Oral Testosterone: What Men Should Know

Can a simple pill help men with low testosterone? Yes, it’s possible…at least for some men. Read on to learn more.

What is testosterone?

One of the most important hormones for men is testosterone. It’s the reason men grow facial hair, have deeper voices, and produce sperm cells. It contributes to their muscle mass and bone health. And it’s essential for their sexual health: both libido and erections are driven by testosterone.

Testosterone production is triggered by the pituitary gland in the brain, which “tells” the testes (glands located near the penis in a sac called the scrotum) to start making the hormone.

What happens when a man’s body doesn’t make enough testosterone?

Sometimes, there is a problem with the testosterone production process.

The problem might be something a man is born with (congenital). Some examples are Klinefelter syndrome (when a male child has an extra X chromosome) or intersex conditions (when a child is born with both male and female sex organs).

Injuries, illnesses, and cancer treatment can affect testosterone production, too. For example, if a man has a pituitary gland disorder, if he has had trauma to his testes from an accident, or if he has had radiation treatment to his genital area, his body might make less testosterone. Obesity, diabetes, liver disease, kidney disease, metabolic syndrome, HIV, or AIDS are other factors.

In addition, men’s bodies naturally make less testosterone as they get older. This is a normal part of aging, and the change is gradual—about 1% a year once a man is in his thirties.

Doctors refer to this overall situation as low testosterone, low T, or hypogonadism. These words mean that the body is not making enough testosterone.

What are the symptoms of low testosterone?

As a result, men might feel weaker, depressed, grumpy, or fatigued. They might lose interest in having sex or experience erectile dysfunction (an inability to get an erection firm enough for sexual activity). Some men with low testosterone lose muscle mass and body hair, and some grow breasts.

It’s important to note that these symptoms can be related to other health conditions or medications as well. For example, erectile dysfunction is a common problem for men with diabetes. Men with depression might lose interest in sex. So it’s important to see a doctor if you have any of these symptoms.

What is testosterone deficiency?

When a man has low testosterone levels and accompanying symptoms, doctors use the term testosterone deficiency (TD). To diagnose TD, doctors take a complete medical history, ask questions about medications used, and conduct a thorough medical exam, including blood tests to check the levels of testosterone and other hormones involved with its production, like luteinizing hormone (LH) and prolactin. (Learn more about TD diagnosis.)

What happens next? Doctors treat the root cause of the TD. If a man has diabetes, they will suggest ways to keep his blood sugar under control. If he has kidney disease, that will be addressed. Proper diet and exercise may be recommended for men with obesity.

Another option is testosterone replacement therapy (TRT). With TRT, a man receives medicine to raise his testosterone levels back to a normal range. Many men find that symptoms like low sex drive and moodiness improve with TRT.

When a man has low testosterone levels and accompanying symptoms, doctors use the term testosterone deficiency (TD).

How is testosterone replacement therapy given?

Nowadays, men have a few options for receiving testosterone:

• Transdermal or topical treatments. These treatments are applied to the skin and usually come as gels, creams, and patches. They’re easy to use, but there are some disadvantages. Some men get rashes or itchiness when they use transdermal treatments. It’s also critical that other members of the household, especially women and children, not get any of the product on their own skin.
• Injections into a muscle. Your doctor might offer regular testosterone injections at their office. You can also learn to do your own injections at home. Depending on the injection schedule, this might be more convenient. But injections aren’t for everyone; if you feel squeamish about needles, they might not be for you.
• Intranasal (through the nose). Testosterone is administered (usually three times a day) through the nostril using a special pump. This method isn’t invasive, but some men have side effects like nasal congestion and changes in smell.
• Pellets. Your doctor places small pellets of testosterone under the skin of your buttocks, thigh, or abdominal wall. Over the next three to six months, the pellets dissolve. Then, the process is repeated. Some men like this method because it can be done every three to six months. But they still need to travel to the doctor’s office, and some have pain, swelling, and bruising.
• Oral route. Oral medications are capsules that you take by mouth. In the rest of this article, we’ll go over the details.

What is oral testosterone?

Oral testosterone is a capsule that you swallow. It is absorbed by your intestinal lymphatic system and the testosterone is carried through your bloodstream.

Currently, doctors prescribe a product called testosterone undecanoate, which was approved by the U.S. Food and Drug Administration in 2019. Testosterone undecanoate is marketed under several brand names, including Jatenzo, Kyzatrex, Tlando, and Undecatrex.

