Your Best Testosterone Replacement Therapy Options

Welcome to Testosterone HQ—Men’s Health‘s guide to the exciting, complicated, and revolutionary world of testosterone. For everything you need to know about T, click here.

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If you’re at a point where your testosterone needs a boost—your levels have been measured as low and you’re having symptoms of low testosterone—there are numerous ways to go about it. (First, if you don’t know if you’re really at that point, discover how to find out, plus the pros and cons of joining the testosterone-everywhere revolution.) The testosterone booster your doc will likely want you to try first is basically the DIY route. Although study results vary, men who are sedentary or overweight can get a 10 to 30 percent lift in total T by making lifestyle changes, says Bradley Anawalt, M.D., an endocrinologist and professor at the University of Washington Medical Center in Seattle. Some people may see even greater gains.

Stress is especially detrimental to T, so emphasize activities that help you relax. Think meditation and yoga. (Both have separately been shown to boost T in the short term.) If you exercise to reduce stress, that’s a bonus. Working out regularly—combined with eating better, good sleep hygiene, and losing weight if you need to—almost always raises your T level significantly.

Raising your testosterone “naturally” doesn’t mean taking supplements, however. Every doctor we talked to was skeptical about supplements. Sure, “testosterone support” pills are all over the shelves. But look at the labels: Even the companies aren’t sure they work. The careful text basically says “none of this has been formally tested and this isn’t a treatment.” UCLA’s Jesse Mills, M.D., author of A Field Guide to Men’s Health is pretty certain. “We’ve done study after study. All the usual suspects. All of these have no role in improving testosterone,” he says. Even if they did, supplements aren’t regulated. Which is to say that for low T, a supplement shouldn’t be what you turn to.

You may, however, want a prescription testosterone product. Plenty of options here, too. Doctors like options, says Dr. Mills. because every patient is different. Each of these options has trade-offs. Here’s what to expect from the many prescription testosterone boosting options. (And if you wonder what it’s really like to take testosterone, three guys under age 50 talk about it here.)

Nasal Gel

You are: Extremely concerned about your ability to make babies. Like, actually make them, not just go through the motions.

Your prescription: Natesto, a fast-absorbing intranasal gel that preliminary research suggests may not suppress sperm production, as some other forms of T therapy do.

How often you’ll take it: 3 times per day.

Pill

You are: Not crazy about needles and have good Rx coverage (or deep pockets).

Your prescription: A new testosterone pill, Jatenzo, the first one approved by the FDA in more than 40 years. (Another, Tlando, is getting close.) The catches: Jatenzo is expensive, and you’ll need a series of doctor visits to dial in your dosage.

How often you’ll take it: 2 times per day.

Buccal System

You are: Comfortable with the mechanism of chewing tobacco. Or a Hone customer—the service offers this delivery device.

Your prescription: A rarely used tablet called a “buccal system” (brand name: Striant) that sticks to your gum like a plug of chaw and slowly dissolves over time. And like chewing tobacco, it can eventually damage your gums and cheek.

How often you’ll take it: 2 times per day.

Topical Gel

You are: Low maintenance, with typically moderate symptoms, and probably a bachelor.

Your prescription: A super-easy-to-apply gel that you rub in, but it requires avoiding direct skin-to-skin contact with women and children at the application site. Also, it’s easy for kids to mistake it for hand sanitizer, now that that stuff is everywhere.

How often you’ll take it: Once per day.

Standard Injection

You are: Someone with a serious tolerance for frequent testing.

Your prescription: Regular intramuscular injections you can do at home, with periodic checks by a urologist or endocrinologist to adjust the dosage. If you have a tough time with needles, an auto-injector, called Xyosted, makes this as easy as an Epipen.

How often you’ll take it: Every 1 to 2 weeks.

Microdosing

You are: A person with a high metabolism and a proclivity for experimentation.

Your prescription: Smaller doses that you’ll inject more often, letting your body maintain its T level better than with big, infrequent doses.

How often you’ll take it: 3 to 5 times per week.

Subcutaneous Pellet

You are: Transitioning gender, or you’re busy and need the convenience.

Your prescription: A pellet inserted under the skin in a minor procedure. The tablet dissolves very slowly, keeping your T level high over a long period of time.

How often you’ll take it: Every four months.

This story originally appeared in the January/February 2022 issue of Men’s Health.