Testosterone Cypionate: The Definitive Guide

What is testosterone cypionate?

Testosterone cypionate is a prescription form of testosterone that is injected into a muscle. It is testosterone with a small chemical tail attached, dissolved in oil. The tail makes the hormone release slowly from the injection site, so one shot lasts days rather than hours. It is widely prescribed in the United States: Medicare Part D alone paid for about 1.1 million generic cypionate prescriptions in 2024. [1], [2]

The name describes the chemistry. "Cypionate" is short for cyclopentylpropionate, the ester (a chemical tail) joined to testosterone. The body snips the tail off to release ordinary testosterone. Because the tail adds weight, 100 mg of testosterone cypionate contains about 70 mg of testosterone. [1], [3]

It is labeled for men with hypogonadism (low testosterone from a medical cause): either primary hypogonadism, where the testicles fail, or hypogonadotropic hypogonadism, where the brain and pituitary do not send enough signal. US labels still say its safety and benefit in "age-related" low testosterone have not been established. It was first approved in the United States in 1953. [1], [4]

[1], [5], [4], [6], [3]

Testosterone cypionate is a controlled substance: Schedule III in the United States. People also meet it outside medical care, as compounded vials or as bodybuilding "test cyp". Those products are not covered by the labels described here, and supraphysiologic (above the natural range) "cycle" doses are not testosterone replacement therapy, or TRT (see TRT vs steroids). [1], [7]

Typical Testosterone Cypionate Protocols

Every guideline schedule averages 50–100 mg a week, and 100 mg weekly or 200 mg every 2 weeks fits all of them; the US urology guideline prefers 100 mg weekly. The labels allow a much wider range: 50–400 mg every 2–4 weeks in the United States and a fixed 200 mg every 2 weeks in Canada. [1], [6], [8], [9], [10], [11], [12]

Titration Adjusting the dose in steps

The US labels adjust the dose to response and side effects and name no blood test. Guidelines adjust by the testosterone level but disagree on when to draw it and what to aim for: the Endocrine Society measures midway between injections and adjusts above 600 or below 350 ng/dL (about 12–21 nmol/L), the AUA aims for 450–600 ng/dL, and two UK societies judge injections by the trough level before the next dose. Hematocrit can also force a change. [1], [8], [9], [12], [13] See why draw timing matters.

Breaks and cycles

Not applicable. Testosterone replacement is continuous treatment; no label or guideline describes planned breaks or cycles, and the UK Society for Endocrinology expects lifelong treatment once the diagnosis is confirmed. Stopping is a separate decision (what happens when you stop). [12]

Read the units. Doses are written in milligrams (mg) of testosterone cypionate, but you draw a volume, and the volume depends on the vial's strength. At 200 mg/mL, 100 mg is 0.5 mL, which is 50 units on a U-100 insulin syringe. At 100 mg/mL, the same 100 mg is 1 mL. The amount each time and the weekly total are different numbers: 200 mg every 2 weeks averages 100 mg a week. Doserly's TRT dose calculator does the arithmetic for any strength and schedule. [1], [5]

These are labeled and guideline doses; prescribers adjust them using blood tests and symptoms. The ranges above are for adult men. For women, see testosterone therapy for women, which uses different products and far smaller doses.

Cautions for every schedule above. The labels rule out testosterone with breast or known or suspected prostate cancer, pregnancy and serious heart, liver or kidney disease, and it must never go into a vein. It shuts down sperm production (fertility), and hematocrit, blood pressure and PSA (prostate-specific antigen, a prostate blood test) need checking (monitoring). [1], [4], [9]

Where schedules differ: label vs guideline doses, weekly vs every 2 weeks, split doses, muscle vs fat and blood-test timing ↓

What do clinic protocol sources use?

The rows are alternatives, not steps to move through. The first two come from one university group, so they count as one source of practice rather than two. All four average 70–100 mg a week, inside the guideline range. [17], [18], [21], [19], [20]

What is testosterone cypionate commonly used for?

Its approved use is replacing testosterone in men whose bodies cannot make enough because of a medical condition. The labels name two groups: testicular failure (from undescended testicles, twisting, infection, removal or a condition present from birth) and a missing signal from the brain or pituitary (from a hormone deficiency, a tumor, injury or radiation). [1]

What does testosterone replacement improve?

In trials, testosterone treatment for low testosterone mainly improves sexual desire and activity; effects on mood are small, and energy did not improve in the Testosterone Trials. Those findings come mostly from trials of gels. In the 12-week trial of cypionate 100 mg weekly in prostate cancer survivors, sexual activity rose by about 0.9 daily events and desire improved, while erections did not change. In the Testosterone Trials of men 65 and older, a year of gel improved sexual activity, desire and erections a little, but not energy or walking in the physical function trial. [22], [23]

It also raises red blood cell production: in the Testosterone Trials, 58.3% of men with unexplained anemia were no longer anemic after a year, compared with 22.2% on placebo. Across 29 randomized trials in middle-aged and older men, testosterone reduced fat by about 1.6 kg and added about 1.6 kg of lean mass without changing body weight. The red-cell effect is also why hematocrit is monitored. [24], [25] See the evidence and the results timeline guide.

How long does testosterone cypionate take to work?

Blood levels rise within a day or two of the first injection, but symptoms change more slowly. A widely cited review found sexual interest improving after about 3 weeks, erections over up to 6 months, mood from 3 to 6 weeks, and body composition over 12 to 16 weeks. The Canadian Urological Association tells men to expect changes in libido, energy and sexual function after 3 months or longer, and body composition and bone after 6 months or more. [6], [26], [11]

Where do testosterone cypionate protocols differ?

The labels are broad and old; the guidelines are narrower and newer. Most real disagreements are about how often to inject, where to inject, how to split doses and when to draw blood.

Is the dose from the label or from a guideline?

A label schedule and a guideline schedule answer different questions. The US label, unchanged in its dosing for decades, allows 50–400 mg every 2–4 weeks with no blood-test rule. Guidelines written with modern blood tests center on about 100 mg a week and adjust by level. The label's top end, 400 mg every 2 weeks, averages 200 mg a week, twice the guideline center. [1], [8], [9]

Weekly or every 2 weeks?

