Subcutaneous Testosterone Administration

Introduction to Subcutaneous Testosterone Administration

Testosterone can be administered subcutaneously biweekly, using the same dosing regimens established for intramuscular injections (100-200 mg every 2 weeks), though weekly dosing may provide more stable levels and is increasingly preferred 1

Weekly subcutaneous administration (50 mg weekly) is increasingly favored over biweekly dosing (100-200 mg every 2 weeks) because it reduces the problematic peaks and troughs inherent to testosterone esters 1, 2
Both intramuscular and subcutaneous injections produce "fluctuating serum testosterone levels with peaks and valleys" when given biweekly 1, 2
These fluctuations may contribute to increased cardiovascular risk by causing extended periods in both supratherapeutic and subtherapeutic ranges 2

Monitor testosterone levels midway between injections (at trough for biweekly dosing) 2-3 months after initiation or dose changes, targeting mid-normal values of 500-600 ng/dL 1, 2
Once stable levels are confirmed, monitoring every 6-12 months is sufficient 2
Dose adjustments should be made based on these trough levels to maintain therapeutic range 1

The American Gastroenterological Association notes that intramuscular injections result in "fluctuating serum testosterone levels with peaks and valleys" 3
The rate of absorption differs between subcutaneous and intramuscular sites, with the latter being faster, according to the American Diabetes Association 4

The American Gastroenterological Association recommends typical intramuscular dosing of 100-200 mg every 2 weeks or 50 mg weekly, which translates effectively to subcutaneous administration 3
Monitoring trough levels 2-3 months after initiation or dose changes, targeting mid-normal testosterone values, is consistent with standard intramuscular monitoring practices, as suggested by the American Gastroenterological Association 5, 6