Testosterone injections vs. topicals vs. nasal gel vs. pellets: choosing the right form of TRT

Lakewood Ranch Concierge  |  October 16, 2026

Medically reviewed by Leo Kao, MD
Board-certified internal medicine physician

Once low testosterone has been confirmed, the next question is how to take it. Injections, skin gels and creams, a nasal gel, and pellets placed under the skin all deliver the same hormone, but they differ a lot in how often you dose, how steady your levels stay, who else in your home could be exposed, and what they cost. Here's how the four main options compare, and how we help each patient choose.

First things first: confirming the diagnosis

The delivery method only matters after a proper diagnosis. That means symptoms plus at least two low morning blood tests, and a look for underlying causes such as sleep apnea, excess weight, or medications. If you haven't been through that process yet, start with our overview, Testosterone therapy for men: symptoms, testing, benefits, and risks.

The four options at a glance

Testosterone injections

How it works. Testosterone cypionate or enanthate is injected into a muscle or just under the skin, anywhere from twice a week to weekly to every few weeks, depending on the patient. Smaller, more frequent doses, such as twice a week or weekly, help smooth out the highs and lows between injections. There is also a weekly under-the-skin autoinjector, and a long-acting injection (testosterone undecanoate) given every 10 weeks after two starting doses. That long-acting shot must be given in a medical office, with a 30-minute observation period afterward, because of a rare but serious risk of a lung reaction or allergic reaction.

Pros: injections are usually the least expensive option, the dose is easy to fine-tune, and absorption is reliable. Many patients learn to give their own injections at home.

The oil matters, too. Injectable testosterone is dissolved in an oil. The FDA-approved forms of testosterone cypionate use cottonseed oil, and testosterone enanthate uses sesame oil. For our injectable patients, we use compounding pharmacies that prepare testosterone in grapeseed oil or MCT oil (medium-chain triglyceride oil, usually derived from coconut). These options can be helpful for patients who react to cottonseed or sesame oil or who notice soreness at the injection site, and MCT oil is thinner, which can make it easier to draw up and inject through a smaller needle. Responses vary from person to person. Like other compounded medications, these preparations are not FDA-approved. Tell us about any food or oil allergies, including nut, seed, or coconut allergies, before starting.

Cons: levels peak a day or two after a dose and dip before the next one, and some men notice their energy or mood follow that cycle. Injections are also more likely than skin gels to raise the red blood cell count, which needs regular monitoring. And of course, some people simply don't want needles.

Topical testosterone: gels, creams, and solutions

How it works. A measured dose of gel is rubbed onto the shoulders, upper arms, or thighs once a day, depending on the product. One FDA-approved solution is applied to the underarms. Some practices also prescribe compounded testosterone creams, which are prepared by a pharmacy and are not FDA-approved.

Pros: daily application keeps levels fairly steady, there are no needles, and the dose can be adjusted easily.

Cons: the biggest concern is transfer. Testosterone gel can rub off onto partners and children through skin contact, and the FDA requires a boxed warning about cases of early puberty in children exposed this way. If you use a topical product, wash your hands after applying it, let it dry, keep the area covered with clothing, and wash the skin before close contact. You also need to wait a few hours before showering or swimming. Absorption varies from person to person, and some men get skin irritation.

Nasal testosterone gel

How it works. The FDA-approved nasal gel is pumped into each nostril two to three times a day, spaced out through the day. The product's labeled dosing is three times daily; your physician sets your schedule based on your symptoms and blood levels.

Pros: no needles and no gel on the skin, so there's no risk of transferring it to family members through touch. Because each dose is short-acting, levels rise and fall within the day in a pattern some patients prefer.

Cons: dosing two to three times a day takes commitment. Side effects in the nose are common, including a runny nose, nosebleeds, irritation, and scabbing. It generally isn't a good fit for men with chronic nasal or sinus problems, and insurance coverage and cost vary.

Testosterone pellets

How it works. Pellets are small cylinders of testosterone, about the size of a grain of rice, placed under the skin of the upper hip or buttock during a short office visit. They dissolve slowly and release testosterone over several months. Men typically need a new insertion roughly every three to six months, depending on the patient, the dose, and how quickly their body uses the hormone.

The procedure. The area is cleaned and numbed with a local anesthetic, and the pellets are placed through a small opening in the skin. At Lakewood Ranch Concierge, Dr. Kao uses atraumatic trocars for insertion. An atraumatic trocar has a blunt, rounded tip designed to gently separate the tissue under the skin rather than cut through it. The goal is a smaller entry site and less disruption of the surrounding tissue, which may mean less bruising and a more comfortable recovery. The site is closed with Steri-Strips (thin adhesive strips) and a bandage, so stitches typically aren't needed. Individual experiences vary.

The pellets we use. We use EvexiPEL pellets, which are compounded in an FDA-registered 503B outsourcing facility. Each EvexiPEL pellet combines testosterone with a small amount of triamcinolone, a corticosteroid (anti-inflammatory) medication intended to reduce inflammation around the pellet. Let us know if you've ever had a reaction to a steroid medication. Like all compounded medications, compounded pellets are not FDA-approved, meaning the FDA has not reviewed them for safety, effectiveness, or quality the way it reviews brand-name drugs. An FDA-approved testosterone pellet also exists. Dr. Kao can discuss the differences with you.

Pros: nothing to remember day to day, no needles at home, no risk of transferring testosterone to family members, and levels that tend to stay steady once the pellets settle in.

Cons: once pellets are placed, the dose can't easily be lowered, so if levels run higher than planned, you may need to wait for them to wear off. Like any minor procedure, insertion carries a small risk of bruising, bleeding, infection, or a pellet working its way out of the skin (called extrusion). You'll need to avoid strenuous lower-body exercise, swimming, and baths for a few days afterward, and you'll get specific aftercare instructions at your visit. Pellet therapy is often paid out of pocket.

What stays the same no matter which form you choose

Every form of testosterone is the same hormone with the same core risks. Any of them can raise your red blood cell count, increase PSA, and suppress sperm production, which can cause infertility. Men who want to father children should talk with their physician before starting any form of testosterone. Every form also requires the same follow-up: testosterone levels, a blood count, and PSA when appropriate, checked a few months after starting and periodically after that. For the full list of risks and who shouldn't use testosterone, see our testosterone therapy overview.

How we match the method to the patient

There's no single best form of testosterone therapy. At Lakewood Ranch Concierge, Dr. Kao offers injections, topicals, nasal gel, and pellets, and recommends the option he thinks fits each patient best. That decision considers:

• Your daily life. Do you travel often, swim or sweat heavily, or prefer not to think about a daily dose?
• Your household. Close contact with young children or a partner may make gels a less appealing choice.
• Your labs and history. A tendency toward a high red blood cell count, prostate history, and other conditions can favor one form over another.
• Your comfort. Some patients dislike needles; others prefer not to have an office procedure.
• Your fertility plans and budget. Both shape what makes sense now and later.

Choosing one form doesn't lock you in. If side effects, lab results, or your preferences change, switching methods is common and straightforward to plan together.

Testosterone therapy at Lakewood Ranch Concierge

Hormone evaluation and management for men is part of our membership. Members can reach Dr. Kao directly by phone, text, or portal, so questions about dosing, injection technique, or a pellet site don't have to wait for the next visit. Medications, pellets, procedure fees, and outside lab costs may not be included in your membership fee; MD Plan members have bloodwork draw fees waived. Contact the office for current pricing. Learn about our hormone services, text us to request an appointment, or call (941) 237-0129.