Guidelines increasingly prefer weekly injections of a smaller dose. The AUA prefers smaller, more frequent doses of short-acting injections: a starting dose of 100 mg weekly is preferred to 200 mg every 2 weeks or 300–400 mg monthly. [9]

The only comparison with clinical results is observational. In one clinic's records of 263 men, hematocrit rose above 54% in 1 of 102 men on 100 mg weekly and 4 of 51 on 200 mg every 2 weeks, with no difference in estradiol; the abstract does not say which ester was used. No randomized trial has compared injection frequencies on health outcomes. [27]

What about twice-weekly or daily injections?

Twice-weekly and daily schedules are widely discussed online, but no guideline or peer-reviewed practice source gives a complete schedule for them. [28] The British Society for Sexual Medicine lists "subcutaneous micro-dosing" as a way cypionate is used, without a dose, and notes little long-term published data. In principle, splitting the same weekly total into smaller, more frequent injections narrows the gap between peak and trough, the same logic behind the AUA's preference for smaller, more frequent doses; no trial has tested split schedules. [13], [9]

What people report on these schedules is in the community section. When a prescriber splits a weekly total, the arithmetic is simple: 100 mg a week given twice weekly is 50 mg per injection, or 0.25 mL at 200 mg/mL. The weekly total is still the number the guidelines describe.

Intramuscular or subcutaneous?

US cypionate labels say intramuscular only, deep in the buttock muscle. The UK Society for Endocrinology says subcutaneous injection (into the fatty layer under the skin) of cypionate or enanthate at 50–100 mg once a week has comparable blood levels, safety and tolerability to intramuscular injection. [1], [12]

The evidence behind that view is small and mostly outside men with hypogonadism:

• In 63 transgender men on weekly subcutaneous cypionate or enanthate, all reached the normal male range, and all 22 who switched from muscle injections preferred subcutaneous ones. [29]
• In small studies of 11 and 14 transgender men, weekly subcutaneous levels stayed fairly stable, exposure per mg was similar by either route, and subcutaneous injections were rated less painful. [30], [31]
• In 234 men with hypogonadism, a weekly subcutaneous enanthate autoinjector gave lower hematocrit and estradiol than weekly intramuscular cypionate, but the ester, device and route all differed, so the study cannot isolate the route. [32]

A 2022 review concluded that subcutaneous injection is a reasonable option but that direct safety comparisons with intramuscular injection are missing. Injection technique is covered in how to inject testosterone. [33]

When should blood be drawn: mid-interval or trough?

Guidelines genuinely disagree, and the same blood test can look very different depending on the day it is drawn. After a 200 mg injection in men with hypogonadism, testosterone roughly tripled by day 2 and returned toward the starting level by day 14. A level drawn on day 3 and a level drawn on day 13 describe the same dose. [6], [34]

[8], [9], [10], [11], [35], [13], [12], [36]

Practice reviews use both for different purposes: a mid-interval level estimates average exposure, and a trough shows whether levels fall too low before the next dose or build up over time. Whatever timing a prescriber uses, recording the day of the draw relative to the last injection makes results comparable. [18], [21], [37] See TRT blood work for the full picture.

What happens when you stop testosterone cypionate?

The drug itself is gone within weeks; your own hormone production takes much longer to return. [34], [38]

• The last injection. After a single 200 mg dose, testosterone and estradiol returned to their starting levels by days 13–14. [34]
• Your own testosterone. Injected testosterone switches off the pituitary's two signals to the testicles, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). How fast they recover depends on the original cause of low testosterone and how long treatment lasted. After men stopped 2 years of long-acting undecanoate injections in the T4DM trial, LH and FSH recovered slowly over 12 months, and full recovery may take longer. In men with a lasting cause of hypogonadism, low testosterone is expected to return, which is why the Society for Endocrinology treats a confirmed diagnosis as lifelong; no study has tracked hormone recovery after long-term cypionate. [38], [12]
• Sperm. In contraceptive trials of healthy men, sperm counts returned to 20 million per mL in 67% within 6 months, 90% within 12 months and 100% within 24 months. The labels warn that effects on fertility may be irreversible for some men. [39], [4]
• Tapering. The Canadian Urological Association says no taper is needed when stopping. [11]

See stopping TRT for the full picture, including fertility recovery and what men describe.

How does testosterone cypionate compare with other forms?

It is a short-acting injectable ester. Compared with gels, it causes high hematocrit more often, according to the Endocrine Society; compared with long-acting undecanoate injections, it is injected far more often. [1], [8], [40]

How long does testosterone cypionate last in the body?

The US label gives a half-life of about 8 days after intramuscular injection. That figure describes how slowly the depot releases testosterone, not how long testosterone itself lasts: testosterone released into the blood is cleared within minutes to about an hour (label figures range from 10 to 100 minutes). A 2018 model of healthy men on weekly injections estimated a median half-life of 4.05 days, so figures differ by method. [1], [41], [42]

What do the peaks and troughs look like?

Measured studies give the shape. In 11 men with hypogonadism given 200 mg, testosterone roughly tripled by day 2 (1,108 ± 440 ng/dL, about 38 nmol/L), peaked between days 2 and 5, and fell back to 360 ± 166 ng/dL (about 12 nmol/L) by day 14. Many values were above the normal range from days 2 to 7. In a crossover study of 6 healthy men comparing 200 mg of cypionate with 194 mg of enanthate, average levels rose to about three times the starting level (about 1,350 ng/dL) at 24 hours and were back to it (about 500 ng/dL) by day 10; the monograph does not report the two esters separately. For Azmiro, the label reports a median time to peak of 71.7 hours (about 3 days, range 1 to 8 days) and an average peak of 758 ng/dL above the starting level. [6], [34], [4]

Doserly

Peaks and troughs after an injection

Measured after one 200 mg injection

Men with hypogonadism (n = 11)

Day 2: 1,108 ± 440 ng/dL (about 38 nmol/L). Peak between days 2 and 5. Day 14: 360 ± 166 ng/dL (about 12 nmol/L).

