Testosterone Propionate is a faster acting ester which can peak in the blood within hours and metabolized over 3 days. Injections should typically be administered every 2-3 days. Propionate can also be co-administered with another testosterone ester, sometimes requiring less frequent injections.
Since it metabolizes so quickly and needs to be administered frequently when used as by itself (as a monotherapy), it is easy to stabilize levels and optimize blood-testosterone-levels quickly.
Some patients benefit from a faster metabolizing ester like propionate, especially those suffering from significant deficiency symptoms like erectile dysfunction or sarcopenia (muscle loss). Commercial testosterone propionate is no longer available; therefore, many compounding pharmacies offer this important ester.
This is the most commonly prescribed testosterone ester, and it metabolizes in roughly 7-8 days. Testosterone cypionate is considered a long-acting testosterone. It is usually injected weekly and sometimes twice per week or more by subcutaneous injection. Compounded Testosterone cypionate in grapeseed oil is the most common form of cypionate prescribed for subcutaneous injection.
Testosterone Enanthate is metabolized in roughly 4-5 days. It can even remain in the body (in very small amounts) for 2 weeks. Some patients report less water retention with enanthate when switched from cypionate. Enanthate is usually injected weekly and sometimes twice per week or more by subcutaneous injection.
Testosterone Undecanoate is a promising ester that allows for much less frequent injections. Unfortunately, it is currently only available as a commercial pharmaceutical product called AVEED®.
Without insurance coverage, AVEED® can be expensive and cost-prohibitive to maintain. When insurance does cover AVEED®, it often limits the dosage allowed, which results in most patients being underdosed or having to pay out of pocket for the remaining dose.
Studies support testosterone levels remaining elevated for roughly 3 months post injection when using testosterone undecanoate. However, as with other esters, not all patients will respond the same. Some may require more frequent injections of testosterone undecanoate to maintain testosterone blood levels, including injections every 30 days.
Insurance limitations also often prevent patients from receiving personalized care when using testosterone undecanoate. Until there are alternative products available and/or the cost reduces significantly, testosterone undecanoate will probably not be a commonly used for men who need testosterone injection therapy.
Compounded Testosterone Combinations
Defy Medical offers compounded injections that combine slow and fast metabolizing esters to provide more options for our patients.
There are some patients who respond better to a combination of two or more esters, usually consisting of esters with different timed releases. This can result in an immediate increase in testosterone followed by a delayed release of a longer ester. In short, you get the benefit of fast-acting and slow-acting esters in one injection.
The most prescribed combination products are:
- Testosterone cypionate/propionate
- Testosterone cypionate/enanthate/propionate
Testosterone can also be combined with other androgenic hormones like nandrolone decanoate, creating a single injection that allows for the convenient administration of two or more hormones. Androgenic anabolic therapies can often supplement a TRT protocol and add their own unique benefits. Learn more about androgenic anabolic therapies.