Choosing how to receive testosterone is one of the key decisions in testosterone replacement therapy. The three main delivery methods are injections, topical gels, and implanted pellets. Each option has its own pros and cons, and the best choice depends on your lifestyle, preferences, and how your body reacts. Here's a straightforward comparison of TRT options to help you decide.
TRT Injections: The Most Common Choice
Injectable testosterone, usually testosterone cypionate or enanthate, is the most commonly prescribed form of TRT. Injections are typically given into a muscle or under the skin, with most people getting them once a week or every other week. After some initial training, many patients learn to give themselves injections at home.
Injections offer reliable absorption, easy dose changes since your provider can adjust the amount at any time, lower cost compared to other methods, and a long history of clinical use. On the downside, you need regular injections, which some people find inconvenient or uncomfortable. Testosterone levels can also rise right after an injection and drop before the next one, and you need to safely dispose of used needles.
Taking smaller injections twice a week instead of once can help keep testosterone levels steadier and reduce the ups and downs some people feel with weekly shots.
Topical Gels and Creams: Daily, Needle-Free
Testosterone gels and creams are applied to the skin every day, usually on the shoulders, upper arms, or abdomen. The testosterone is absorbed through the skin and slowly enters the bloodstream throughout the day. Popular brands include AndroGel and Testim, and there are also custom-made versions available.
The main benefits of gels are that you don't need needles, they keep testosterone levels fairly steady during the day, and they are simple to use. However, there is a risk that testosterone can rub off on others through skin contact, which is especially important for partners and children. Gels are usually more expensive than injections, absorption can change depending on where and how you apply them, and some people find putting them on every day inconvenient.
Testosterone Pellets: Set It and Forget It
Testosterone pellets are small implants, about the size of a grain of rice, placed under the skin in the hip or buttock during a short office procedure. After they are put in, the pellets slowly release testosterone over three to six months. Well-known brands include Testopel.
Pellets are convenient because once they are in place, you do not have to worry about daily or weekly doses. They also keep testosterone levels steady, avoiding the ups and downs that can happen with injections. However, there are some downsides. The procedure to insert the pellets has a small risk of infection or the pellet coming out. After the pellets are implanted, it is hard to change the dose if it is too high or too low. Each procedure costs money, and the yearly cost can be higher than injections. Some people also notice their testosterone levels slowly drop as the pellets get close to the end of their lifespan.
How to Choose
There is no single best way to take testosterone. The right method depends on what matters most to you, such as convenience, flexibility, cost, simplicity, and whether you are comfortable with needles or daily creams. People who want the most control over their dose often choose injections. Those who want convenience and do not like needles may prefer gels. People who want the least involvement in their daily routine often choose pellets.
It is common for patients to try more than one method before finding what works best for them. Your provider should be open to talking about the pros and cons of each option and help you switch if your first choice does not work well.
At HRT Wellness, we provide several TRT delivery options and work with each patient to find the method that matches their lifestyle and goals. Contact us to set up a consultation and talk about which approach could be right for you.
References
- Bhasin S, et al. Testosterone therapy in men with hypogonadism. Journal of Clinical Endocrinology & Metabolism. 2018;103(5):1715–1744.
- Shoskes JJ, et al. Pharmacology of testosterone replacement therapy preparations. Translational Andrology and Urology. 2016;5(6):834–843.
- Kaminetsky JC, et al. Pharmacokinetics, safety, and efficacy of a novel testosterone pellet. Andrology. 2017;5(2):256–263.