Healthy men (n = 6, crossover study)

About 1,350 ng/dL at 24 hours; back to their starting level (about 500 ng/dL) by day 10. The study compared 200 mg cypionate with 194 mg enanthate and reports these values without separating the two.

When blood is drawn

Mid-interval: day 7 of a 2-week schedule (Endocrine Society range 350–600 ng/dL). Trough: just before the next injection (day 14).

Model: same 100 mg/week total, different schedules

Relative level at steady state over 4 weeks; triangles mark injections.

200 mg every 2 weeks

Peak about 2.4 × the trough

100 mg weekly

Peak about 1.4 × the trough

50 mg twice a week

Peak about 1.1 × the trough

Simplified model; individual levels vary; your labs are what count.

Those swings explain the guideline split on frequency and draw timing (above), and why one practice review offers 100 mg every 7–10 days for men whose mood or acne swings with the peaks and troughs. [18]

Is cypionate different from enanthate?

Very little in practice. Both are short-acting esters in oil, and the US labels give them the same dosing, 50–400 mg every 2–4 weeks. The main differences are the ester's size, the oil (US cypionate uses cottonseed oil; US enanthate vials use sesame oil) and which products are sold where. Canada markets both; the UK and Australia list enanthate products but no cypionate product in their current product information. See cypionate vs enanthate and the enanthate guide, which covers the Xyosted autoinjector. [1], [41], [43], [44], [45]

The Depo-Testosterone label warns against swapping cypionate for testosterone propionate, a much shorter-acting ester, because their durations differ. [1]

What is in the vial, and why can it crystallize?

US cypionate vials contain testosterone cypionate dissolved in cottonseed oil, with benzyl benzoate to help it dissolve and benzyl alcohol as a preservative. Spain's product uses olive oil and ethyl oleate instead. Below the labeled storage temperature, crystals can form; the label says warming and shaking the vial should redissolve them. [1], [3], [46]

The label's "gasping syndrome" warning about benzyl alcohol concerns newborns, not adult doses. [1]

Azmiro: what is it, and how is it different from Depo-Testosterone?

Azmiro is testosterone cypionate 200 mg/mL in a single-dose glass vial or a single-dose prefilled glass syringe. It is not an autoinjector: the syringe comes without a needle, holds only a 200 mg dose, and the label says it is given by a healthcare professional. Other doses come from the single-dose vial. [4]

Why it exists. Cypionate vials can form crystals when stored below 20–25 °C. Azmiro's maker added more benzyl alcohol (20 mg/mL instead of 9.45) to reduce crystallization, and because the ingredients were no longer identical to Depo-Testosterone, FDA required a new drug application under its 505(b)(2) pathway, which relies partly on the older product's record. [46]

The evidence. Azmiro was bridged to Depo-Testosterone by one single-dose crossover study in men with hypogonadism: 28 enrolled and 26 completed, each receiving 200 mg of both products 70 days apart. Blood levels fell within the standard 80–125% range used to call two products bioequivalent, and the median time to peak was 71.7 hours for Azmiro and 70.3 hours for Depo-Testosterone. Injection-site redness occurred in 7 of 27 men (26%) with each product, all mild. [46], [4]

Timeline. FDA approved the application (NDA 216318, from Slayback Pharma) on June 2, 2022. The name Azmiro was added on February 1, 2024, Azurity's name went on the carton on December 18, 2024, and blood-pressure and blood-clot labeling was updated on July 11, 2025. [47], [48], [49], [50]

How it differs on paper:

• Substitution. The Orange Book lists Azmiro as its own reference product with no equivalence code, so it is not rated as interchangeable with Depo-Testosterone for pharmacy substitution. Its label says injectable testosterone products are not substitutable milligram for milligram. [5], [4]
• Label content. Azmiro's newer-format label carries the TRAVERSE heart-trial results and lists sleep apnea, lipid changes, prostate checks and possible azoospermia as warnings. The Depo-Testosterone and generic vial labels still carry the older statement that long-term heart-safety trials have not been done. [4], [1]
• Storage. Azmiro is stored at 15–25 °C in its carton; Depo-Testosterone at 20–25 °C. [4], [1]
• Open questions. FDA required a 24-hour blood-pressure monitoring study after approval, due for its final report in July 2025; no result appears in the current label. No official US price was found. Azmiro is not sold in Canada or the UK (checked September 2026). [47], [4], [43], [44]

If you switch between Azmiro and another cypionate product, ask the prescriber whether the dose or the timing of blood tests should change.

How should testosterone cypionate be stored?

Store it at controlled room temperature and protect it from light. Crystals can form when it gets colder than the labeled range. Each product's label sets its own rules, so the leaflet in your box is the final word. [1], [4], [6]

[1], [15], [4], [6]

How long does an opened vial last? No US cypionate label gives an in-use period for a 10 mL multi-dose vial. US guidance for healthcare settings says an opened multi-dose vial should be dated and discarded within 28 days unless the manufacturer states another date, and the US Pharmacopeia (USP), which sets pharmacy standards, applies the same 28-day limit after first puncture. That guidance was written for clinics, but it is the only US standard; the Canadian monograph allows 56 days. [51], [52], [6]

For carrying vials on a trip, see traveling with testosterone. This guide does not teach injection technique; the Academy note below covers the practical basics, and how to inject testosterone covers sites and needles.

What does testosterone cypionate do to fertility, estrogen and red blood cells?

These three effects come with every form of testosterone; each has its own hub guide. Here is what is specific to cypionate.

