Oral Testosterone vs Injection: Which Is Best?
Learn the benefits and side effects of each.
Learn the benefits and side effects of each.
If you’re exploring testosterone replacement therapy (TRT) to tackle symptoms of low testosterone, such as depleted energy, low mood, or a lagging libido, picking the correct delivery method is key. Oral testosterone and injections are common ways to bring testosterone back up to optimal levels, but each method comes with its own set of perks and trade-offs.
Oral options like pills and dissolvable troches are convenient and offer a needle-free way to get a steady hormone boost. Injections provide a larger, lasting dose but are administered every couple of days.
Choosing between oral and injectable testosterone often comes down to lifestyle and personal preference, say experts. Understanding the pros and cons of each can help you lock in the approach that keeps you feeling strong and fits seamlessly into your routine.
About the Experts
Paul Gittens, M.D., is a urologist specializing in sexual medicine and male infertility. He’s the medical director at Rockwell Centers for Sexual Medicine & Wellness.
Andrew Sun, M.D., is a urologist specializing in testosterone replacement therapy and sexual dysfunction. He’s the director of men’s health for Urology Partners of North Texas.
Oral testosterone comes in capsules and dissolvable troches. Either option can be prescribed to raise your hormone levels if you’ve been diagnosed with low testosterone, also called hypogonadism.
For years, oral testosterone had a bad reputation because an older formula, methyltestosterone, was linked to serious liver problems, including jaundice, toxicity, and even cancer (1).
The new formulation for testosterone pills, testosterone undecanoate, is considered much safer because it largely bypasses the liver (2). Instead, your gut and lymphatic system break down most of it.
Like all FDA-approved forms of testosterone, pills require a prescription, Gittens says. They’re taken twice daily, regardless of the brand or dose. Here’s a quick rundown of three common testosterone capsules.
Testosterone troches look similar to zinc lozenges you take to kick a sore throat. You put one under the tongue or tuck one between your cheek and gums. As it dissolves, testosterone quickly enters your bloodstream, allowing it to work faster than pills. Troches are typically taken once or twice daily, depending on the dose you’re prescribed.
One downside? The taste, which patients say are bitter. Troches also require a bit of patience. They take 10-15 minutes to dissolve, and you’ll need to avoid swallowing saliva during that time to ensure the medication gets fully absorbed through the membranes of your mouth.
Currently, testosterone troches aren’t FDA-approved. You can only buy them from pharmacies or telehealth services that compound drugs, Gittens says.
Like any medication, oral testosterone has its strengths and drawbacks. One perk? Compared to injections, oral testosterone is noninvasive—ideal for anyone who wants to avoid needles.
When taken twice a day as prescribed, oral testosterone closely mimics your body’s natural testosterone production, urologist Andrew Sun, M.D. says. By taking your first dose in the morning and the second in the afternoon, you get a steady hormone boost that aligns with your body’s natural production patterns. This helps to keep your mood and energy levels stable.
“You’re [giving] your body testosterone during the daytime hours when you need energy and then letting it naturally drift away overnight when you don’t need it,” Sun says.
The main downside of oral TRT is that it’s easy to miss a dose compared with weekly testosterone injections. “A lot of guys forget to take it that second time,” Gittens says. Missing one dose isn’t a big deal, Sun says. You just skip that hormone bump. But you’re likely to experience a return of low testosterone symptoms if you miss multiple doses back to back, Gittens explains.
Research suggests oral and injectable testosterone are equally effective at increasing testosterone levels and improving mood, body composition, and sexual function (4). A 2009 randomized-controlled trial also found the two delivery methods have the same positive effect on sexual health and performance (5).
“Once [both forms] metabolize, they work about the same,” Gittens says.
Oral testosterone’s half-life is about 10-12 hours, meaning it doesn’t stay in your body long. That’s why you need to take the pills twice daily. As long as you take the pills or troches around the same time each day, you shouldn’t notice any fluctuations in your hormone levels.
In contrast, testosterone injections can stay in your body for up to 12 days, Sun suggests. This is why you only need to give yourself an injection every seven to 10 days. Injections deliver a large dose of testosterone, which gradually tapers off. In the day or two leading up to your next injection, you may experience hormone dips that trigger symptoms of low testosterone.
No matter how you take TRT, it usually takes a few weeks to see improvements in energy and mood, Gittens says. Changes in body composition—like increased muscle or fat loss—can take three to four months. If you have erectile dysfunction, it may take up to six months to see a significant improvement (6).
All forms of TRT can cause side effects. All forms of testosterone therapy can reduce your HDL (good) cholesterol levels, slightly elevate blood pressure, and increase your blood clot risk. Injectable testosterone, in particular, may cause mild reactions like redness at the injection site. Oral testosterone is more likely to lead to gastrointestinal issues like nausea, abdominal discomfort, diarrhea, and constipation.
Another common side effect of TRT is temporary infertility. Once you start replacing testosterone with a steady stream of hormone from the outside, the body senses it doesn’t need to produce as much on its own, Gittens says. The result? Your brain stops sending signals to your testicles to produce sperm.
Experts recommend taking oral testosterone with food, especially foods high in healthy fats to increase absorption (7). If you’re taking twice-a-day pills or troches, add peanut butter to your protein shake alongside your morning dose and two percent yogurt with almonds in the afternoon.
For troches, it’s important to switch up where you place them in your mouth to ensure they get absorbed by different cells. If you put the troche under your tongue in the morning, place the afternoon dose between your cheek and gums. Don’t swallow until the troche has fully dissolved.
There are no generic versions of FDA-approved testosterone pills, making them pricey if you don’t have health insurance. Monthly costs can range from roughly $150 to more than $1,000, though some manufacturers offer payment plans (8, 9).
“Testosterone injections are a lot cheaper,” Gittens says. “If insurance covers it, it’s fairly inexpensive.” Without health insurance, a typical three-month supply of testosterone cypionate for about $65.
Pills and injections aren’t the only TRT options. Topical and transdermal remedies, including testosterone gels, creams, and patches, also exist and are easy to use. Gels and creams need to be applied to clean, dry skin in the morning (10, 11). Patches are typically placed on the back, stomach, upper arm, or thigh in the evening before bed and should be replaced every 24 hours (12). Other TRT options include testosterone pellets—about the size of a grain of rice and implanted just underneath the surface of the skin—and nasal gel (13, 14). All of these forms of TRT require a prescription.
Oral testosterone and testosterone injections are common and effective ways to treat symptoms of low testosterone. Oral options like pills and dissolvable troches are as effective as testosterone injections, but you typically need to take them twice a day.