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Mar 23, 2021
6 min read

Testosterone cypionate injection

Testosterone cypionate is an FDA-approved injection used in the treatment of low testosterone (called hypogonadism). It is also commonly prescribed for the treatment of gender dysphoria in transgender men and can have benefits before or after gender-affirming surgeries. This form of testosterone is known as a depot, which means it only requires an injection every 2 to 4 weeks.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

What is testosterone cypionate?

Testosterone cypionate is an injectable form of testosterone (T) that is available by prescription only. It’s also known under the brand name Depo-testosterone. If taken correctly, it can raise your T levels back to what is considered normal for adult men.

Because it is a depot injection, this form of T has a long half-life. Half-life is basically a measurement of how long it takes your body to process, absorb, and get rid of a drug. The longer the half-life, the more time a medication has to work—which is why this form of T only requires an injection every 2 to 4 weeks.

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Testosterone cypionate is FDA-approved to treat hypogonadism in patients who can’t produce enough testosterone on their own (Mulhall, 2018). It is also useful in treating gender dysphoria in transgender men (and for those seeking masculinization). It’s a common tool for the gender-affirming process and can even reduce anxiety, social distress, and depression (Hembree, 2017).

Testosterone is notorious for being a male sex hormone responsible for “androgenic” functions like sexual health and performance.  But actually, testosterone contributes to many functions in men, women, and those who identify otherwise.

An androgen is a type of sex hormone, and when someone can’t produce enough of it on their own, specific bodily changes can happen. In some cases, these changes are undesirable and can lead to health risks. For example men with low T can develop the symptoms of erectile dysfunction (ED)

There are several conditions that testosterone plays a role in; here are a few (Saad, 2017):

  • Mood and depressive symptoms
  • Red blood cell conditions (like anemia and changes in hemoglobin levels)
  • Bone mineral density loss and loss in bone strength

Using testosterone to raise T levels has become increasingly common in the United States over the last decade. A study reported that in 2013 an estimated 2.3 million American men were receiving testosterone replacement therapy (Petering, 2017).

What conditions can testosterone cypionate benefit?

Hypogonadism

There are a couple of ways that a person can develop low T levels. Some forms of hypogonadism are genetic, and others are acquired.

Here are a few ways that men can develop low T levels in their lifetime (Petering, 2017):

Patients who suffer from hypogonadism can have many symptoms. The most common that are recognized by healthcare providers are breast discomfort, lower bone density, loss of body hair, and decreased libido (sex drive). If you’re experiencing symptoms of low T, pay a visit to your healthcare provider who can run a blood test to measure your serum testosterone levels. 

But does taking testosterone help with these symptoms?

The Testosterone Trials (aka T-trials) were coordinated large-scale clinical trials that followed 788 older men with hypogonadism for one year. Researchers in the study gave half of the patients testosterone replacement therapy, and the other half were given a placebo. Below are the reported risks and benefits (Snyder, 2018):

  • Benefits: improved sexual function, slightly improved mood, improved bone mineral density, and bone strength, improved mild to moderate anemia
  • Risks: increased coronary artery plaque volume, changes in cholesterol, the potential for cardiovascular problems

Your own balance of risks and benefits with testosterone replacement therapy will be evaluated by your healthcare provider in deciding on the best treatment for you. 

Gender dysphoria

Testosterone therapy in transgender men has been demonstrated to alleviate the psychological distress resulting from gender dysphoria in a small trial (Gómez-Gil, 2012). It can be useful before and after any surgical interventions and is helpful in gender affirmation.

Hormone therapy in trans men usually comes with the primary goal of masculinization and can produce results like a deeper voice, increased hair growth, and increased lean muscle mass. These changes (commonly called virilization in scientific studies) typically appear within three months of starting testosterone therapy (Unger, 2016).

As T has become more commonly prescribed in trans men, more clinical trials are necessary to evaluate its effect on this often marginalized community.  

What are the possible side effects of injectable testosterone?

Testosterone cypionate is a medication you will have to inject yourself at home. It is given as an intramuscular (into the muscle) injection. Talk to your healthcare provider about how to properly inject testosterone. You’ll need syringes, alcohol wipes, and a sharps container for proper disposal.

You should store testosterone cypionate at room temperature to prevent crystals from forming. If they do form, you can get rid of them by rolling the bottle in between your palms before drawing the dose up in the syringe. 