Fertility. In a randomized study of healthy men, cypionate 100 mg a week made LH and FSH undetectable within 5–6 weeks and impaired sperm production at every dose tested; the effects reversed after stopping. In a World Health Organization (WHO) trial of weekly 200 mg of enanthate, a closely related ester, 65% of healthy men had no sperm at all (azoospermia) within 6 months. The AUA says testosterone should not be prescribed to men trying to conceive, and the US male infertility guideline extends that to men interested in future fertility. See TRT and fertility. [53], [54], [9], [55]

Estrogen. Some testosterone is converted into estradiol. After a 200 mg cypionate injection, estradiol roughly tripled between days 2 and 7, tracking the testosterone peak. No guideline sets a routine estradiol target: the AUA measures it mainly when breast symptoms appear, and the VA does not recommend aromatase inhibitors. See estrogen on TRT. [34], [9], [10]

Red blood cells. In a network meta-analysis of 29 randomized trials, hematocrit rose by about 4.0 percentage points more than on placebo with enanthate and cypionate injections, 3.0 with gel and 1.6 with undecanoate injections. The analysis could not show a clear difference between injections and gel, only between injections and skin patches; the Endocrine Society still lists fewer red-cell rises as an advantage of gels over injections [8]. In a 4-month randomized trial, cypionate 200 mg every 2 weeks raised average hematocrit from 42.7% to 46.6%, while nasal testosterone did not change it. In a clinic sample of 30 men on 100–200 mg weekly, 3 reached 54% or more and 10 reached 50% or more. See hematocrit on TRT. [56], [57], [58]

What do we actually know about testosterone cypionate in people?

That it restores testosterone is settled; it has been used for decades and is labeled for that. What it does over years comes mostly from trials of other forms of testosterone. Trials of cypionate itself are small or short.

Which studies used cypionate itself?

The randomized trials of cypionate ran 4 months or less, so for longer-term questions the evidence comes from other testosterone trials.

What did the large trials of other forms find?

• TRAVERSE (about 5,200 men, daily gel): heart attack, stroke or heart death in 7.0% vs 7.3% on placebo, which met the trial's safety margin, but more heart-rhythm, kidney, clot and fracture events (full results). [59], [4]
• Testosterone Trials (790 men aged 65 or older, gel for 1 year): small gains in sexual function and mood; no gain in energy or walking in the physical function trial. [23]
• T4DM (1,007 men with prediabetes or new diabetes in a lifestyle program, undecanoate injections for 2 years): fewer men developed diabetes (55 of 443 with results, 12%, vs 87 of 413, 21%), but hematocrit went above 54% in 106 of 491 men on testosterone (22%) vs 6 of 484 on placebo (1%). [60]

Whether those results transfer to weekly or every-2-week cypionate is not known; the swings in level and the rise in hematocrit are reasons for caution. [56]

How does testosterone cypionate work?

Once injected, the oil forms a depot in the muscle. The ester slowly moves out of the oil into the blood, where enzymes remove the cypionate tail and free testosterone. That slow exit, not testosterone's own short life in the blood, sets the dosing interval. [1], [41]

Testosterone then acts like the body's own hormone. In many tissues it works after being converted to dihydrotestosterone (DHT), and some is converted to estradiol. In the blood, most is bound to proteins, including sex hormone-binding globulin (SHBG), and about 2% is free. [4], [1]

Why it switches off your own production. The brain senses testosterone from any source. When levels are high, the pituitary lowers its LH signal to the testicles, and at higher doses its FSH signal too. Without LH the testicles make little testosterone, and without FSH and the high testosterone level inside the testicle, sperm production falls. [1], [53]

Why it raises red blood cells. Androgens stimulate red blood cell production; the Depo-Testosterone label describes this as increased production of an erythropoietic (red-cell-making) factor. The Endocrine Society notes more red-cell rises with injections than with gels; the studies do not show exactly why. [1], [8], [56]

What are the risks and unanswered questions?

Is testosterone cypionate safe?

For men with a confirmed diagnosis and regular monitoring, it has a long record as standard treatment, and its main risks are well known: a rise in red blood cells, blood clots, higher blood pressure, fluid retention, breast enlargement, prostate effects and loss of fertility. What remains uncertain is long-term heart and prostate safety on injections specifically, since the largest safety trial used a gel. [1], [4], [59]

What side effects do the labels list?

The labels list acne, oily skin, hair loss in a male pattern, breast enlargement (gynecomastia), fluid retention, changes in libido, headache, anxiety, depression, nausea, prolonged or frequent erections, a rise in red blood cells (polycythemia), and pain or inflammation where the injection went in. Rare reports include liver problems, allergic reactions and a fluid build-up behind the retina. [1], [4]

In the Azmiro study, the most common reaction was mild redness at the injection site (26%); another 4% had other mild injection-site reactions. [4]

Does testosterone cypionate affect the heart?

The best evidence comes from TRAVERSE, a randomized trial of about 5,200 men aged 45 to 80 with heart disease or high heart risk, given daily testosterone gel or a placebo gel. Among the 2,596 men who used testosterone gel and the 2,602 who used placebo gel, it found:

• Heart attack, stroke or heart death: 182 men (7.0%) on testosterone vs 190 (7.3%) on placebo; hazard ratio 0.96, with a 95% confidence interval of 0.78 to 1.17. The top of that range stayed below the trial's safety margin of 1.5, so a large rise in risk was ruled out. [59], [4]
• Heart rhythm: atrial fibrillation 3.5% vs 2.4%; nonfatal rhythm problems needing treatment 5.2% vs 3.3%. [4]
• Kidneys: acute kidney injury 2.3% vs 1.5%. [4]
• Clots: venous clots 1.7% vs 1.2%, including pulmonary embolism 0.9% vs 0.5%. [4]
• Fractures: 91 of 2,601 men (3.50%) vs 64 of 2,603 (2.46%), counting every randomized man. [61]
• Blood pressure: systolic pressure rose 1.0 mm Hg on testosterone and fell 0.5 mm Hg on placebo by 36 months. [4]
• Substudies: in men with low libido, testosterone increased sexual activity and desire but not erections; it did not significantly slow progression from prediabetes to diabetes; and it did not improve persistent depressive disorder in the 49 men who had it. [62], [63], [64]

Doserly

TRAVERSE: absolute results

Testosterone gel (2,596 men)Placebo gel (2,602 men)

Heart attack, stroke or heart death

Testosterone 7.0% vs placebo 7.3% (182 vs 190 men; hazard ratio 0.96, 95% CI 0.78–1.17; met the 1.5 safety margin)

Nonfatal rhythm problems needing treatment

Testosterone 5.2% vs placebo 3.3%

Atrial fibrillation

Testosterone 3.5% vs placebo 2.4%

Clinical fracture

Testosterone 3.5% vs placebo 2.5% (91 of 2,601 vs 64 of 2,603 in the full analysis set)

Acute kidney injury

Testosterone 2.3% vs placebo 1.5%

Venous clots (all)

Testosterone 1.7% vs placebo 1.2%

Pulmonary embolism

Testosterone 0.9% vs placebo 0.5%

About 5,200 men aged 45–80 at high heart risk; daily gel; mean treatment 21.7 months; about 61% stopped their study gel. Not a trial of injections.

