellets, and oral formulations each have distinct profiles for convenience, cost, hormone stability, and clinical monitoring requirements.
Understanding these differences helps you have a more productive conversation with your prescribing clinician and choose the approach that best fits your lifestyle and health goals.
Injectable Testosterone
Injectable testosterone — typically testosterone cypionate or enanthate in the US — is the most widely prescribed and cost-effective method available through telehealth TRT programs.
How It Works
Testosterone is dissolved in an oil-based carrier and injected subcutaneously (into fat tissue) or intramuscularly. The oil depot releases testosterone gradually over several days. Most protocols use weekly or twice-weekly injections to maintain more stable levels.
Practical Profile
- Frequency: Weekly or twice-weekly self-injection
- Self-administration: Yes — small insulin-gauge needles for subcutaneous injection
- Hormone stability: Very good with weekly dosing; excellent with twice-weekly
- Cost: Lowest among all methods (generic testosterone cypionate is inexpensive)
- Storage: Room temperature for most oil-based formulations
Considerations
- Requires comfort with self-injection — most people adapt quickly
- Testosterone levels peak 1–2 days after injection and trough before the next dose; twice-weekly reduces this fluctuation
- Subcutaneous injection is increasingly preferred over intramuscular for convenience and reduced discomfort
Topical Testosterone: Gels and Creams
Topical formulations are applied daily to the skin — typically the shoulders, upper arms, or inner thighs. Absorption varies between individuals and is affected by skin characteristics and application site consistency.
Practical Profile
- Frequency: Daily application
- Self-administration: Yes — topical application
- Hormone stability: Good, but more variable than injections
- Cost: Higher than injectable; varies by formulation and brand
- Storage: Room temperature
Considerations
- Transfer risk: Must avoid skin contact with partners, children, or pets until fully dry or washed
- Absorption variability means dose adjustments may take longer to dial in
- Some individuals are poor absorbers through skin — requires monitoring to confirm adequate levels
- Cannot be used immediately before swimming or showering
Testosterone Pellets
Pellets are small, rice-sized implants inserted subcutaneously by a clinician. They dissolve slowly over 3–6 months, releasing testosterone continuously.
Practical Profile
- Frequency: Every 3–6 months (in-clinic procedure)
- Self-administration: No — requires clinical insertion
- Hormone stability: Generally stable; levels decline toward end of cycle
- Cost: Higher due to procedure fees
Considerations
- Dose adjustments require waiting for pellets to dissolve — less flexibility
- Minor surgical procedure with small risk of infection or extrusion
- Not available through most telehealth programs — requires in-person clinic
Oral Testosterone
FDA-approved oral testosterone (testosterone undecanoate) is available but less commonly prescribed due to cost, twice-daily dosing, and meal timing requirements.
Practical Profile
- Frequency: Twice daily with food
- Hormone stability: Variable; subject to meal timing
- Cost: Highest among all methods
Delivery Method Comparison
| Method | Frequency | Hormone Stability | Relative Cost | Needle Required |
|---|---|---|---|---|
| Injectable (Cypionate) | Weekly / 2x weekly | Excellent | Lowest | Yes |
| Topical Cream/Gel | Daily | Good (variable) | Moderate | No |
| Pellets | Every 3–6 months | Good (declines at end) | Higher | Procedure |
| Oral (Undecanoate) | Twice daily | Variable | Highest | No |
Frequently Asked Questions
Which delivery method is most commonly prescribed?
Injectable testosterone cypionate is the most commonly prescribed method through telehealth TRT programs, primarily because of its favorable cost, clinical manageability, and hormone stability profile.
Can I switch delivery methods after starting TRT?
Yes, in consultation with your clinician. Switching methods typically requires a transitional period and updated lab monitoring to re-establish stable levels.
Are all methods available through telehealth?
Most telehealth TRT providers offer injectable and topical options. Pellet therapy requires an in-person clinical relationship. Oral testosterone is technically available but rarely prescribed through telehealth.
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