As a capsule, oral testosterone is a convenient, easy-to-take option.

Like other forms of TRT, the goals of oral testosterone therapy are to bring low testosterone levels back up to a normal level (generally above 300 ng/dL) and to relieve symptoms.

How has oral testosterone changed over the years?

At one time, an oral testosterone product called methyltestosterone was the common form prescribed. However, scientists were concerned about side effects, such as jaundice, liver disease, and liver damage. These problems occurred because the medicine was absorbed by the body’s portal system; it was going from the digestive system to the liver.

Methyltestosterone is not typically used nowadays. Scientists developed testosterone undecanoate, the current form, which is not processed through the liver, making it a safer option in this regard.

Is oral testosterone better than other forms, like gels, pellets, or injections?

All types of testosterone are effective, so often men choose their method depending on their preferences. As a capsule, oral testosterone is a convenient, easy-to-take option. Some men find gels and creams to be messy, and there is the risk of transferring the medicine to people in the household. Others are uncomfortable with the idea of injections or pellets under the skin.

Side effects may also play a role. For example, men who have skin irritation from injections or creams may decide that the oral route is a better fit.

If one method isn’t ideal for you, ask your doctor about trying another method.

Is oral testosterone OK everyone?

Before prescribing oral testosterone, your doctor will take your complete medical history and conduct tests. They’ll also need to know what other medications you currently take (both prescription and over-the-counter) as well as any vitamins or supplements. If you have allergies, be sure to let them know that, too.

Men should also let their doctor know if they have any of the following conditions:

• Diabetes
• Prostate cancer
• High blood pressure
• High cholesterol
• Heart disease or a history of heart attack
• Sleep apnea
• Liver disease
• Lung disease
• Blood disorders
• Problems with blood clotting
• An enlarged prostate
• Breast cancer
• Obesity
• A history of drug dependence
• High levels of calcium in the blood

It’s critical to be open and honest about your health history and medications. Some drugs, like bupropion (an antidepressant), insulin (for diabetes), and warfarin (a blood thinner used to reduce the formation of blood clots) can interact with oral testosterone. Your health information will help your doctor determine whether the oral route is best for you or if any adjustments need to be made.

Also note that testosterone undecanoate has been FDA-approved only for men who have low testosterone caused by medical conditions. It has not been approved for men who have low testosterone caused by aging.

Women should not take oral testosterone.

How should I take oral testosterone?

Like all medications, oral testosterone should be taken exactly as a doctor prescribes. Your dose will be based on your personal needs, depending on your testosterone levels and symptoms. Over time, your doctor will follow up and monitor your progress. If necessary, your dose can be adjusted.

Some men take oral testosterone once a day; others take it twice a day. It should be taken with food. You might decide to take it with breakfast or dinner.

What risks of oral testosterone should I be aware of?

One concern is high blood pressure, which can raise your risk for a stroke or heart attack. If you’ve already had a stroke or heart attack before taking oral testosterone, your risk might be even higher.

Some men measure their blood pressure at home while taking oral testosterone. If your blood pressure increases, you may need to take medicine to control it. Or you might need to stop taking oral testosterone altogether.

Other potential risks include the following:

• Higher levels of red blood cells, which could increase your risk for blood clots, heart attack, and stroke
• Worsened enlarged prostate symptoms, like trouble urinating
• Blood clots
• Lower sperm count and fertility issues
• Liver issues
• Sleep apnea
• Swelling of ankles, feet, or body
• Mood changes, irritability, depression, or suicidal thoughts
• Higher levels of calcium, cholesterol, and fats in the blood
• Breast swelling or pain
• Increased risk for heart or blood vessel problems

Currently, the U.S. Food and Drug Administration (FDA) warns that men taking testosterone could be at a higher risk for prostate cancer. However, guidelines issued by the American Urological Association (AUA) in 2024 state that “there is accumulating evidence against a link between testosterone therapy and prostate cancer development.”

For some men, oral testosterone is habit forming and they might start to abuse it.

What are some common side effects of oral testosterone?

Some men experience:

• Diarrhea
• Nausea
• Gas
• Burping
• Heartburn
• Indigestion
• Sore throat
• Upset stomach
• Runny nose
• Nasal congestion
• Headache
• Higher levels of the hormone prolactin
• Weight gain
• Muscle or bone pain
• Upper respiratory tract infection

Often, these side effects go away as your body gets used to the medicine. If they trouble you, talk to your doctor. It may help to adjust the dose, but any changes should be made under a doctor’s care.