Its limits matter for cypionate. TRAVERSE tested only a gel, the average man used it for 21.7 months, about 61% stopped their study gel early, and it enrolled men at high heart risk. It did not test the higher peaks and larger hematocrit rises of injections. A 2025 meta-analysis of 23 trials lasting at least a year found no increase in death, heart attack or stroke, but about 50% more heart-rhythm problems (risk ratio 1.53). [59], [4], [65]

Which label says what. In February 2025 FDA added the TRAVERSE results to testosterone labels. Azmiro's label carries them. The Depo-Testosterone and generic cypionate vial labels, including versions revised in 2026, still say that long-term heart-safety trials "have not been conducted" (checked September 2026). [66], [4], [1], [15]

Blood pressure and red cells. All testosterone products can raise blood pressure, and the labels advise against use with uncontrolled high blood pressure. In a large records study of men on testosterone, heart attacks, strokes or clots in the first year occurred in 301 of 5,842 men whose hematocrit reached 52% or more (5.15%) vs 226 of 5,842 matched men whose hematocrit stayed lower (3.87%); it was observational, so it cannot prove cause. [1], [66], [67]

See TRT and heart health for the full picture.

What about blood clots, sleep apnea and fluid retention?

• Blood clots. The labels report clots in the legs (deep vein thrombosis) and lungs (pulmonary embolism) after marketing and in TRAVERSE; leg pain, swelling, warmth or redness, or sudden shortness of breath need urgent assessment. [1], [4]
• Sleep apnea. Azmiro's label warns that testosterone may worsen sleep apnea, especially with obesity or lung disease. [4]
• Fluid retention. Swelling, with or without heart failure, can be serious in people with heart, kidney or liver disease. [1]

Can oil injections cause a cough or an allergic reaction?

Rarely. Oil injected into muscle can occasionally reach the lungs as tiny droplets (pulmonary oil microembolism), causing a sudden urge to cough or shortness of breath. FDA noted rare reports of severe cases and allergic reactions with enanthate and cypionate injections, but counted only 33 reports over 44 years across all approved testosterone injections combined. The Endocrine Society guideline says such coughs occur even more rarely with enanthate and cypionate than with undecanoate injections. In an older study of 551 nurse-given weekly enanthate injections in castor oil, 1.5% were followed by a brief cough with faintness. No incidence figure exists for cypionate itself. [68], [8], [69]

Could testosterone cypionate affect the prostate?

Testosterone can enlarge the prostate and raise PSA slightly; in TRAVERSE, PSA rose about 0.15 ng/mL more than on placebo at 12 months. US labels contraindicate it in known or suspected prostate cancer and warn that men with an enlarged prostate may develop urinary blockage. In TRAVERSE, which excluded men with PSA above 3.0 ng/mL, high-grade prostate cancer occurred in 5 of 2,596 men on testosterone (0.19%) vs 3 of 2,602 on placebo (0.12%), a difference that was not significant. In the 2026 trial of cypionate in men treated surgically for low-grade prostate cancer, no PSA recurrence occurred over 12 weeks. [1], [70], [22] See TRT and the prostate.

Is testosterone cypionate legal? Is it FDA approved?

Checked September 2026. Rules differ by country and change often.

United States. Testosterone cypionate is an FDA-approved prescription medicine and a Schedule III controlled substance. The key steps:

• Products. Depo-Testosterone, Azmiro and generics from several makers are approved; the newest generic was approved on September 3, 2026. [5], [71]
• 2015 and 2016. In 2015 FDA required labels to say that safety and benefit in "age-related" low testosterone have not been established; since 2016, labels have also carried warnings on abuse and dependence. [66], [1]
• February 28, 2025. FDA added TRAVERSE results and blood-pressure warnings to testosterone labels and removed boxed-warning language about heart risk. Injectable esters such as cypionate have no boxed warning. [66], [1]
• June 18, 2026. The Department of Health and Human Services (HHS) announced that FDA is requesting label changes: removing the age-related limitation, contraindicating testosterone only in metastatic prostate cancer, and revising the prostate-enlargement warning. These are requests: the newest cypionate label, effective September 9, 2026, still carries the old wording. [72], [15]
• Telehealth. Temporary rules let clinicians prescribe controlled medicines such as testosterone without an in-person visit through December 31, 2026; a permanent Drug Enforcement Administration (DEA) special-registration rule is still under review. [73], [74]
• Compounded cypionate. The AUA advises commercially made testosterone over compounded products when possible. [9]

Canada. Testosterone is a Schedule IV controlled substance and prescription-only. Taro's cypionate is marketed; Depo-Testosterone was cancelled on July 18, 2025, and a StériMax cypionate was approved on July 20, 2026 but is not yet marketed. [75], [43]

United Kingdom. Testosterone is a Class C controlled drug (Schedule 4 Part II), prescription-only. No testosterone cypionate product has current UK product information; UK injections are enanthate, Sustanon 250 and undecanoate. [76], [44]

Australia. Testosterone is a Schedule 4 (prescription-only) medicine with extra controls on possession. No cypionate product is among Australia's current testosterone product information documents. [77], [45]

European Union. Rules are national. Spain licenses and markets cypionate as Testex Prolongatum; other member states were not checked for this guide. [3] See TRT in Europe.

A "research use only" label on a vial does not make it legal, tested or the same as a licensed product.

