Once a licensed provider has confirmed low testosterone, the next question is usually how to take it. Injections and creams deliver the same hormone, but they get it into your blood differently, and that changes what living with each one looks like.
The AUA's 2018 testosterone deficiency guideline uses a total testosterone below 300 ng/dL, measured on two separate early-morning blood draws, together with symptoms. One low reading isn't enough. Our guide to reading testosterone lab numbers walks through the details.
Injections go into a muscle or under the skin on a schedule your provider sets. Levels rise after each shot and drift down before the next one, and some men notice that swing in energy or mood near the end of the cycle. There's no daily routine and no risk of passing testosterone to someone else by touch. The AUA guideline notes that injectable testosterone is associated with higher rates of raised red blood cell counts (erythrocytosis) than skin-applied forms.
A cream is rubbed into the skin once a day and absorbed gradually, so levels stay steadier from day to day. The trade-offs are the daily habit, possible skin irritation where you apply it, and transfer. FDA-approved testosterone gels carry a boxed warning because children who touched treated skin developed signs of virilization, such as genital enlargement and body hair; the same transfer risk applies to a cream. Wash your hands after applying, let it dry, cover the area with clothing, and keep treated skin away from children and partners.
The testosterone cream and testosterone injection offered through Osirius are prepared by a licensed compounding pharmacy. Compounded medications are not FDA-approved and have not been evaluated by the FDA for safety or effectiveness.
Either form turns down the signals that drive sperm production, so the AUA advises against testosterone therapy for men trying to conceive; our guide to enclomiphene vs. TRT covers that trade-off. Labeling says testosterone shouldn't be used by men with breast cancer or known or suspected prostate cancer. The Endocrine Society's 2018 guideline advises against starting when hematocrit is above 50% without first looking into why, and stopping until it comes down if it rises above 54% on treatment. The TRAVERSE trial (NEJM, 2023), which studied testosterone gel in men with or at high risk for heart disease, found no increase in major cardiac events versus placebo, but did see more atrial fibrillation, acute kidney injury, and blood clots in the lungs. Get care right away for chest pain, sudden shortness of breath, or pain or swelling in a leg.
The Endocrine Society recommends rechecking testosterone and hematocrit at 3 to 6 months and again at 12 months after starting, then yearly, with prostate monitoring where it applies. For injections, levels are usually drawn midway between shots; for a cream, your provider will tell you when to test relative to your daily application. Which form fits often comes down to needles versus a daily habit, whether there are children at home, and your blood counts. A licensed provider reviews your history and labs and decides what, if anything, is appropriate.
This guide explains general information and is not medical advice. It doesn't replace a licensed provider reviewing your own history.
