Intramuscular Testosterone Dosing for Low Testosterone

Standard Dosing Regimens

The American College of Physicians recommends starting with 50-100 mg of intramuscular testosterone cypionate or enanthate weekly, or 100-200 mg every 2 weeks, for men with testosterone levels in the 100s ng/dL, with the weekly regimen providing more stable serum levels 1, 2
Weekly dosing of 50-100 mg provides more stable testosterone levels and is preferred over biweekly administration, according to clinical practice guidelines 1, 2

The Endocrine Society suggests beginning with 50-100 mg weekly and measuring testosterone levels 2-3 months after initiation, targeting mid-normal values, and adjusting the dose in 25-50 mg increments based on these results and clinical response 1, 2
For injectable formulations, testosterone levels should be checked midway between injections, as recommended by the American Association of Clinical Endocrinologists 1, 2

Weekly injections produce more stable serum testosterone levels compared to biweekly administration, which results in supraphysiological peaks followed by subtherapeutic troughs, according to the American College of Physicians 2
Injectable testosterone may carry greater cardiovascular risk than transdermal preparations, possibly due to fluctuating levels, as noted by the American Heart Association 1, 2
Higher rates of erythrocytosis are associated with injectable testosterone, as reported by the National Institutes of Health 1

Initial monitoring should include checking testosterone levels at 2-3 months after starting or changing doses, as recommended by the Endocrine Society 1
Ongoing monitoring should occur every 6-12 months once stable, according to the American Association of Clinical Endocrinologists 1
Additional surveillance should include monitoring hematocrit/hemoglobin and PSA levels regularly, as suggested by the American Urological Association 2
The timing of blood draw is crucial, and levels should be obtained midway between injections for accurate assessment, as recommended by the American College of Physicians 1, 2

Biweekly dosing should not be used if the patient experiences mood fluctuations or symptoms returning before the next injection, as this indicates the need for weekly administration, according to the American College of Physicians 2
Cardiovascular risk assessment should not be neglected before initiating therapy, as testosterone may increase cardiovascular events in high-risk patients, as noted by the American Heart Association 1, 2