Is testosterone cypionate banned in sport? Does it show up on a drug test?

Yes. Testosterone and its esters are on the World Anti-Doping Agency (WADA) Prohibited List in class S1, banned in and out of competition, and the 2027 list keeps that from January 1, 2027. Athletes with a medical need can apply for a therapeutic use exemption, which WADA grants only when low testosterone has an organic cause (such as a testicular or pituitary disorder), not for age, obesity or earlier steroid use. [78], [79], [80]

Anti-doping labs can detect injected testosterone, and a study of a single 100 mg cypionate dose found markers that extend the detection window. No source gives a fixed number of days, so there is no reliable clearance time to plan around. [81]

Who should be especially cautious?

• Men who want children now or soon. Testosterone suppresses sperm production; guidelines advise against it for men trying to conceive, and recovery can take months or longer. [9], [55]
• Men with prostate or breast cancer. Contraindicated on current US labels (known or suspected prostate cancer). [1]
• Heart, kidney or liver disease, or high blood pressure. Fluid retention and blood-pressure rises can worsen these; the labels advise against use with uncontrolled high blood pressure. [1], [4]
• High hematocrit or a history of clots. Several guidelines treat a high starting hematocrit or unexplained clots as reasons not to start. [8], [10]
• Sleep apnea. Untreated severe sleep apnea is a caution in guidelines and labels. [8], [4]
• Women and children. Testosterone is contraindicated in pregnancy and can harm an unborn baby; these guides are for men. Use in teenagers is specialist care only, because it can close growth plates early. [1]
• Drug-tested athletes. Banned at all times. [78]
• People taking other medicines, such as blood thinners, insulin or corticosteroids; see the next question.

Can testosterone cypionate be taken with other medicines?

The labels list three interactions:

• Blood thinners (oral anticoagulants). Testosterone can change their effect; the Azmiro label advises frequent blood-clotting tests (INR and prothrombin time), especially when starting and stopping testosterone. [4]
• Insulin and diabetes medicines. Testosterone can lower blood sugar and insulin needs. [1], [4]
• Corticosteroids. Together they can increase fluid retention. [4]

Testosterone can also lower thyroxine-binding globulin, which changes total thyroid hormone results without changing thyroid function. Guidelines discuss hCG, clomiphene and aromatase inhibitors alongside testosterone for fertility or estrogen questions; see TRT and fertility and estrogen on TRT. Bring a full list of everything you take, including supplements, to a pharmacist or doctor. [1]

Is testosterone cypionate available, and what does it cost?

Checked September 2026.

In the United States it is widely prescribed: Medicare Part D alone paid for about 1.1 million generic cypionate prescriptions in 2024. FDA's drug shortage data lists no testosterone shortage (updated September 26, 2026). [2], [82]

There is no single US price. As a reference point, the average price pharmacies paid for generic cypionate in September 2026 was about $3.58 per mL for 10 mL vials of 200 mg/mL (about $36 a vial), $4.53 per mL for 10 mL vials of 100 mg/mL, and $11.39 per mL for 1 mL single-dose vials. What you pay depends on the pharmacy, insurance and any fees. Medicare's average gross cost was $37.01 per generic prescription in 2024, before rebates. No official price was found for Azmiro. [83], [2]

What should be monitored while using testosterone cypionate?

The labels ask for hemoglobin and hematocrit checks "periodically", blood pressure checks and, on Azmiro's label, PSA and lipid checks; they give no numeric hematocrit limit. The numbers come from guidelines. Use this summary to prepare questions for your prescriber; it is not a personal testing plan. [1], [4]

[8], [9], [10], [12], [1], [4]

The European urology guideline monitors testosterone and hematocrit at 3, 6 and 12 months and then yearly, more often in the first year for men at higher hematocrit risk. The Canadian Urological Association uses its own hematocrit trigger of 55%. [40], [11] See TRT blood work and hematocrit on TRT.

Write down the timing. For every testosterone result, note the date of the last injection and the dose. On cypionate, a result without its timing is hard to interpret. [37]

What do people in public communities report?

Public forums hold every kind of cypionate story: men who feel like themselves again, men who notice nothing after months, and men who stopped after side effects. The accounts below come from public Reddit threads from the past year and are described without identifying anyone.

What do the positive reports look like, and how long do they take?

Better sex drive, erections, energy and mood are the usual good news, over weeks to months. A 41-year-old whose antidepressant had flattened his sex drive was started by a urologist on 200 mg every 2 weeks; at about 4 months he described desire and erections as much better, with only a small dip before each injection, and kept that schedule despite replies urging more frequent shots. A 29-year-old on 100 mg weekly noticed more energy, sex drive and morning erections by his fourth injection, though anxiety about performance still got in the way at times. [84], [85]

Early reports are hard to read. One man felt calmer and more energetic 9 days into daily subcutaneous injections and called it "probably placebo" himself. Another felt nothing by week 5 on 200 mg weekly except more hunger, and chose to keep a symptom log until his week-12 blood tests. [86], [87]

Does everyone respond?

No. A man on 50 mg and then 75 mg twice weekly felt no better after 4 months and planned to discuss stopping, partly because of a $200 monthly cost. A 39-year-old on 200 mg weekly felt stronger, but his sex drive and erections got worse, alongside acne, water retention, oily skin and headaches; his level 8 days after the injection was 574 ng/dL. [88], [89]

What do people say about injection frequency?

It is the most discussed topic, and experiences point both ways:

• Every 2 weeks felt too long for some. One man felt very unwell before each 200 mg dose until his doctor switched him to 100 mg weekly; he also had several other health problems. [90]
• A switch that helped, with a catch. After several cypionate schedules, one man moved to 75 mg of enanthate weekly and described steadier weeks, better libido and average blood pressure falling from 140/90 to 118/84 on the same medicine. His dose and schedule had changed too, so the ester alone cannot explain it. [91]
• Daily was not better for everyone. Some describe feeling "flat" on daily injections, and one found troughs hard on every-4-day doses as well. [92], [93]
• New symptoms need checking. One man who moved from weekly to every-other-day injections developed chest tightness and shortness of breath; hospital tests were normal and his doctor suspected reflux. [94]

Replies in these threads agree that the best-feeling schedule differs between people, and many see no reason to change a schedule without symptoms to fix. [28]

Why do blood results confuse people?