How soon will I start feeling better?

This answer is different for each man, but many men start seeing improvements in their symptoms—such as better sexual function and mood—within a few weeks.

What kind of follow-up will I have when taking oral testosterone?

Your doctor will want to see you regularly for follow-up visits. At these appointments, they’ll likely do further blood and urine testing to see how well the medicine is working. They will also check your blood pressure and red blood cell count.

Can oral testosterone affect my fertility?

For some men, oral testosterone reduces sperm count, making it more difficult to conceive a child. If you are planning to have a child, tell your doctor before you start taking oral testosterone.

Does oral testosterone have to be prescribed by a doctor? Can I use the over-the-counter versions I see online and in stores?

All forms of testosterone should always be prescribed by a doctor and taken with a doctor’s guidance. Over-the-counter products and supplements are not regulated by the U.S. Food and Drug Administration and may contain ingredients that are harmful for you.

Be sure to tell your doctor about any other medications, vitamins, or supplements you take. They should also know about any allergies you have.

Summary: Key points about oral testosterone

• Testosterone deficiency means that a man’s body does not produce adequate amounts of testosterone. It is accompanied by symptoms like low libido, poor erections, moodiness, and weakness.
• Testosterone replacement therapy (TRT) is one way to treat testosterone deficiency. The goal of TRT is to raise testosterone levels to a normal range and alleviate symptoms. Many men see improvements in their sexual function, mood, and overall quality of life when they undergo TRT.
• There are several ways to administer testosterone replacement therapy. They include transdermal (through the skin), injections, nasal sprays, and oral formulations.
• A previous formulation of oral testosterone, methyltestosterone, had side effects, such as jaundice, liver disease, and liver damage. Scientists have since developed a safer version called testosterone undecanoate, which is the type used today.
• Testosterone undecanoate is a capsule taken by mouth. It is marketed under brand names like Jatenzo, Tlando, Kyzatrex, and Undecatrex.
• Men may find that oral testosterone is more convenient than other formulations, like injections, gels, and creams.
• Oral testosterone dosage depends on a man’s personal situation.
• Oral testosterone does have some risks and side effects. High blood pressure is a particular concern. Men should have a thorough medical exam before starting therapy.
• Regular checkups with a doctor are essential for men taking oral testosterone.
• Oral testosterone is available by prescription only. Over-the-counter products are not the same and could be harmful. It’s important to follow your doctor’s guidance.

Resources

American Urological Association

Azad, Babak K., MD and Faysal A. Yafi, MD, FRCSC.
“Oral Testosterone Replacement Therapy: What’s Available and What Took so Long?”
(September 19, 2023)
https://auanews.net/issues/articles/2023/september-extra-2023/oral-testosterone-replacement-therapy-whats-available-and-what-took-so-long

Mulhall, J.P., et al.
“Evaluation and Management of Testosterone Deficiency (2024).”
(2024)
https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline

Cureus

Ahmad, Syed W., et al.
“Is Oral Testosterone the New Frontier of Testosterone Replacement Therapy?”
(August 8, 2022)
doi: 10.7759/cureus.27796
https://www.cureus.com/articles/26237-is-oral-testosterone-the-new-frontier-of-testosterone-replacement-therapy

Drugs.com

“Undecatrex: Package Insert / Prescribing Info”
(Last updated September 25, 2024)
https://www.drugs.com/pro/undecatrex.html

The Endocrine Society

“Study finds oral testosterone therapy undecanoate is effective, with no liver toxicity”
(Press release. March 20, 2021)
https://www.endocrine.org/news-and-advocacy/news-room/featured-science-from-endo-2021/study-finds-oral-testosterone-therapy-undecanoate-is-effective-with-no-liver-toxicity

Jatenzo.com

“Important Safety Information”
https://jatenzo.com/oral-testosterone-safe-effective/

Kyzatrex.com

“Medication Guide”
https://www.kyzatrex.com/medication-guide/

Mayo Clinic

“Testosterone (oral route).”
Drug information provided by: Merative, Micromedex®.
(Portions last updated February 01, 2025)
https://www.mayoclinic.org/drugs-supplements/testosterone-oral-route/description/drg-20461351

Tlando.com

“Important Safety Information”
https://www.tlando.com/introducing-tlando

Up to Date

Snyder, Peter J., MD.
“Testosterone treatment of male hypogonadism.”
(Topic last updated October 21, 2022)
https://www.uptodate.com/contents/testosterone-treatment-of-male-hypogonadism