Oral testosterone is less commonly used in Canada compared to injectable or topical forms. It offers a convenient, needle-free alternative, but absorption can be unpredictable, which limits how often it’s used. For some patients, oral testosterone can be a practical choice, particularly when starting therapy or when other options aren’t suitable.
How Oral Testosterone Works
The active ingredient, testosterone undecanoate, is absorbed through the lymphatic system rather than directly through the liver. This route reduces liver stress and avoids the toxicity problems seen with older oral testosterone formulations such as methyltestosterone.
Bioavailability and Absorption
Despite these improvements, oral testosterone has low and variable bioavailability, typically around 3–7 percent. The amount absorbed depends heavily on dietary fat and timing. When taken with a high-fat meal, absorption increases significantly. When taken on an empty stomach, very little testosterone reaches the bloodstream.
Because of this variability, maintaining consistent hormone levels can be difficult. Oral testosterone can still reach therapeutic levels, but its short half-life often requires multiple daily doses. For patients who need steady hormone levels, other routes such as injections or gels are generally preferred.
When Oral Testosterone Can Be Useful
Despite its limitations, oral testosterone can still be useful in certain situations:
- Starting therapy: It allows for a gradual introduction to testosterone and easy dose adjustments.
- Trial use: It can be discontinued quickly if unwanted side effects occur.
- Preference or access: It may be useful when injections or gels are not preferred or available.
Although oral testosterone may not provide consistent levels for every patient, it remains a legitimate and safe option when properly prescribed and monitored.
Products Available in Canada
There is currently only one oral testosterone product available in Canada:
- Taro Testosterone Undecanoate Capsules – manufactured by Taro Pharmaceuticals Inc.
This product provides testosterone in an oil-filled capsule designed for lymphatic absorption. It must be taken with food, ideally containing dietary fat, to ensure proper absorption.
Because there is only one option, shortages usually require switching to a different type of testosterone.
Public Coverage
Oral testosterone may be covered by some provincial and territorial public drug plans in Canada. Coverage usually depends on medical criteria and may require approval before it is paid for. Coverage can also depend on where you live and the specific criteria of your plan.
Shortages and Supply Context
Oral testosterone in Canada is particularly vulnerable to shortages because Taro Pharmaceuticals is the sole manufacturer. When production or distribution is interrupted, there are no alternative suppliers to fill the gap.
Shortages of oral testosterone have occurred repeatedly in recent years, often lasting several months. These interruptions highlight the fragility of Canada’s testosterone supply chain and the risks of relying on a single manufacturer for an essential medication.
Oral testosterone undecanoate offers a convenient, safe option for patients when other forms are not suitable. It avoids the liver toxicity seen with older oral formulations, but its variable absorption and dependence on dietary fat make it less reliable for long-term use. Because it relies on a single manufacturer, this formulation is also one of the most vulnerable to shortages in Canada.