Timing. One man injecting 50 mg a week split over three days had blood drawn 7 days after his last shot, following instructions written for a weekly schedule: his testosterone came back at 186 ng/dL, below his pretreatment 356 ng/dL, and he felt foggy by day 5. The opposite happened to a man on 160 mg a week whose estradiol read 102 pg/mL on blood drawn about 11 hours after an injection, near a peak. [95], [96] See when blood should be drawn.

What unwanted effects come up?

• Acne. Painful chest and back acne after months of treatment comes up repeatedly. One man lowered his dose and started an aromatase inhibitor at the same time; the acne improved, but his sex drive and morning erections disappeared, and with two changes at once he could not tell which was responsible. [97], [98]
• Breast and nipple sensitivity and water weight. One man's nipple sensitivity came and went from week 4 and settled by week 8 with no lump. Another, on 180 mg a week without a prescription, gained about 7 lb of puffiness and planned a lower dose. [99], [100]
• Blood pressure. After a first 200 mg injection, one man reported blood pressure of 160–175/105, headaches and irritability, and stopped treatment. [101]
• Prostate symptoms. A man with a known enlarged prostate described pelvic pressure and a weaker urine stream 7–8 weeks after starting. [102]
• Injection-site reactions. One man had skin reactions that needed a week of steroid treatment and returned after a change of carrier oil; others describe lumps after subcutaneous injections. [103], [104]
• Tiredness with another cause. A man who had felt well on 120 mg a week developed fatigue that turned out to involve low iron, months after donating blood. [105]

What do people report about doses, costs and access?

Volume mix-ups come up: one newly prescribed man first posted his compounded dose as "15 ml per day" before correcting it to 0.15 mL daily of 200 mg/mL, which replies worked out as 210 mg a week. Costs vary widely; one man paid a telehealth service $250 for a 10 mL vial of 200 mg/mL and described a similar vial costing about $50 at a retail pharmacy with a discount coupon. One urology practice proposed 100 mg once a month, which falls inside the US label's range but is far less frequent than any guideline schedule; replies urged a second opinion. [106], [107], [108], [1]

Many other threads describe non-prescribed "cycles" at several times replacement doses. Those are outside replacement therapy and this guide (TRT vs steroids).

How can you judge a cypionate story?

Ask: Was the product prescribed, and at what strength (mg/mL)? What was the dose in mg, not just mL or units, how often, and into muscle or fat? When was blood drawn relative to the last injection? What else changed at the same time, such as hCG, an aromatase inhibitor, weight-loss medicine, training or diet? What happened a few months later?

These selected discussions show what people experience and the questions research should answer. They are not a survey of all users, a success rate or a substitute for the studies.

How does testosterone cypionate compare with other testosterone forms?

These are the forms most often weighed against cypionate. Status was checked in September 2026.

No trial ranks these forms on long-term outcomes. The practical differences are how often you dose, how much levels swing, how much hematocrit rises and whether someone else can be exposed. [56] See cypionate vs enanthate for the closest comparison.

Common questions about testosterone cypionate

What is the usual dose of testosterone cypionate?

It depends on the source. US labels allow 50–400 mg every 2–4 weeks, Canada's label gives 200 mg every 2 weeks, and guideline schedules average 50–100 mg a week, typically 100 mg weekly or 200 mg every 2 weeks, with the AUA preferring 100 mg weekly. The prescriber then adjusts the dose using blood tests and symptoms. [1], [6], [8], [9] See typical protocols.

How many units is 100 mg of testosterone cypionate?

At 200 mg/mL, 100 mg is 0.5 mL, which is 50 units on a U-100 insulin syringe. At 100 mg/mL, 100 mg is 1 mL, or 100 units. Units on an insulin syringe measure volume, so the answer always depends on the vial's strength; check the label on your vial. [1] Doserly's TRT dose calculator shows each step. See typical protocols.

How long does one injection last?

Levels peak within about 2–5 days of a 200 mg injection and return toward the starting level by about 2 weeks. The label half-life is about 8 days, which is why labels allow intervals of 2–4 weeks, while many guidelines prefer weekly doses for steadier levels. [34], [1], [9] See peaks and troughs.

Can testosterone cypionate be injected subcutaneously?

US labels say intramuscular only. The UK Society for Endocrinology says weekly subcutaneous injection of 50–100 mg gives comparable levels, safety and tolerability, and small studies, mostly in transgender men, support that, but no randomized trial has compared routes in men with hypogonadism. Discuss the route with your prescriber before changing it. [1], [12], [33] See intramuscular or subcutaneous.

Is Azmiro the same as Depo-Testosterone?

It contains the same drug at 200 mg/mL, and one single-dose study showed equivalent blood levels. It differs in its preservative content (to reduce crystals), its single-dose vial and prefilled syringe, its storage range and its newer label. It is not an autoinjector, the prefilled syringe is given by a healthcare professional, and it is not rated as interchangeable for pharmacy substitution. [46], [4], [5] See Azmiro.

What should I do if I miss an injection?

The labels give no missed-dose instruction, so ask your prescriber or pharmacist how to get back on schedule. Near the end of a 2-week interval levels are already at their lowest, so a delay there means more days below the normal range. If a blood test is due, tell the prescriber when your last injection actually was. [1], [6]

Does an opened vial expire?

US cypionate labels give no in-use period for multi-dose vials. US guidance for healthcare settings says to discard an opened multi-dose vial within 28 days unless the manufacturer states otherwise; Canada's cypionate monograph allows 56 days. The printed expiry date applies to an unopened vial. [51], [52], [6] See storage.

Is testosterone cypionate a steroid?

Yes. Testosterone is an anabolic-androgenic steroid hormone, and that is why it is a controlled substance. At replacement doses under medical supervision it restores normal levels; bodybuilding use relies on much higher doses with different risks. [1], [7] See TRT vs steroids.

