In short
A long-acting testosterone injection of testosterone undecanoate is given every 10 to 14 weeks after a loading dose, which means about four to five injections a year. Two rare reactions can follow straight after the injection. Oil reaching the lungs, which causes a short cough or breathlessness, occurs in about 1.5 of every 10,000 injections, roughly 1 in 7,000. An allergic reaction occurs in about 0.4 of every 10,000, roughly 1 in 25,000. For this reason, the injection is given in a clinic.
Treatment Overview
What is a long-acting testosterone injection?
A long-acting testosterone injection is testosterone undecanoate injected deep into the muscle every 10 to 14 weeks after a loading dose. One study found that 1,000 mg every three months kept average testosterone in the normal range for 18 months. All forms are compared on the testosterone replacement therapy page.
What is the dosing schedule for testosterone undecanoate?
The international prescribing information recommends a first injection of 1,000 mg deep into the muscle, a second one 6 weeks later, and then one injection every 10 to 14 weeks. The shorter gap at the start is the loading dose that brings the level up. In the United States, a smaller dose of 750 mg is injected into the buttock, with the second injection after 4 weeks and then one every 10 weeks. For the 1,000 mg testosterone undecanoate preparation, routine interval adjustment uses a testosterone measurement near the end of the interval, shortly before the next injection, together with symptoms. Different injectable products have different monitoring schedules.
What reactions can occur after the injection?
Rare reactions after a testosterone undecanoate injection are oil reaching the lungs, called pulmonary oil microembolism, and allergic reactions. Oil in the lungs causes a short cough or breathlessness and occurs in about 1.5 of every 10,000 injections, roughly 1 in 7,000. An allergic reaction occurs in about 0.4 of every 10,000 injections, roughly 1 in 25,000. In the United States the injection is given only in a registered clinic with 30 minutes of observation afterwards. The large oil volume and fixed intervals also make dose changes less flexible.
Who is a long-acting injection suitable for?
A long-acting injection suits men who cannot use or do not want daily gel or frequent injections and who attend a clinic for each dose. Clinical guidance suggests it mainly for men without access to, or preference for, other forms, because of the injection volume, clinic setting and less flexible dosing.
Long-acting testosterone in Dubai and the UAE
Is long-acting testosterone available in the UAE?
Testosterone undecanoate is prescribed in the UAE only by a licensed doctor and dispensed by a licensed pharmacy. Which products Dr. Felix uses is explained in the consultation. The rules for bringing testosterone into the UAE are explained under bringing testosterone into the UAE.
Who Is a Good Candidate?
- Men with symptoms of low testosterone and a low morning fasting testosterone confirmed on at least two days.
- Men whose low testosterone comes from the testes or the pituitary gland, established with LH and FSH.
- Prostate or breast cancer, a haematocrit above 50 percent, severe untreated sleep apnoea or uncontrolled heart failure: treated or excluded first.
- Doses aimed above the normal range, or a prescription without examination and blood tests: not offered.
What Happens During the Consultation
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1
Diagnosis confirmed
Morning fasting testosterone on two days, LH and FSH, and the other causes of the symptoms are reviewed before any preparation is chosen.
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2
Safety checks
Haematocrit, PSA and prostate examination where age-appropriate, sleep apnoea, heart failure and plans for children are checked.
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3
Choice of preparation
Dr. Felix compares gel, injections and hCG with you by dosing rhythm, practical limits and fertility.
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4
Plan and review dates
The plan sets the dose, the first blood test at 2 to 3 months and the monitoring schedule.
Program Structure & Follow-Up
How is long-acting testosterone followed up?
Long-acting testosterone is followed up with testosterone measured near the end of the injection interval, shortly before the next dose, plus blood count, blood pressure and other reviews on an individual schedule. Contact between appointments runs through the membership programmes.
Benefits, Limits & Safety
What happens after stopping long-acting testosterone?
After the last long-acting injection, testosterone falls over the following weeks and then stays low for months while the body restarts its own production. A planned stop is scheduled with blood tests.
What it offers
About four to five injections a year, with average testosterone kept in the normal range.
How you are followed
Testosterone at 2 to 3 months and after each dose change, then every 6 to 12 months. Haematocrit at 3 to 6 months, then yearly. Prostate checks at 3 and 12 months from age 50.
When it is not used
Prostate or breast cancer, raised haematocrit, severe untreated sleep apnoea, uncontrolled heart failure, or a current wish for children.
Cost & Program Investment
The cost depends on the preparation and the monitoring it needs. Dr. Felix explains the full cost before any prescription. Ongoing care runs through the membership programmes.
Frequently Asked Questions
A long-acting testosterone undecanoate injection is given every 10 to 14 weeks after a loading dose, according to the international prescribing information.
Two rare reactions occur shortly after the injection: oil reaching the lungs in about 1 in 7,000 injections and an allergic reaction in about 1 in 25,000. The injection is therefore given with observation.
For the described 1,000 mg testosterone undecanoate preparation, testosterone is measured near the end of the interval, shortly before the next injection. The clinician uses this result and symptoms to adjust the interval. Other injection formulations have different schedules.
The cost depends on the product and the monitoring. Dr. Felix explains the full cost before any prescription.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline
- Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE)
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.