Treatment options for low testosterone
Testosterone therapy is one option, not the only one. What fits you depends on what's causing your low level, whether you want children, and how you feel about shots, gels or pills.
The short answer
- Fix what's driving it firstWeight, sleep apnea and medicines can lower testosterone. Treating them helps whether or not you start therapy.
- Want children? Skip testosterone therapyIt shuts down sperm production. Clomiphene or hCG raise your own testosterone instead.
- On therapy, monitorTestosterone level, blood count and PSA, checked on a schedule. Aim for 450 to 600 ng/dL.
Start with one question
The biggest fork in treatment is fertility. Testosterone from outside the body tells your brain to stop sending LH and FSH, so your testicles make less testosterone and fewer sperm, often none.
Raise your own testosterone
Medicines that boost your body's signal keep sperm production going. They work best in secondary low testosterone, where LH is low or normal.
- Clomiphene
- hCG
- Anastrozole, in selected men
Testosterone therapy
Replaces testosterone directly. Choose among shots, gels, pills, nasal gel and pellets based on how you live and what you'll stick with.
- Most reliable way to reach a normal level
- Needs ongoing monitoring
- Usually long-term
Options that protect fertility
All of these are prescribed and monitored by a urologist, men's health specialist or endocrinologist. Most are used off-label in men, which is common and well studied, but means they aren't FDA-approved for this purpose.
| Medicine | How it works | Good to know |
|---|---|---|
| Clomiphene pill, daily or every other day | Blocks estrogen feedback in the brain, so LH and FSH rise and the testicles make more testosterone | Inexpensive. Usually raises testosterone meaningfully in secondary low T. Uncommon side effects: mood changes, visual disturbances (stop and call if these occur). |
| Enclomiphene pill | The active half of clomiphene | Not FDA-approved. Available mainly through compounding pharmacies, so quality varies. |
| hCG shot under the skin, 2–3 times a week | Acts like LH directly on the testicles | Supports both testosterone and sperm. Also used alongside testosterone therapy, or after stopping it, to restart production. |
| Anastrozole pill | Lowers conversion of testosterone to estrogen | Used when estrogen is high relative to testosterone, often in men with extra weight. Can lower bone density over time. |
| FSH shot | Directly stimulates sperm production | Added for low sperm counts, usually by a fertility specialist. |
Testosterone therapy, compared
Every form works when dosed correctly. The differences are convenience, steadiness of levels, side effects and cost. The AUA recommends FDA-approved products over compounded ones when possible, and advises against the older methyltestosterone pills, which can harm the liver.
| Form | How often | Pros | Watch for | Cost |
|---|---|---|---|---|
| Injection into muscle cypionate, enanthate | Every 1–2 weeks, often at home | Long track record, lowest cost | Peaks and dips; highest rise in blood count | $ |
| Injection under the skin | Weekly | Small needle, steadier levels; autoinjector available | Injection-site reactions; blood pressure | $–$$$ |
| Long-acting injection undecanoate | Every 10 weeks after loading doses | Few visits, steady levels | Given in the office with 30 minutes of observation for a rare lung reaction or allergy | $$$ |
| Gel or solution | Daily | Steady levels, no needles | Transfers to women and children by skin contact; cover the site and wash hands | $$ |
| Oral capsules undecanoate | Twice daily with food | No needles, no transfer risk | Raises blood pressure in some men; check it regularly | $$$ |
| Nasal gel | 2–3 times daily | Short-acting; may suppress your own production less | Frequent dosing; nasal irritation | $$$ |
| Pellets | Every 3–6 months | Nothing to remember day to day | Minor in-office procedure; pellets can work out; dose fixed until next placement | $$ |
| Patch | Daily | Steady levels | Skin irritation is common | $$ |
Cost is a rough guide to cash price; insurance coverage varies widely by plan and product.
What to expect, and when
Not every symptom responds the same way. In controlled trials, sexual function improves most consistently. Energy and mood improve for some men but less reliably, so it's worth knowing what you're hoping to change.
The AUA suggests reassessing after 3 to 6 months. If your level is in range and your symptoms haven't improved, stopping therapy and looking for other causes is reasonable.
Side effects and safety
Monitoring on therapy
| Check | When | Target or action |
|---|---|---|
| Testosterone | 2–3 months after starting or a dose change, then every 6–12 months | 450–600 ng/dL. Timing depends on the form: right before the next injection, a few hours after gel. |
| Hematocrit | Before starting, then with each testosterone check | Act at 54% or higher |
| PSA | Before starting in men 40 and over, then periodically | A meaningful rise warrants urologic evaluation |
| Blood pressure | At visits; more often with oral products | Treat high readings |
| Symptoms | At 3–6 months | Continue if helping; reconsider if not |
What changed at the FDA
Testosterone labeling has shifted twice recently. In February 2025, after reviewing TRAVERSE, the FDA removed the boxed warning about heart attack and stroke from all testosterone products and added a class-wide blood pressure warning.
In June 2026, the FDA asked manufacturers to revise labels again: remove the statement that safety and effectiveness weren't established for age-related low testosterone, narrow the prostate cancer contraindication to metastatic disease, and drop the warning that testosterone may worsen enlarged-prostate symptoms. Label updates take time to appear on every product.
Choosing where to get treated
Testosterone is widely offered by telehealth companies and "men's health" clinics. Good care looks the same anywhere:
- Two morning testosterone levels before starting, not one
- LH checked, and the cause looked for
- A fertility conversation before any prescription
- Baseline hematocrit and PSA, then a monitoring schedule
- FDA-approved products preferred over compounded versions
- No pressure to buy supplements, peptides or add-ons
Common questions
Once I start testosterone, is it for life?
Not necessarily. If the cause is reversible, like weight or a medicine, you may be able to stop later. Stopping lowers your level, sometimes below where you started for a while, until your own production recovers. Clomiphene or hCG can help that recovery.
Can I be on testosterone and still have children?
Some urologists add hCG to testosterone therapy to help preserve sperm production, but it isn't guaranteed. If children are a near-term goal, fertility-sparing options alone are usually the better choice.
Does testosterone cause prostate cancer?
Current evidence doesn't show that testosterone therapy causes prostate cancer. PSA can rise slightly at the start, which is why it's checked before and during treatment.
My level is normal on treatment but I don't feel better. Now what?
Your symptoms may have another cause, such as sleep apnea, depression, thyroid disease or a medicine side effect. The AUA suggests reassessing at 3 to 6 months and stopping if there's no benefit.
Is compounded testosterone OK?
Compounded products aren't FDA-reviewed for quality or dose accuracy. The AUA advises using FDA-approved products when possible. Compounding has a role when an approved product isn't available or suitable.
See which options fit you
Enter your labs or upload your report. My Testosterone Levels lays out options based on your numbers, health factors and fertility plans.
Open the My Testosterone Levels checkerSources
- Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol 2018;200:423–432. Reviewed and validity confirmed 2024.
- Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE). N Engl J Med 2023;389:107–117.
- Snyder PJ, Bhasin S, Cunningham GR, et al. Effects of Testosterone Treatment in Older Men (Testosterone Trials). N Engl J Med 2016;374:611–624.
- Saad F, Aversa A, Isidori AM, et al. Onset of effects of testosterone treatment and time span until maximum effects are achieved. Eur J Endocrinol 2011;165:675–685.
- US Food and Drug Administration. Class-wide labeling changes for testosterone products. February 28, 2025.
- US Department of Health and Human Services. FDA requests updates to testosterone therapy labeling. June 18, 2026.