Glossary

Plain explanations of the medical, dosing and research terms used in this guide. Underlined terms in the text link here.

Adverse event

A harmful or unwanted medical event reported after someone used a treatment. A report alone does not prove the treatment caused it.

Aromatase inhibitor

A medicine, such as anastrozole, that blocks the enzyme that turns testosterone into estradiol. The VA does not recommend them for men on testosterone.

Azoospermia

No sperm at all in a semen sample.

Bioequivalence

When two products deliver the same drug into the blood at the same rate and amount, within set limits (usually 80–125%). Azmiro was shown bioequivalent to Depo-Testosterone after a single dose.

Controlled substance

A medicine whose prescribing and possession are restricted by law because it can be misused. Testosterone is Schedule III in the US, Schedule IV in Canada and Class C in the UK.

Controlled trial

A study that compares people who receive a treatment with a similar group who do not, often receiving a placebo instead. Randomly assigning people to each group makes the comparison fairer.

Depot

A pool of medicine left in the body, such as oil in a muscle, that releases the drug slowly over days or weeks.

Dose (amount each time)

The amount given on one occasion. A protocol lists both the dose and how often it is given.

Ester

A chemical tail joined to testosterone that makes it dissolve in oil and release slowly after injection. The body removes the tail to free testosterone. Cypionate, enanthate and undecanoate are esters.

Estradiol

The main form of estrogen. In men it is made mostly from testosterone, so it rises when testosterone rises.

FSH (follicle-stimulating hormone)

A pituitary hormone that acts on the cells supporting sperm production. Testosterone therapy lowers it.

Gynecomastia

Growth of breast tissue in men, often tender at first. It is linked to a higher estrogen-to-testosterone balance.

Half-life

The time it takes for the level of a substance in the blood to fall by half. For injected testosterone cypionate the label gives about 8 days, which reflects slow release from the oil depot. It is not the same as how long an effect lasts.

Hematocrit

The share of the blood made up of red blood cells. Testosterone raises it, and most guidelines act when it reaches about 54%.

Hypogonadotropic hypogonadism

Low testosterone because the brain and pituitary send too little LH and FSH to the testicles. It can be present from birth or start later. Also called secondary hypogonadism.

Hypogonadism

Low testosterone caused by a problem in the testicles or in the brain and pituitary signals that control them, confirmed with symptoms and repeated morning blood tests.

Intramuscular (IM)

Injected into a muscle. US testosterone cypionate labels specify deep injection into the buttock muscle.

LH (luteinizing hormone)

A pituitary hormone that tells the testicles to make testosterone. Testosterone therapy switches it off.

MACE (major adverse cardiovascular events)

A combined measure used in heart-safety trials. In TRAVERSE it meant heart attack, stroke or death from heart disease.

Mid-interval level

A blood test taken halfway between two injections, such as day 7 of a 2-week schedule. Several guidelines use it to judge the dose.

Multi-dose vial

A vial meant for several doses, with a preservative. A single-dose vial is used once and any leftover is discarded.

Pharmacokinetics

How the body absorbs, moves, breaks down and removes a substance.

Placebo

A dummy treatment with no active ingredient, used as a comparison in studies.

Polycythemia (erythrocytosis)

Too many red blood cells, shown by a high hematocrit. Testosterone therapy is a common cause.

Pulmonary oil microembolism (POME)

Tiny droplets of injected oil reaching the lungs, causing a sudden cough or shortness of breath soon after an injection. It is rare with cypionate.

Primary hypogonadism

Low testosterone because the testicles themselves do not work well, even though the pituitary sends plenty of LH and FSH.

PSA (prostate-specific antigen)

A blood test for a protein made by the prostate. It rises slightly on testosterone and is used to decide whether prostate checks are needed.

SHBG (sex hormone-binding globulin)

A blood protein that carries testosterone. Testosterone bound to it is not immediately available to tissues, so SHBG affects how much free testosterone there is.

Subcutaneous (SC)

Injected into the fatty layer just under the skin. It is not a route on the US cypionate labels, but a UK guideline accepts it for weekly doses.

Syringe units

Markings on an insulin syringe that measure volume. On a U-100 syringe, 100 units equal 1 mL, so 0.5 mL is 50 units.

Titration

Adjusting a dose in steps, usually based on blood tests and symptoms.

Trough level

The lowest level of a drug in the blood, measured just before the next dose. Some UK guidelines judge injections by it.

TRT (testosterone replacement therapy)

Prescribed testosterone, by injection, gel or other forms, for men with low testosterone. It switches off the brain's LH and FSH signals.

WADA

The World Anti-Doping Agency, which publishes the list of substances banned in sport. Testosterone is banned at all times.

Weekly total

All the amounts given in one week, added together. For example, 50 mg twice a week is a 100 mg weekly total, and 200 mg every 2 weeks averages 100 mg a week.

How this guide was researched

This guide is built from a thorough review of the sources cited throughout it: product labels from the United States, Canada and Spain, clinical guidelines from the United States, Canada, the United Kingdom, Europe and Australia, published clinical trials and studies, FDA review documents and regulatory records. We also reviewed public online forums where people describe their own experiences with testosterone cypionate.

The guide cites 114 sources, including 14 product labels, 11 guidelines and position statements, and 27 original studies in people, plus 26 public community threads. Each type of source answers a different question. Labels, guidelines and trials show what was approved and measured. Practice papers show how prescribers typically use it. Personal accounts show what individual people experienced. Every numbered citation links to its entry below, labeled by source type.

How this guide was made

Research and drafting were AI-assisted. Every cited source was checked against the original, and the guide was reviewed and edited by Doserly before publication. It has not had an independent clinical review, and Doserly does not currently have medical reviewers. Doserly makes a medication and health-tracking app and runs Doserly Academy, both of which are promoted in this guide. Read our editorial policy for how guides are researched, updated and corrected.

This guide is for educational purposes. It summarizes what the reviewed sources report so the research is easier to understand; it is not medical advice. For a deeper dive, or to check any point for yourself, go straight to the cited sources.

Explore the sources