The Testosterone Formulary
Every FDA-approved testosterone product, mapped
Evidence grade 5 of 5, Settled. Read how the Atlas grades evidence.
The written rationale for this grade is still being prepared.
- FDA
- Multiple FDA-approved products
Reference only. Not medical advice.
What can go wrong
Choice of formulation drives the side-effect profile: injectables cause peak-trough swings, gels carry transference risk to partners/children, oral undecanoate raises blood pressure, pellets cannot be dose-adjusted after implantation. All suppress fertility.
This is something to take to a clinician. The Atlas can tell you what is known about the testosterone formulary in general. It cannot tell you what is happening in your body, and the difference matters most for exactly the symptoms that bring people to this page.
There is one testosterone molecule but many FDA-approved delivery systems, each engineered to solve the same problem: testosterone is cleared too fast to take as a simple pill (and unmodified oral testosterone is hepatotoxic). The approved routes are injectable esters (cypionate, enanthate, undecanoate), subcutaneous auto-injector (Xyosted), transdermal gels (AndroGel, Testim, Fortesta, Vogelxo, Axiron) and patch (Androderm), pellets (Testopel), oral undecanoate (Jatenzo, Kyzatrex, Tlando), nasal gel (Natesto), and buccal (Striant). They differ in pharmacokinetics, monitoring needs, transference risk, and fertility/HPG effects.
One molecule, a dozen delivery systems, each with a different release curve.
What people take it for
What it is taken for. Approval, where it exists, covers only some of these.
Safety in detail
Testosterone is a Schedule III controlled substance. Every formulation requires evaluation and ongoing monitoring by a qualified physician; self-administration without oversight carries documented risks.
What it does to fertility
All exogenous testosterone formulations suppress LH/FSH and spermatogenesis; none preserve fertility (unlike hCG, enclomiphene, or clomiphene).
What has to be monitored
The bloodwork this needs, and the reason it belongs with a clinician rather than a website.
- Total testosterone
- Hematocrit
- PSA (over 40)
- Estradiol if symptomatic
- Blood pressure (oral)
What people get wrong
Often saidAll testosterone products are basically the same
ActuallyThey share one active molecule but differ enormously in pharmacokinetics, transference risk, blood-pressure effect, and convenience, the formulation choice is clinically meaningful.
Who profits, and who pushes back
Nobody is named here yet, because we have not done that work on this entry. Read that as unfinished. Somebody almost certainly sells this, and somebody almost certainly disputes it. Assume both until we have checked.
Set against the alternatives
Compared on the axes that matter to patients: stability of levels (subQ/pellets/oral most stable; biweekly IM least), convenience (pellets and long-acting injectable least frequent; gels/nasal most frequent), transference risk (gels highest; injectables none), and fertility (none preserve it).
| Product | Route | Frequency | Note |
|---|---|---|---|
| Depo-Testosterone | IM/SubQ injection | weekly-biweekly | Peak-trough swings |
| Xyosted | SubQ auto-injector | weekly | Stable; BP warning |
| Aveed | IM undecanoate | every 10 weeks | POME/anaphylaxis REMS |
| AndroGel | Transdermal gel | daily | Transference risk |
| Androderm | Patch | nightly | Skin irritation |
| Testopel | SubQ pellets | 3-6 months | Cannot titrate |
| Jatenzo | Oral undecanoate | twice daily | BP elevation |
| Natesto | Nasal gel | 3x daily | Spares LH/FSH |
At a glance
- Injectable esters
- Cypionate, enanthate, undecanoate
- Transdermal
- Gels (AndroGel etc.), patch (Androderm)
- Oral
- Undecanoate (Jatenzo, Kyzatrex, Tlando)
- Other
- Pellets (Testopel), nasal (Natesto), buccal (Striant)
What this entry does not yet cover
What follows is unfinished work on our side, not a finding about The Testosterone Formulary. A short entry is not a safe entry.
- Timeline. We have not built the dated record of research and regulatory events.
- Cost and market. We have not documented what it sells for or who sells it.
- Supply chain. We have not mapped where it is made.
- Who uses it. We have not documented the user groups.
- What could change. No forward-looking summary yet.
- Children and teenagers. We have not checked what is known about younger people.
- Where we land. We have not taken a position on this yet.
Sources
No sources recorded for this entry yet. Nothing on this page can be checked against a citation until that changes, so treat it as a summary awaiting its evidence.