Injectable testosterone is the most common and cost-effective testosterone product used in Canada. It delivers testosterone into muscle tissue, where it is gradually absorbed into the bloodstream over several days or weeks. This slow release helps maintain more stable hormone levels between doses compared to shorter-acting formulations.
How It’s Administered
In Canada, injectable testosterone is most often given as an intramuscular (IM) injection, usually into the ventrogluteal, dorsogluteal or thigh muscle. However, many patients now use the subcutaneous (SubQ) route. This involves injecting into the layer of fat just beneath the skin. Although SubQ administration is considered off-label, many patients prefer it because it’s less painful and easier to manage at home. A growing body of research supports its safety and effectiveness.
- Testosterone Therapy With Subcutaneous Injections: A Safe, Practical, and Reasonable Option (2022) – PDF
- Pharmacokinetics, safety, and patient acceptability of subcutaneous versus intramuscular testosterone injection for gender-affirming therapy: A pilot study (2018)
Benefits
Injectable testosterone remains popular for several reasons. For many patients, it offers a predictable way to maintain hormone levels. It’s well-studied and generally less expensive than other formulations. Because it’s delivered by injection, there’s no risk of accidental transfer to others through skin contact, as there is with testosterone gel. Many patients also find the dosing schedule convenient, as injections are typically given every one to two weeks depending on the formulation and individual needs.
Drawbacks and Considerations
The main challenges of injectable therapy come from its delivery method and the nature of its release cycle. Injections can cause mild soreness or swelling at the site, especially when first starting treatment. Hormone levels can fluctuate between doses. This can lead to changes in mood or energy, especially if injection intervals are too long. Some people find the process of self-injecting stressful, or prefer not to rely on clinic visits for each dose.
Supply interruptions have affected injectable products in Canada, which rely on a small number of manufacturers. More detail about supply challenges is provided below.
Products Available in Canada
There are currently two injectable testosterone products available in Canada:
Both are oil-based injectable testosterone formulations requiring weekly or biweekly injections, and both require a prescription from a licensed healthcare provider.
With only two options, shortages can quickly affect access and may require switching between formulations.
Public Coverage
Injectable testosterone is often covered by provincial and territorial public drug plans in Canada. Coverage usually depends on medical criteria and may require approval before it is paid for. The exact rules can vary depending on where you live and the specific product being used.
Cypionate vs. Enanthate
Cypionate and enanthate are closely related forms of testosterone that differ only slightly in their chemical structure. Enanthate has a seven-carbon ester chain, while cypionate has an eight-carbon chain. This small difference means cypionate is released a little more slowly and has a slightly longer half-life, but the real-world difference is minimal.
In practice, both provide comparable results. However, they are not considered interchangeable under Health Canada guidelines. Switching between them requires a new prescription and an adjustment to the injection volume or frequency, since they come in different concentrations. Patients who switch formulations may notice subtle differences in how their body responds as levels stabilize.
Shortages and Supply Context
Injectable testosterone has faced recurring shortages in Canada for more than a decade. Each formulation relies on a single manufacturer, leaving little redundancy when production issues arise. When one product goes into shortage, it often triggers a national ripple effect that leaves pharmacies struggling to secure stock or allocate remaining supplies fairly among patients.
Injectable testosterone remains the foundation of testosterone therapy in Canada. It’s effective, affordable, and trusted by both physicians and patients. However, its reliability depends on a fragile supply chain with very few manufacturers. When shortages occur, they reveal just how vulnerable that system has become.