How to Take Testosterone

Medically reviewed by Mark Ziats, MD, PhD

Last Updated: July 15, 2022 References

Testosterone can decrease as a man ages. A normal decrease in levels is expected, but sometimes levels drop too low. This can lead to negative symptoms that affects everyday life, such as a below average decreased sex drive, fatigue, and depression. If you believe your testosterone levels are too low, you can take testosterone supplementation. It is important to know that there has been no conclusive scientific evidence that demonstrates this has any actual effect on the symptoms for people who have low testosterone due to normal aging. Furthermore, there is some new evidence that taking testosterone may actually have adverse effects to your health, especially cardiovascular. Make sure you thoroughly discuss your options with your doctor first.^{[1]
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Method 1

Method 1 of 3:

Choosing the Right Testosterone Replacement Therapy

1
Try buccal testosterone. Buccal testosterone is taken orally through a lozenge. The lozenge dissolves in your mouth. It is normally taken twice a day, in the morning and night. This approach is an efficient way to dose testosterone in men.^{[2]
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- However, the lozenges have a bitter taste and can cause mouth irritation.
2
Take transdermal testosterone gel. Transdermal testosterone gel is a commonly used approach. It is a gel that is applied on the body which mimics a dose that would normally occur. The gel is applied to the shoulders, upper arms, chest, or belly. Make certain you wash your hands after application. The gel is applied once a day at the same time, usually in the morning by about eight a.m.^{[3]
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- The cost of the gel can be high.
- You have to make certain the areas are dry before coming into contact with women (especially pregnant women) or children. There is a risk of transferring the testosterone if the gel isn't dry.
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3
Consider transdermal testosterone patch. The transdermal testosterone patch is another skin-dosing approach, which mimics a dose that would normally occur. Some of the patches may be applied onto the scrotum, though they may be placed on the arms or back as well. The patch is applied once a day at the same time, usually in the morning by about eight a.m.^{[4]
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- When you remove the patch, make certain no one else is exposed to the testosterone. Dispose of the patch immediately.
- The cost of the transdermal patch is high as well.
4
Talk to your doctor before starting any testosterone replacement therapy. Testosterone replacement therapy (TRT) is only done under the care of a physician. No matter which method you use, it is important to get regularly checked to make certain enough testosterone is entering your blood to be effective.^{[5]
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- Before beginning testosterone therapy, your doctor must perform a digital rectal exam and PSA blood test should be measured. If these are abnormal (suggesting an enlarged prostate), then therapy should not be started and further testing should be done.
- Three months after starting testosterone, the same tests should be performed. If there is concern for enlarged prostate or prostate nodules at that time, then testosterone should be stopped.
- The Endocrine Society generally recommends TRT if the tested levels of testosterone are lower than 300 ng/dL and there are symptoms of low testosterone.^{[6]
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- Testosterone pills are available, but are not useful, as taking plain testosterone by mouth has no effect because the liver metabolizes it too rapidly. Modified forms of testosterone pills were made that prevented the testosterone from being metabolized in the liver, but it was shown that these forms can cause damage to the liver.^{[7]
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Method 2

Method 2 of 3:

Taking Intramuscular Testosterone Injections At Home

1
Do not take testosterone unless it is prescribed by a physician. Testosterone must be prescribed to you by a licensed physician. This hormone is often abused and can be purchased on the black market, which is extremely dangerous. There is no way to verify the product you receive illegally is safe for you to take, or verify the quality, sterility, and purity of the product.
2
Choose intramuscular testosterone. Intramuscular testosterone (IM) is an intramuscular injection. The dose usually varies from 200 to 400 milligrams. It can be given every two, three, or four weeks, usually injected into the thigh muscle. The testosterone seeps out of the injection site into the body. The injections may be given in an office, though self injection is often possible, depending on your physician. This approach usually is the least expensive, though you have to get a shot every few weeks.^{[8]
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- This method does not mimic a dose that would normally occur in the body. There may be times, like right after injection, when the levels of testosterone are higher than normal, and times between injections when the levels of testosterone are lower than normal. This is called a roller coaster effect.
3
Gather the materials. Find a clear, comfortable place to set up where you can place everything you need. Remove the testosterone from the refrigerator and allow the testosterone to come to room temperature.^{[9]
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- Make sure you know what dosage you need to administer for yourself.
- Wash your hands before beginning.
4
Draw up the prescribed amount of testosterone. Insert the needle straight down through the center of the rubber stopper of the vial. Push the plunger of the syringe down, pushing the air from the syringe into the vial. Keep the needle in the vial and turn the vial upside down. Make certain the liquid in the vial is covering the tip of the needle. Keep the vial upside down and slowly pull back on the plunger to fill the syringe with the medication to the dose that matches the dose your doctor ordered.^{[10]
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- Do not put the needle through the rubber stopper more than once.
- While keeping the needle in the vial, check for air bubbles. If there are any air bubbles, gently tap the syringe with your fingers until the air bubbles rise to the top of the syringe. Slowly push the plunger up to force the air bubbles out of the syringe without removing the needle from the bottle.
5
Clean the area. Remove the syringe needle from the vial. Make sure you do not let the needle touch anything. Use an alcohol wipe to clean the injection area.^{[11]
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- The injection site is generally the outer middle third of your thigh, but follow your physician's instructions.
6
Administer the medicine. Form a "V" with your first and second fingers. Place the heel of your hand near your hip and gently spread the skin on the outer middle third of your thigh. The injection site will be between the knuckles of the V formed by your fingers. Use a quick, firm, and single motion to insert the needle. If there is no blood, gently, slowly, and firmly push the plunger to inject the testosterone.^{[12]
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- Pull back on the plunger just a bit to check that there is no blood. If you see any blood in the syringe, do not inject.
7
Clean up the materials. Remove the syringe needle and clean the area with the alcohol swab once again. Dispose of used needles in an appropriate sharps or biohazard waste container.^{[13]
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- Apply pressure if needed to stop any bleeding.

