Testosterone dosing regimens for male hypogonadism

Administration route	Preparation	Initial dose	Usual dose range
IM	Solution (testosterone enanthate, testosterone cypionate)	75 to 100 mg once weekly, or 150 to 200 mg every 2 weeks*	50 to 100 mg once weekly, or 100 to 200 mg every 2 weeks*
IM	Solution (testosterone undecanoate)	750 mg; repeat 750 mg dose after 4 weeks, and then every 10 weeks thereafter
Intranasal	Gel (Natesto)	11 mg (2 pump actuations; 1 actuation per nostril) 3 times daily (6 to 8 hours apart)
Oral	Capsule (Jatenzo)	237 mg twice daily	158 to 396 mg twice daily
	Capsule (Kyzatrex)	200 mg twice daily	100 mg once daily to 400 mg twice daily (maximum: 800 mg/day)
	Capsule (Tlando)	225 mg twice daily	Dose is not adjusted; may continue use at fixed dose if serum testosterone concentrations remain within normal range
	Capsule (testosterone undecanoate)^¶	120 to 160 mg/day in 2 divided doses for 2 to 3 weeks	40 to 120 mg/day
SubQ (injection)	Solution (Xyosted)	75 mg once weekly	50 to 100 mg once weekly
SubQ (implantation)	Pellet (Testopel)	150 to 450 mg every 3 to 6 months
Topical	1% Gel (eg, AndroGel 1%, Testim, Vogelxo)	50 mg applied once daily in the morning to the shoulders and/or upper arms^Δ^◊	50 to 100 mg/day (maximum: 100 mg/day)^◊^§
	1.62% Gel (eg, AndroGel 1.62%)	40.5 mg applied once daily in the morning to the shoulders and upper arms^¥	20.25 to 81 mg/day (maximum: 81 mg/day)^¥
	2% Gel (eg, Fortesta)	40 mg (4 pump actuations) applied once daily in the morning to the thighs	10 to 70 mg/day (1 to 7 pump actuations; maximum: 70 mg/day)
	Transdermal solution	60 mg (2 pump actuations) applied once daily in the morning to the axillae	30 to 120 mg/day (1 to 4 pump actuations)
	Transdermal system (Androderm)	4 mg/day (as one 4 mg/day patch; do not use two 2 mg/day patches)	2 to 6 mg/day^‡

IM: intramuscular; SubQ; subcutaneous.

* Dosing for this formulation is from the following sources: AUA (Mulhall 2018)^[1], ES (Bhasin 2018)^[2].

¶ Canadian product.

Δ AndroGel 1% may also be applied to the abdomen.

◊ For the testosterone 1% gel and Vogelxo pump formulations, 1 pump actuation = 12.5 mg.

§ Maximum dose according to manufacturers of Testim and Vogelxo.

¥ For the AndroGel 1.62% pump formulation, 1 pump actuation = 20.25 mg.

‡ Administer the 6 mg/day dose as one 2 mg/day patch and one 4 mg/day patch.

References:

Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol 2018; 200:423.
Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2018; 103:1715.

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Testosterone dosing regimens for male hypogonadism