Testosterone Injections vs Gels: Questions to Ask First

Available formulations

FDA lists topical gel, transdermal patch, a buccal system, and injections among approved formulations. Its class-wide notice also lists oral products. FDA testosterone information FDA class-wide notice Current AndroGel and XYOSTED labels describe replacement therapy for adult males with conditions associated with absent or deficient endogenous testosterone. AndroGel label XYOSTED label

The gel-specific risk that belongs near the top

AndroGel has a boxed warning about secondary exposure. Virilization has been reported in children who were exposed to testosterone gel. Children should avoid contact with unwashed or unclothed application sites. AndroGel label This warning remained in force after FDA removed a different boxed warning concerning cardiovascular risk.

Reported signs in children included enlargement of genitalia, pubic hair, increased erections and libido, aggressive behavior, and advanced bone age. Most signs regressed after exposure ended, but some effects did not fully return to an age-appropriate state. The label says to discontinue the gel promptly until the cause is identified if virilization is reported. AndroGel label

The label directs users to wash their hands with soap and water after application, cover the dry site with clothing, wash the site before anticipated skin contact, and promptly wash another person's skin after contact with an unwashed site. Children and pregnant people should avoid contact with treated skin. The product is flammable until dry. Anyone prescribed a gel should follow the exact product label and pharmacist instructions. AndroGel label

What one injectable label emphasizes

XYOSTED does not carry the gel transfer warning. Its most common adverse reactions above 5 percent included increased hematocrit, hypertension, increased PSA, injection-site bruising, and headache. Its label also has a warning about depression and suicide. It directs patients and caregivers to seek medical attention for suicidal thoughts or behavior, new or worsening depression, anxiety, or other mood changes. XYOSTED label

AUA reports different average hemoglobin changes across formulations and cites a retrospective series in which polycythemia was more frequent with intramuscular products than topical gel. AUA guideline These comparisons come from different evidence types and do not determine the right formulation for a particular person.

Blood pressure is a class effect

FDA said ambulatory studies confirmed increased blood pressure with all testosterone products and required class-wide labeling changes. FDA class-wide notice XYOSTED and AndroGel report different average changes from separate studies, so their figures should not be treated as a head-to-head comparison. Both labels say the products are not recommended for uncontrolled hypertension. XYOSTED label AndroGel label

What changed in labeling

In February 2025, FDA recommended adding TRAVERSE findings and removing boxed-warning language about increased cardiovascular risk while requiring product-specific blood-pressure information and warnings. FDA class-wide notice The gel boxed warning about secondary exposure was not removed and remains in the AndroGel label. AndroGel label

FDA's June 2026 requested changes concern the limitation for age-related hypogonadism and prostate and BPH safety language. They do not remove household handling precautions for gels. FDA testosterone information

What ACP says about choosing a route

ACP Recommendation 1c says clinicians should consider intramuscular rather than transdermal formulations when starting treatment for sexual function in men with age-related low testosterone. ACP cites considerably lower cost and says clinical effectiveness and harms are similar. ACP guideline This is clinician guidance, not a conclusion that one route is appropriate for everyone.

Questions to ask a licensed clinician

• Do children, a pregnant partner, shared spaces, or frequent skin contact make a topical product unsuitable?
• If a gel is prescribed, which exact label precautions apply in the household?
• If an injectable product is prescribed, who will administer it and how will clinical follow-up work?
• How will blood pressure, hematocrit, and prostate-related risks be monitored?
• Which contraindications or mental-health changes are most relevant to the medical history?
• How do insurance coverage and total cost differ by prescribed product?

Limits and urgent symptoms

This article is general education, not medical advice, diagnosis, treatment, or a recommendation of one formulation. If a child or partner develops signs of unintended exposure, contact a clinician promptly. For chest pain, shortness of breath, or leg swelling, seek immediate care or call 911. AndroGel label XYOSTED label

Testosterone labeling is being revised product by product following FDA actions in February 2025 and June 2026. Label facts here reflect AndroGel 1.62% revised October 2025 and XYOSTED revised July 2025, verified August 26, 2026.