Hypogonadism in Males - Late-Onset Drug Summary

Last updated: 19 September 2025
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Androgens & Related Synthetic Drugs

Drug Available Strength Dosage Remarks
IM Injection
Testosterone cypionate 100 mg/mL
200 mg/mL		 50-400 mg IM every 2-4 weeks Adverse Reactions
  • Endocrine effects (gynecomastia, patients with BPH may develop urethral obstruction, elderly may have higher risk of developing prostatic hypertrophy, oligospermia with prolonged or excessive use); Lipid effects (serum cholesterol may increase); Hematologic effects (increase in hematocrit, Hb); CNS effects (headache, anxiety, depression); Dermatologic effects (hirsutism, male-pattern baldness, seborrhea, acne); GI effect (nausea); Other effects (edema, fluid and electrolyte disturbances)
  • Inflammation and pain at site of IM injection
Special Instructions
  • Contraindicated in patients with prostate or breast cancer
  • Use with extreme caution or not at all in men with significant polycythemia, untreated sleep apnea, severe heart failure or significant bladder outlet obstruction
Testosterone decanoate/testosterone isocaproate/testosterone phenylpropionate/testosterone propionate 100 mg/60 mg/60 mg/30 mg/mL 1 mL IM every 3 weeks
Testosterone enantate
(Testosterone enanthate)		 250 mg/mL 250 mg IM every 2-3 weeks
Maintenance dose:
250 mg IM every 3-6 weeks
Testosterone propionate 100 mg/2 mL 50 mg IM 2-3x/week
Testosterone undecanoate 1,000 mg/4 mL 1,000 mg (4 mL) slow IM injection every 10-14 weeks
To maintain serum testosterone levels, first injection interval may be reduced to minimum of 6 weeks
Implant
Testosterone 100 mg/implant
200 mg/implant		 100-600 mg implanted SC every 4-5 months
Nasal
Testosterone Metered-dose pump nasal gel 11 mg (2 pump actuations; 1 actuation per nostril) nasally 8 hourly
Max dose: 33 mg/day
Oral Adverse Reactions
  • Endocrine effects (gynecomastia, patients with BPH may develop urethral obstruction, elderly may have higher risk of developing prostatic hypertrophy, oligospermia with prolonged or excessive use); Lipid effects (serum cholesterol may increase); Hematologic effects (increase in hematocrit, Hb); CNS effects (headache, anxiety, depression); Dermatologic effects (hirsutism, male-pattern baldness, seborrhea, acne); GI effect (nausea); Other effects (edema, fluid and electrolyte disturbances)
  • Inflammation and pain at site of IM injection
Special Instructions
  • Contraindicated in patients with prostate or breast cancer
  • Use with extreme caution or not at all in men with significant polycythemia, untreated sleep apnea, severe heart failure or significant bladder outlet obstruction
  • Oral Testosterone should be taken with food
  • Topical gel is applied on clean, dry, intact skin of the shoulders or upper arms; abdomen, back, upper arms or thighs for the patch
    • Daily rotation between the abdomen and inner thighs is recommended
Mesterolone 25 mg tab 25 mg PO 6-8 hourly
Maintenance dose:
25 mg PO 8-12 hourly
Testosterone undecanoate 40 mg cap Initial dose:
120-160 mg/day PO divided 12 hourly x 2-3 weeks
Maintenance dose:
40-120 mg/day PO divided 12 hourly
or
Initial dose:
237 mg PO 12 hourly
Maintenance dose:
158-396 mg PO 12 hourly
Topical
Testosterone 1% metered-dose pump gel Initial dose:
Apply 50 mg (4 pump actuations) on skin 24 hourly in the morning
Max dose: 100 mg/day
1.62% metered-dose pump gel Initial dose:
Apply 40.5 mg (2 pump actuations) on skin 24 hourly in the morning
Max dose: 81 mg/day
4 mg/24 hr patch Apply 1 patch on skin 24 hourly at night
May decrease dose to 2 mg (one 2 mg/24 hr patch)
Max dose: 6 mg/day (one 4 mg/24 hr and one 2 mg/24 hr patches)

Gonadotropins

Drug Dosage Remarks
FSH
Follitropin alfa With concomitant hCG therapy:
150 IU SC 3x/week x 4-18 months
Max dose: 900 IU/week		 Adverse Reactions
  • Endocrine effects (gynecomastia, weight gain); Other effects (headache, acne, varicocele)
Special Instructions
  • Contraindicated in patients with hypothalamus or pituitary gland tumors, primary gonadal failure
  • Use with caution in patients with elevated endogenous FSH
  • Assess response with semen analysis for 4-6 months after beginning of treatment
Follitropin beta With concomitant hCG therapy:
75 IU SC/IM 24 hourly or
75 IU SC/IM 2-3x/week or
150 IU SC/IM 3x/week or
225 IU SC/IM 2x/week
FSH and LH
Menotrophin 75-150 IU SC/IM 2-3x/week Adverse Reactions
  • Cerebral thrombosis, gynecomastia
Special Instructions
  • Existing hypothyroidism, adrenocortical deficiency, hyperprolactinemia or pituitary tumors should be treated first
hCG
Chorionic gonadotrophin 5,000 IU IM 2x/week x 12 weeks Adverse Reactions
  • CNS effects (headache, irritability, restlessness, depression, tiredness); Other effects (edema, gynecomastia, pain at injection site)
Special Instructions
  • Contraindicated in patients with uncontrolled thyroid, adrenal or pituitary disorders, breast or testicular tumors, prostate carcinoma
  • Use with caution in patients with epilepsy, migraine, asthma, cardiac or renal disease

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

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