It’s possible to have an allergic reaction to the contents in testosterone cypionate injection. If you experience any severe symptoms of an allergy (severe swelling at the injection site, hives, trouble breathing) after your first dose do not take a second dose and seek immediate medical care. 

The FDA put out a disclaimer in 2015 that using testosterone can put you at an increased risk for heart problems. This risk of toxicity is higher in those with pre-existing heart disease, especially older patients (FDA, 2015). Talk to your healthcare provider for medical advice if you are an older patient suffering from low T symptoms to evaluate the best approach for you.  

T therapy should not be prescribed to patients with breast cancer, those who are pregnant or who are trying to become pregnant, those with certain blood conditions, and people living with prostate cancer. The reason for this is that testosterone can affect these conditions and sometimes can make them worse. Using testosterone for extended periods of time can also increase your risk of liver problems.

Testosterone is a schedule III controlled substance and has the potential for abuse. Taking high doses of testosterone or using it in combination with anabolic steroids can lead to severe and life-threatening side effects. These side effects include heart attack, heart failure, and notoriously, changes in mood or behavior (Elagizi, 2018). 

Some of the more common side effects are less serious and include (Zitzmann, 2013):

  • Pain or redness at the injection site
  • Acne or skin changes
  • More frequent erections that last longer than normal
  • Enlargement of the prostate
  • Gynecomastia (enlargement of breast tissue)
  • Headaches
  • Sleep apnea
  • Edema (fluid retention)
  • Increase in blood pressure
  • Polycythemia (an increase in red blood cells)
  • Changes in metabolites (raises calcium levels, lowers potassium)

Testosterone can interact with other prescription drugs that you take. Blood thinners like warfarin taken in combination with T can put you at a much higher risk for bleeding, for example. 

Drug interactions can put you at risk for having serious side effects or not getting enough of a medication that you need. Talk to your healthcare provider about all of the medical conditions you have and the medications you take before starting any new therapy.

References

  1. Elagizi, A., Köhler, T. S., & Lavie, C. J. (2018). Testosterone and Cardiovascular Health. Mayo Clinic Proceedings, 93(1), 83–100. doi: 10.1016/j.mayocp.2017.11.006. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29275030/
  2. Gómez-Gil, E., Zubiaurre-Elorza, L., Esteva, I., Guillamon, A., Godás, T., Cruz Almaraz, M., et al. (2012). Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology, 37(5), 662–670. doi: 10.1016/j.psyneuen.2011.08.010. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21937168/
  3. Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., et al. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism, 102(11), 3869–3903. doi: 10.1210/jc.2017-01658. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28945902/
  4. Mulhall, J. P., Trost, L. W., Brannigan, R. E., Kurtz, E. G., Redmon, J. B., Chiles, K. A., et al. (2018). Evaluation and Management of Testosterone Deficiency: AUA Guideline. The Journal of Urology, 200(2), 423–432. doi: 10.1016/j.juro.2018.03.115. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29601923/
  5. Petering, R. C. & Brooks, N. A. (2017). Testosterone Therapy: Review of Clinical Applications. American Family Physician, 96(7), 441–449. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29094914/
  6. Saad, F., Röhrig, G., von Haehling, S., & Traish, A. (2017). Testosterone Deficiency and Testosterone Treatment in Older Men. Gerontology, 63(2), 144–156. doi: 10.1159/000452499. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27855417/
  7. Snyder, P. J., Bhasin, S., Cunningham, G. R., Matsumoto, A. M., Stephens-Shields, A. J., Cauley, J. A., et al. (2018). Lessons From the Testosterone Trials. Endocrine Reviews, 39(3), 369–386. doi: 10.1210/er.2017-00234. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29522088/
  8. Unger, C. A. (2016). Hormone therapy for transgender patients. Translational Andrology and Urology, 5(6), 877–884. doi: 10.21037/tau.2016.09.04. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28078219/
  9. U. S. Food and Drug Administration (FDA). (2015, March). FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. Retrieved Mar. 5, 2021 from https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-cautions-about-using-testosterone-products-low-testosterone-due
  10. Zitzmann, M., Mattern, A., Hanisch, J., Gooren, L., Jones, H., & Maggi, M. (2013). IPASS: a study on the tolerability and effectiveness of injectable testosterone undecanoate for the treatment of male hypogonadism in a worldwide sample of 1,438 men. The Journal of Sexual Medicine, 10(2), 579–588. doi: 10.1111/j.1743-6109.2012.02853.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22812645/