If you have low testosterone levels, your doctor may recommend testosterone replacement therapy with Xyosted.

Xyosted is a prescription drug used in adult males* to treat testosterone deficiency (low or no natural testosterone) caused by certain conditions. It’s not used in males younger than 18 years or to treat low testosterone due to aging. See “What is Xyosted used for?” below for details.

* In this article, we use the term “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

Xyosted basics

The active drug in Xyosted is testosterone enanthate. It’s a type of androgen (male sex hormone). This drug is not currently available as a generic.

Xyosted comes as a liquid solution that’s injected under your skin with a prefilled autoinjector pen.

Keep reading to learn more about Xyosted, including its dosage, side effects, and more.

Find answers below to some commonly asked questions about Xyosted.

What should I know about Xyosted vs. testosterone cypionate?

Xyosted contains the active drug* testosterone enanthate. Testosterone enanthate and testosterone cypionate are similar forms of testosterone.

Both drugs are types of testosterone injections. And they’re both androgens (male† sex hormones) used for replacement therapy.

These drugs do have some differences as well. For example, testosterone cypionate is available as a generic and as the brand-name drug Depo-Testosterone. Testosterone enanthate isn’t available as a generic.

If you’re interested in learning more about how these forms of testosterone compare, talk with your doctor or pharmacist.

* An active drug is the ingredient that makes a medication work.
† In this article, we use the term “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

Is Xyosted used for bodybuilding?

Xyosted is not approved for bodybuilding or to help with increasing muscle. Testosterone products like Xyosted are sometimes misused for this purpose. This can lead to dangerous side effects.

To learn more, see the “Can Xyosted be misused?” section below. You can also learn more about the risks of misusing Xyosted by talking with your doctor or pharmacist.

Does Xyosted have alternatives?

Yes, there are alternative testosterone replacement therapies to Xyosted. Examples include:

Talk with your doctor or pharmacist if you’re interested in learning more about alternatives to Xyosted.

How should I store Xyosted?

Xyosted pens should be stored at room temperature, between 68°F and 77°F (20°C to 25°C). Do not store the pens in the refrigerator, and do not freeze them.

You should also keep Xyosted pens protected from light until you’re ready to use them. Keep them in their original carton until you’re ready to inject a dose.

Your doctor will recommend the dosage of Xyosted that’s right for you. Below are commonly used dosages, but always take the dosage your doctor prescribes.

Form and strengths

Xyosted comes as a liquid solution in a prefilled autoinjector pen. A healthcare professional will show you how to inject Xyosted under your skin.

Xyosted pens come in three strengths:

  • 50 milligrams (mg) per 0.5 milliliters (mL)
  • 75 mg/0.5 mL
  • 100 mg/0.5 mL

Recommended dosage

You’ll inject Xyosted once per week. Try to inject your dose on the same day each week.

Before prescribing Xyosted, your doctor will have you get a blood test to check your testosterone level. You’ll have this test done on at least two separate mornings to confirm the results.

Your doctor will also check your testosterone levels during treatment. They might adjust your dose if needed.

Questions about Xyosted’s dosage

Below are some common questions about Xyosted’s dosage.

  • What if I miss a dose of Xyosted? If you miss a Xyosted injection, take the dose as soon as you remember. But if it’s almost time for your next dose, skip the missed dose and inject your next dose on your usual day. Do not inject more than one Xyosted dose at once.
  • Will I need to use Xyosted long term? If you and your doctor agree that Xyosted is safe and effective for you, you’ll likely use the drug long term.
  • How long does Xyosted take to work? Xyosted begins to work as soon as you inject a dose. But it can take several weeks for testosterone levels to increase to a steady level.

Like most drugs, Xyosted may cause mild or serious side effects. The lists below describe some of the more common side effects Xyosted may cause. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

  • your age
  • other health conditions you have
  • other medications you take

Your doctor or pharmacist can tell you more about the potential side effects of Xyosted. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a list of some of the mild side effects that Xyosted can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Xyosted’s prescribing information.

Mild side effects of Xyosted that have been reported include:

* For more information about this side effect, see the “Side effect focus” section below.

Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Xyosted can occur, but they aren’t common. If you have serious side effects from Xyosted, call your doctor right away. If you think you’re having a medical emergency, call 911 or your local emergency number.

Serious side effects of Xyosted that have been reported include:

* This side effect wasn’t seen in studies of Xyosted but has been reported since the drug was approved.
† For more information about this side effect, see the “Side effect focus” section below.

SUICIDE PREVENTION

If you think someone is at immediate risk of self-harm or hurting another person:

  • Call 911 or your local emergency number.
  • Stay with the person until help arrives.
  • Remove any guns, knives, medications, or other things that may cause harm.
  • Listen, but don’t judge, argue, threaten, or yell.

If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Side effect focus

Learn more about some of the side effects Xyosted may cause.

Boxed warning

Xyosted has a boxed warning. This is a serious warning from the Food and Drug Administration (FDA).

Risk of increased blood pressure. Xyosted can increase blood pressure, which can result in serious heart problems. These include heart attack and stroke (lack of blood flow to the brain), which can be life threatening.

High blood pressure usually doesn’t cause noticeable symptoms. But your doctor will have you monitor your blood pressure during your Xyosted treatment to watch for increases.

Symptoms of heart problems can include:

  • pain or pressure in your chest, which may spread to your arm, back, or jaw
  • dizziness
  • shortness of breath
  • sudden weakness or numbness on one side of your body
  • trouble speaking

Due to this warning, doctors may not prescribe Xyosted if you have existing heart problems or risk factors for heart problems.

What might help

Your doctor will recommend how often you should monitor your blood pressure during Xyosted treatment.

If you have increased blood pressure while using Xyosted:

  • Your doctor might prescribe medications to treat high blood pressure. If you already take medications for this, your doctor may:
    • adjust your dose,
    • prescribe another medication for you to take, or
    • change your blood pressure medication altogether
  • Your doctor might lower your Xyosted dosage. Or they might recommend stopping Xyosted temporarily or permanently.

If you think you’re having symptoms of a heart attack or stroke, immediately seek medical attention. Call 911 (or your local emergency number) or go to the closest emergency room.

Depression and suicidal thoughts

Treatment with Xyosted can cause depression and suicidal thoughts or actions, in rare cases.

Symptoms of depression can include:

  • appetite changes
  • fatigue (low energy)
  • feeling irritable or frustrated
  • loss of pleasure in activities you usually enjoy
  • persistent feelings of sadness
  • sleep problems, such as sleeping too much or too little
  • thoughts of worthlessness or self-blame

What might help

If you notice symptoms of depression or suicidal thoughts during treatment with Xyosted, contact your doctor. They can help decide whether it’s safe for you to continue using the drug. They might recommend trying a different testosterone replacement therapy.

Enlarged prostate

Xyosted can cause enlargement of your prostate. This refers to inflammation (swelling and damage) that causes your prostate to get larger. This condition is also called benign prostatic hyperplasia (BPH). This side effect wasn’t common in studies.

Symptoms of an enlarged prostate can include:

  • accidental urination
  • feeling a sudden urge to urinate
  • increased need to urinate at night
  • needing to urinate more often than usual
  • urinary hesitancy (trouble starting or maintaining urination) or inability to urinate

What might help

If you notice symptoms of an enlarged prostate, talk with your doctor. They’ll likely want to examine you. They may suggest stopping Xyosted and treating your symptoms, in some cases.

Allergic reaction

Some people may have an allergic reaction to Xyosted. Allergic reaction wasn’t reported in studies of Xyosted, but it can still happen.

Symptoms of a mild allergic reaction can include:

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to Xyosted. But if you think you’re having a medical emergency, call 911 or your local emergency number.

Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use.

If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Xyosted manufacturer’s website to see if they have support options.

You can also check out this article to learn more about saving money on prescriptions.

Your doctor or another healthcare professional will explain how to inject Xyosted. They’ll also explain how much to use and how often. Be sure to follow their instructions.

Xyosted comes as a liquid solution in a prefilled autoinjector pen. You’ll inject the drug under your skin.

Xyosted injection sites

You should inject Xyosted under the skin of your belly area. Do not inject Xyosted into a muscle or a vein. Also, you should not inject it within 2 inches of your navel (belly button).