Method 3

Method 3 of 3:

Understanding Testosterone Replacement Therapy

1
Learn the importance of testosterone. Testosterone is responsible for the production of male sexual characteristics and functions, including a deep voice, facial hair, and denser bone and muscle mass. It is directly related to erectile functions, penis and testicular size, and the sex drive. Testosterone is also involved with the production of red blood cells and sperm.^{[14]
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- Normal levels of testosterone help to prevent high blood pressure and heart attacks.
2
Understand why low testosterone levels occur. Low levels of testosterone may represent normal male aging; however, low levels of testosterone are also associated with a number of different health issues in men, as well as an increased risk of death. Testosterone levels vary in different men, so it can be difficult to determine if the levels detected in one man are too low or if they represent a normal decrease with age.^{[15]
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Research source
Shores, M. M., Smith, N. L., Forsberg, C. W., Anawalt, B. D., & Matsumoto, A. M. (2012). Testosterone treatment and mortality in men with low testosterone levels. The Journal Of Clinical Endocrinology And Metabolism, 97(6), 2050-2058.}
- It is quite normal for a man's testosterone level to decrease gradually with age. It is also quite normal to have fewer erections as a man ages.
- It is not normal, however, to be unable to have or sustain an erection, and it is not normal to lose interest in sex. This can be a symptom of many other, more common cases as well, including diabetes and depression.
3
Know the symptoms of low testosterone. Though low testosterone is normal, levels that are too low can lead to many health problems. Symptoms of low levels of testosterone in men include:^{[16]
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- Problems with sexual function. This can include erectile dysfunction, decreased desire for sexual activity, and a decrease in the number and quality of erections.
- Smaller testes
- Emotional problems, such as depression, irritability, anxiety, problems with memory or concentration
- Sleep disruption
- Increased fatigue or a general overall lack of energy
- Body changes, such as increased belly fat, decreased muscle mass, decreased strength and endurance, decreased cholesterol levels, and osteopenia (softening of the bones) and osteoporosis (decreased bone density)
- Swollen or tender breasts
- Loss of body hair
- Hot flashes
- Women can have low testosterone as well. Symptoms of low testosterone in women include decreased sexual desire and function, muscle weakness, decreased vaginal lubrication, and infertility.^{[17]
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4
Diagnose testosterone levels. To diagnose low testosterone levels, your physician will perform a physical exam and take a blood sample to test for testosterone levels. Depending on your physical exam, your symptoms, and your history, other tests may be performed as well. These tests check for thyroid function, diabetes, high blood pressure, and heart disease.
- If you are experiencing any of the symptoms, call your physician to have your testosterone levels tested.
5
Know the side effects of TRT. For those individuals who do choose TRT, you should know about potential side effects. Because of these potentially serious side effects, your physician will be most likely asking you to come in frequently for checkups. This may be every three to six months. You should also keep track of any changes in your body and report them immediately to your physician. The side effects include:^{[18]
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- Increased risk of heart attacks and heart disease
- Increased risk of strokes and blood clots
- Increased risk of prostate cancer
- Sleep apnea
- Polycythemia, or increased levels of red blood cells — this causes the blood to get thicker and increases the risk of blood clots.
- Enlargement of male breasts
- Acne and oily skin
- Changes in hair patterns
- Decrease in the size of testicles
- Changes in cholesterol and blood lipid levels
6
Understand when not to take testosterone. Testosterone replacement therapy (TRT) is not for every man. There are circumstances in which it is not recommended. For example, TRT is not recommended for men with sleep apnea, a high red blood cell count, congestive heart failure, or prostate conditions, such as benign prostatic hypertrophy, prostate cancer, or breast cancer.^{[19]
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Expert Q&A

Question

How can I find a doctor who will prescribe testosterone?

Mark Ziats, MD, PhD
Internal Medicine Physician
Dr. Mark Ziats is an Internal Medicine Physician, Scientist, Entrepreneur, and the Medical Director of xBiotech. With over five years of experience, he specializes in biotechnology, genomics, and medical devices. He earned a Doctor of Medicine degree from Baylor College of Medicine, a Ph.D. in Genetics from the University of Cambridge, and a BS in Biochemistry and Chemistry from Clemson University. He also completed the INNoVATE Program in Biotechnology Entrepreneurship at The Johns Hopkins University - Carey Business School. Dr. Ziats is board certified by the American Board of Internal Medicine.

Mark Ziats, MD, PhD

Internal Medicine Physician

Expert Answer

Any physician should be able to do this, and for the most part you should not need to see a specialist like an endocrinologist. Your primary care physician should be able to handle it.