Testosterone replacement therapy (TRT) is having a moment. Scroll through social media, tune into late-night radio, or walk past a strip mall, and odds are you’ll spot an ad or clinic offering to “boost your T.” But behind the hype is a decades-deep history of clinical use and an evolving toolkit designed to restore balance for men dealing with low testosterone.
Just how many decades back did the research start? In 1889, physician Charles-Édouard Brown-Séquard injected himself with a concoction made from animal testicles, believing it rejuvenated his vitality. While his experiment was probably more alchemy than science, it sparked over a century-long exploration into testosterone’s potential. By the 1930s, testosterone had been isolated and synthesized in a lab; by the 1950s, longer-acting injections became the gold standard of therapy.¹
Since then, TRT has expanded to include intramuscular injections, transdermal gels, subdermal pellets, buccal tablets, nasal sprays, and, more recently, oral capsules, each with unique pharmacokinetics and benefits.
We’ve come a long way, with options that are more ethical, advanced, accessible, and personalized – but they also require thoughtful guidance. In the following sections, we’ll dip into modes of testosterone delivery, how they work, and what patients can expect from each one.
Modern Options
Testosterone, the primary male sex hormone, plays a central role in sexual development, reproductive function, muscle mass, bone density, and mood regulation. When levels dip too low – a condition known as hypogonadism – men may experience symptoms ranging from fatigue and depression to erectile dysfunction, infertility, and reduced lean body mass. In cases where testosterone is measurably low (typically under 250 nanograms per deciliter), clinicians may recommend therapy to bring levels back into a normal physiological range.
While testosterone levels naturally decline with age, dropping about 1% per year starting around age 30, not all men develop symptoms. That’s why treatment isn’t based solely on numbers, but on the presence of real, disruptive symptoms supported by lab work and a legitimate medical evaluation.
The FDA-approved options on the market today offer flexibility in how testosterone is delivered, how often it’s dosed, and how steadily it’s absorbed. Each route comes with its rhythm, risks, and appeal depending on your lifestyle, goals, and medical profile.
Subdermal Pellets
Testosterone pellets are tiny cylinders placed just under the skin (usually in the upper buttock or hip area) during a quick in-office procedure. Once implanted, they slowly release testosterone over several months by diffusing steadily into the surrounding tissue and bloodstream.
Why people like them: They’re hands-off after insertion. No daily doses, no weekly shots, and most people get them reinserted every 3 to 6 months. Pellets are popular for their consistency, eliminating the need for self-administration or adhering to a strict daily schedule.
What to consider: The timing of symptom relief and when levels start to taper can vary. Some men feel great right away, while others may experience a lag as hormone levels build. Toward the end of the dosing cycle, it’s common for symptoms to return as the pellets lose potency.
There’s also a small risk that the pellet may work its way out or cause skin irritation or infection at the insertion site. It doesn’t happen often, but it’s worth being informed when making a decision.
Intramuscular Injections
Testosterone injections have been around longer than any of the other methods of delivery. They’re typically administered into a large muscle (like the glute or thigh) every 1 to 2 weeks, depending on the formulation or brand.
Why people like them: Injections deliver a full dose of testosterone directly into the bloodstream, which can bring fast symptom relief. Many men appreciate the simplicity and cost-effectiveness, especially when self-administering becomes routine.
What to consider: Levels can spike and crash between injections, leading to mood swings or fluctuations in energy. Some men find the needle aspect intimidating at first, but with a little practice (or help from a provider), it usually becomes second nature.
Transdermal Gels and Patches
Transdermal testosterone is delivered through the skin in two forms: gels and patches. Gels are applied once daily to clean, dry skin – typically on the shoulders, upper arms, or abdomen – while patches are worn continuously, usually on the back, thigh, or upper arm, and replaced every 24 hours.
