Testosterone Cypionate for TRT & Hormone Optimization — Anabolic Steroids
The most widely prescribed testosterone ester for replacement therapy with an 8-day half-life and flexible dosing.
Overview
Testosterone Cypionate is the most commonly prescribed form of testosterone replacement therapy (TRT) in the United States. It is an esterified form of testosterone with a half-life of approximately 8 days, allowing for weekly or biweekly intramuscular or subcutaneous injections. The cypionate ester is attached to the 17-beta hydroxyl group, slowing release from the injection depot. In February 2025, the FDA removed cardiovascular black box warnings following the TRAVERSE trial, and a December 2025 expert panel recommended removing prostate cancer warnings. At physiological replacement doses (100-200mg/week), it restores serum testosterone to the 350-650 ng/dL range, improving muscle mass, bone density, libido, mood, cognitive function, and metabolic health. It is the gold standard for male hypogonadism treatment.
Indications
- Primary and secondary hypogonadism in males
- Age-related testosterone decline (andropause)
- Testosterone deficiency with symptoms (low libido, fatigue, depression)
- Muscle wasting and sarcopenia
- Osteoporosis in testosterone-deficient males
- Gender-affirming hormone therapy (FTM)
- Metabolic syndrome with concurrent low testosterone
- Post-surgical or trauma-related androgen deficiency
Mechanism of Action
Low serum testosterone (<300 ng/dL) with symptoms: fatigue, decreased libido, depression, muscle loss, cognitive decline
Dosing
| Compound | Dose | Frequency | Notes |
|---|---|---|---|
| Testosterone Cypionate | 100-200 mg | Once weekly | Standard TRT replacement dosing to restore physiological levels (350-650 ng/dL) |
| Testosterone Cypionate | 50-100 mg | Twice weekly (split dose) | More stable blood levels with less peak-trough variation |
| Testosterone Cypionate | 150-200 mg | Every 14 days | Less frequent but greater peak-trough fluctuation |
Evidence Grade
GRADE A
Safety & Contraindications
- Schedule III controlled substance - prescription required
- Monitor hematocrit - discontinue or reduce dose if >54%
- Contraindicated in prostate cancer (under review as of 2025)
- Contraindicated in breast cancer in males
- May cause polycythemia - therapeutic phlebotomy may be needed
- Monitor PSA levels in men over 40
- Can suppress spermatogenesis and fertility - counsel patients
- Cardiovascular black box warning removed by FDA in February 2025
- May worsen sleep apnea - screen before initiating
- Transference risk with topical forms - not applicable to injections
- Monitor liver function periodically
- Can cause gynecomastia via aromatization - may require AI adjunct