Injections, most flexible
Testosterone cypionate or enanthate, dissolved in oil, injected once or twice weekly. Subcutaneous is the modern default, see SubQ vs IM. Pros: dose flexibility, smooth steady-state with twice-weekly, easy to adjust based on labs, lowest cost route generally. Cons: requires self-injection (which most men adapt to quickly).
Cream / gel
Daily transdermal application, to shoulders, upper arms, or scrotum. Compounded creams are common in men's hormone optimization. Pros: no needles, daily steady delivery, easy to adjust dose. Cons: skin transfer risk to partners and children, daily compliance required, absorption variability between individuals.
Modern formulation note: scrotal cream often produces better systemic absorption with smaller dose than upper-body application.
Pellets
Crystalline testosterone implanted subcutaneously every 3-6 months. Released slowly. Pros: no daily/weekly action required, sustained delivery. Cons: dose can't be adjusted once placed (you wait until depletion), supraphysiologic peaks early, often produces estradiol issues, minor surgical procedure for placement.
Pellets have devoted followers but have lost ground to injections in modern men's clinics due to the dosing inflexibility.
Oral testosterone
Newer formulations (Jatenzo, Tlando) deliver testosterone orally. Twice-daily dosing required. Pros: no needles or skin application. Cons: more expensive, must be taken with fat-containing meals, requires twice-daily compliance, peak-trough variation greater than injections.
Patches
Adhesive patches applied to skin. Less commonly used now due to skin reactions and inferior pharmacokinetics vs cream. Niche role.
Side-by-side
| Factor | Injection (SubQ) | Cream | Pellets |
|---|---|---|---|
| Frequency | 2x/week | Daily | Every 3-6 months |
| Dose flexibility | High | High | Low (locked once placed) |
| Pharmacokinetics | Smooth | Daily peak-trough | Initial peak, slow decline |
| Skin transfer concern | None | Real (precautions needed) | None |
| Required procedure | Self-inject | Self-apply | In-office implantation |
| Cost (relative) | Lower | Moderate | Higher |
| Lab adjustment ease | Easy | Easy | Difficult |
The principle: The right route is the one you'll do consistently with the dose flexibility your protocol requires. For most patients, injections check both boxes, which is why they've become the standard.
Bottom line
Subcutaneous injections are the modern default for good reasons: dose flexibility, smooth pharmacokinetics, lab-adjustable, no skin transfer concerns. Cream is a legitimate alternative for needle-averse patients with stable protocols. Pellets work for some but limit fine-tuning. The right route is the one matched to your needs and your protocol.