Why people like them: Both gels and patches offer a consistent, daily dose of testosterone that closely mimics the body’s natural hormone cycle, offering steady absorption and bypassing the peaks and valleys commonly associated with intramuscular injections. Gels absorb quickly with minimal mess, and patches are easy to use once you get into a routine – no needles or office visits required for administration.
What to consider: Transdermal methods require careful hand-washing and drying time before dressing to avoid skin transfer to others, especially children or partners. Patches can sometimes cause mild skin irritation or redness at the application site, and may not stick as well in hot or humid climates. Still, many men find these options easy to integrate into daily life with a bit of trial and error, and rotating where the patch is applied helps to reduce skin irritation.
Oral Capsules
Several oral testosterone options have been FDA-approved in the last five years. In the past, oral testosterone was discontinued due to concerns about liver toxicity. But newer formulations have solved that issue by bypassing the liver entirely – they’re absorbed through the lymphatic system instead, making them a safer option for long-term use.
Why people like them: Oral testosterone is straightforward and needle-free. It’s in a form most of us are familiar with, and dosing is usually twice a day with food. There’s no need for patches, gels, or procedures, and it avoids the skin-to-skin transfer risks associated with topical products.
What to consider: Despite the convenience, hormone levels can sometimes fluctuate compared to other delivery methods until you get a rhythm going. Some men also experience gastrointestinal side effects, and for those with cardiovascular concerns, you’ll need to work more closely with your provider.
Buccal Tablets
These are small, sticky tablets that you press against your upper gum twice a day, where they slowly dissolve and deliver testosterone through the tissues in your mouth.
Why people like them: They’re discreet, they don’t require needles or gels, and they don’t come with the peaks and valleys of some other methods. Once they’re in place, you can go about your day with a steady release of testosterone.
What to consider: They can take a little getting used to. Some men notice a strange taste and potential gum irritation. The need to apply it twice a day like clockwork creates a steady influx of the medication, so missing a dose can throw off the constant flow your body gets used to.
Nasal Spray
Nasal delivery is a fast-absorbing option for men seeking more frequent microdoses – one spray in each nostril, three times a day. It might seem odd to take a hormone through your nose, but the nasal lining gives testosterone a direct and efficient path to your bloodstream.
Why people like it: It’s a good option if you’re looking for something less invasive that keeps hormone levels from swinging too much, and it has the advantage of minimal systemic buildup, meaning there’s less chance of having to dial back the dose to avoid off-target effects from elevated testosterone levels.
What to consider: Because it requires multiple applications a day, it might not suit everyone’s schedule. Nasal irritation or a stuffy nose are potential side effects, and the delivery can be impacted by congestion, especially in allergy season.
The Next Move
Research shows that most delivery methods are equally effective in raising testosterone to therapeutic levels and improving body composition, mood, and sexual function.² What differs most is the side effect profile and how well each method fits into your daily life. Other medications you take will also be a deciding factor.
With so many options on the market, it can be tricky to navigate legitimate therapy and fly-by-night online distributors. That’s why it’s essential to work with a knowledgeable and experienced provider who understands the nuances of hormone therapy and can tailor treatment based on your full medical picture.
If you’re feeling a drop in energy, a dip in sex drive, or noticing changes in mood or muscle tone, Dr. Kapadia specializes in personalized hormone therapy that prioritizes safety, efficacy, and your preferences. Reach out to schedule a consultation and start feeling like yourself again.
References:
- Figueiredo, M. G., Gagliano-Jucá, T., & Basaria, S. (2022). Testosterone Therapy With Subcutaneous Injections: A Safe, Practical, and Reasonable Option. The Journal of clinical endocrinology and metabolism, 107(3), 614–626. https://doi.org/10.1210/clinem/dgab772.
- Ahmad, S. W., Molfetto, G., Montoya, D., & Camero, A. (2022). Is Oral Testosterone the New Frontier of Testosterone Replacement Therapy?. Cureus, 14(8), e27796. https://doi.org/10.7759/cureus.27796.
