Quick answer
Testosterone shots, gels and pellets all deliver the same hormone. What changes is how often you dose, how steady your levels stay, what upkeep each one needs and which side effects are more likely. Shots are usually given every week or two, gels go on every day, and pellets are placed under the skin every few months. There are also FDA-approved oral capsules and a nasal gel. Every option needs a confirmed diagnosis first and the same follow-up labs.
Who testosterone treatment is for
The form only matters once you know testosterone treatment is right for you. The American Urological Association calls for two total testosterone measurements, both taken in the early morning on separate occasions, along with symptoms, before diagnosing low testosterone. The Endocrine Society also recommends ruling out other causes and checking a baseline blood count and prostate screening where appropriate.
Fatigue, low drive and a stalled workout can come from low testosterone. They can also come from poor sleep, thyroid problems, depression or medications, which is why the workup comes before the choice between shots and gel.
Testosterone shots (injections)
Shots are the most familiar form of testosterone therapy. There are three FDA-approved ways to get testosterone by injection.
Intramuscular testosterone cypionate or enanthate
These are injected into a muscle, usually every week or every two weeks as your prescriber directs. You can be taught to give them at home, or have them given in the office. Levels rise after each shot and drift down before the next one, and some men notice that swing in energy or mood toward the end of a cycle. Some prescribers use smaller, more frequent doses to reduce that swing.
Weekly under-the-skin autoinjector
A prefilled pen delivers testosterone just under the skin once a week. Its labeling carries a boxed warning that it can raise blood pressure, so blood pressure is checked after starting and regularly after that.
Long-acting testosterone undecanoate
This shot is given in a muscle at the start of treatment, again at four weeks, then every 10 weeks. Because of a rare but serious lung reaction to the oil (pulmonary oil microembolism) and the risk of an allergic reaction, it's available only through a restricted FDA program, and you're observed in the office for 30 minutes after each injection.
Testosterone gels, solutions and nasal gel
Topical gels and solutions are applied to the skin once a day. They give steadier day-to-day levels than shots and involve no needles. The trade-off is daily upkeep and the risk of passing testosterone to someone else through skin contact. Their labeling carries a boxed warning about exposure in children, so you wash your hands after applying, cover the area and wash the skin before close contact. Some men get skin irritation where they apply it.
An FDA-approved nasal gel is applied inside the nose several times a day. It avoids skin transfer, though it means more frequent dosing.
Testosterone pellets
Pellets are small cylinders of testosterone placed under the skin of the hip or buttock in a short office procedure, after the area is numbed. They release testosterone slowly over a few months, so there's nothing to do day to day.
The downside is flexibility. Once pellets are in, the dose can't be lowered quickly if your labs or symptoms call for it. Some soreness or bruising is possible, and rarely a pellet works its way out or the site becomes infected. An FDA-approved pellet product exists; compounded pellets are not FDA-approved.
Oral testosterone capsules
Oral testosterone undecanoate capsules are FDA-approved and taken by mouth twice a day. They carry a boxed warning about increases in blood pressure, which can raise the risk of heart attack and stroke, and they're approved for men whose low testosterone has specific medical causes rather than age alone. Blood pressure is checked before and during treatment.
Testosterone options side by side
| Form | How it's given | How often | Things to know |
|---|---|---|---|
| Cypionate or enanthate shot | Into a muscle, at home or in the office | Usually every 1 to 2 weeks | Levels rise and fall between doses |
| Weekly autoinjector | Under the skin with a prefilled pen | Once a week | Boxed warning about blood pressure increases |
| Long-acting undecanoate shot | Into a muscle, in a certified medical office | Every 10 weeks after the first two doses | 30-minute observation after each shot; restricted program |
| Gel or solution | Rubbed onto the skin | Daily | Can transfer to others by skin contact; boxed warning about children |
| Nasal gel | Inside the nose | Several times a day | No skin transfer; more frequent dosing |
| Oral capsules | By mouth | Twice a day | Boxed warning about blood pressure; approved for specific medical causes |
| Pellets | Placed under the skin in a short office procedure | Every few months | Dose can't be lowered quickly once placed |
What stays the same no matter which form you choose
Testosterone therapy needs ongoing monitoring. Guidelines call for checking testosterone and red blood cell levels (hematocrit) after starting and at regular intervals, along with blood pressure and prostate monitoring where appropriate. Testosterone can lower sperm production and fertility, so tell your clinician if you may want children.
Testosterone is a Schedule III controlled substance under federal and Florida law. It's prescribed only after a medical evaluation, and guidelines call for lab tests that confirm low levels before starting. In February 2025 the FDA updated labeling across testosterone products to add results from the TRAVERSE heart-safety trial and to require warnings about increased blood pressure.
Compounded creams, troches and pellets
Some clinics and online services offer testosterone made by compounding pharmacies, such as custom creams, troches that dissolve in the mouth, or compounded pellets. Compounded drugs are not FDA-approved, and the FDA does not verify their safety, effectiveness or quality before they're marketed. If you're offered one, ask why an FDA-approved product isn't being used.
How to choose with your clinician
The right form is usually the one you'll use consistently and that keeps your labs where they should be. These questions help narrow it down:
- Are you comfortable with needles, or would you rather apply something daily?
- Do you have young children or a partner at home who could be exposed to a gel?
- Do you travel often, or prefer something you don't have to think about for months?
- Is your blood pressure well controlled?
- Do you want the option to adjust your dose quickly?
- Are you planning to have children?
Testosterone options at Ascend Mind and Body
At Ascend, testosterone care sits inside a practice that also offers primary care and mental health. Treatment starts with morning lab work, and the options discussed include injections, topical gel and pellets, chosen around your goals, your tolerance for needles, your schedule and your fertility plans. Visits take place in person at the Tampa (Carrollwood) and Wesley Chapel offices or by Florida telehealth, first evaluation included, with labs drawn at a local lab near you anywhere in Florida.
Learn more about men's health care in Florida at Ascend or Ascend's TRT clinic in Tampa. Comparing clinics? See how TRT clinics in Florida compare.
Frequently asked questions
How often do you need testosterone shots?
Most testosterone cypionate or enanthate shots are given every week or every two weeks, as your prescriber directs. A weekly under-the-skin pen is also FDA-approved, as is a long-acting shot given in a medical office every 10 weeks after the first two doses.
Are testosterone shots or gel easier to use?
It depends on what you'd rather manage. Shots mean a needle every week or two but nothing to do in between. Gel means no needles but a daily application and care to keep the skin covered so it doesn't transfer to others.
Can my partner or children be affected by testosterone gel?
Yes. Testosterone gels and solutions can pass to others through skin contact, and their labeling carries a boxed warning about exposure in children. Wash your hands after applying, cover the area with clothing, and wash the skin before close contact.
Do testosterone pellets hurt?
Pellets are placed under the skin of the hip or buttock through a small opening after the area is numbed. Some soreness or bruising afterward is possible, and rarely a pellet works its way out or the site becomes infected.
Are compounded testosterone creams FDA-approved?
No. Compounded drugs are not FDA-approved, and the FDA does not verify their safety, effectiveness or quality before they're marketed. FDA-approved topical testosterone comes as specific gels and solutions.
Is there an FDA-approved testosterone pill?
Yes. Oral testosterone undecanoate capsules are FDA-approved and taken twice a day. They carry a boxed warning about increases in blood pressure and are approved for men whose low testosterone has specific medical causes.
Do I need the same lab tests no matter which form I use?
Yes. Every form needs the same confirmed diagnosis first and the same follow-up checks of testosterone, red blood cell levels (hematocrit), blood pressure and, where appropriate, the prostate.
Can I switch from shots to gel or pellets?
Usually, yes. Switching is a decision to make with your prescriber, and your labs are typically rechecked after any change in form or dose.
Does any form of testosterone protect fertility?
No. Every form of testosterone can lower sperm production and fertility. If you may want children, tell your clinician before starting so you can talk through other options.
Sources
- American Urological Association, Evaluation and Management of Testosterone Deficiency (2018, amended 2024). www.auanet.org, accessed October 22, 2026.
- Bhasin S, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. academic.oup.com, accessed October 22, 2026.
- U.S. Food and Drug Administration, FDA issues class-wide labeling changes for testosterone products (2025). www.fda.gov, accessed October 22, 2026.
- U.S. Food and Drug Administration, Compounding and the FDA: Questions and Answers. www.fda.gov, accessed October 22, 2026.
- U.S. Food and Drug Administration, testosterone undecanoate injection risk evaluation and mitigation strategy documents. www.accessdata.fda.gov, accessed October 22, 2026.
- U.S. Food and Drug Administration, oral testosterone undecanoate capsule prescribing information (NDA 213953). www.accessdata.fda.gov, accessed October 22, 2026.
This article is for general educational purposes only and is not medical advice. It does not create a provider-patient relationship. Talk with a qualified Florida-licensed clinician about your individual situation.