The manufacturer of Xyosted provides a video on its website showing how to inject the drug. You can also review Xyosted’s instructions for use.

Accessible medication containers and labels

If it’s hard for you to read the label on your prescription, tell your doctor or pharmacist. Certain pharmacies may provide medication labels that:

  • have large print
  • use braille
  • contain a code you can scan with a smartphone to change the text into audio

Your doctor or pharmacist may be able to recommend a pharmacy that offers these options if your current pharmacy doesn’t.

Questions for your doctor

You may have questions about Xyosted and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

  • Before your appointment, write down questions such as:
    • How will Xyosted affect my body, mood, or lifestyle?
  • Bring someone with you to your appointment if doing so will help you feel more comfortable.
  • If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So, don’t hesitate to ask questions or offer feedback on your treatment.

Xyosted is used as replacement therapy to treat testosterone deficiency (low or no natural testosterone). It’s prescribed for adult males* with certain conditions caused by hypogonadism. This refers to a lack of testosterone produced by the body, mainly in the testes.

Testosterone is an androgen (a male sex hormone). It’s found in males and females,* but males typically produce more of it. In males, it has a key role in sperm production and sex drive. It also affects muscle mass, bone growth, and the way fat is stored in the body.

In adult males, low testosterone levels can cause symptoms such as decreased muscle mass, loss of strength, and decreased sex drive. Xyosted works to treat low testosterone by replacing testosterone that your body doesn’t make on its own.

Doctors typically won’t prescribe Xyosted to treat low testosterone due to aging. (Testosterone levels tend to decrease naturally with age.)

Also, it’s not known if Xyosted is safe for males under age 18 years. The drug has only been studied in adults.

* In this article, we use the terms “male” and “female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

There are some important things to discuss with your doctor when considering Xyosted treatment. These include your overall health and any medical conditions you may have, as well as all medications you take.

Interactions

Taking a medication with certain vaccines, foods, and other things can affect how the medication works. These effects are called interactions.

Before starting Xyosted, be sure to tell your doctor about all medications you take, including prescription and over-the-counter types. Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Xyosted.

Interactions with drugs or supplements

Xyosted can interact with several types of drugs. These drugs include:

This list does not contain all types of drugs that may interact with Xyosted. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with Xyosted.

Boxed warning

Xyosted has a boxed warning about the risk of increased blood pressure. A boxed warning is a serious warning from the Food and Drug Administration (FDA) about drug effects that may be dangerous.

Increased blood pressure caused by Xyosted can result in serious heart problems, which can be life threatening. To learn more, see “What are Xyosted’s side effects?” above.

Warnings

Xyosted may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Xyosted. Factors to consider include those in the list below.

  • Breast or prostate cancer. Treatment with Xyosted could worsen existing breast cancer or prostate cancer. Due to this risk, doctors typically will not prescribe Xyosted if you have either of these conditions.
  • Benign prostatic hyperplasia (BPH). Xyosted can worsen an enlarged prostate, also called BPH. Your doctor can help determine whether treatment with Xyosted is safe for you if you already have this condition.
  • Polycythemia (high red blood cell levels). Xyosted can cause polycythemia, which can raise your risk of blood clots. If you already have this condition, Xyosted might make it worse. Your doctor can help determine if Xyosted is safe for you.
  • Heart failure. Xyosted can cause edema (swelling in your hands, ankles, or feet caused by excess fluid). If you have heart failure, edema can worsen your condition. Xyosted may not be safe for you.
  • Kidney problems or liver problems. Xyosted can worsen kidney or liver problems. This drug may not be safe for you if you already have problems with your kidney or liver. Your doctor will determine whether Xyosted is safe for you.
  • Low testosterone due to age. Xyosted isn’t used to treat low testosterone caused by aging. This is due to the drug’s boxed warning for risk of serious heart problems (see “What are Xyosted’s side effects?” above for details). Your doctor can suggest safer treatments to manage low testosterone caused by aging.
  • Mental health conditions, such as depression. Treatment with Xyosted can cause mood changes. This can cause or worsen mental health conditions, including depression or suicidal thoughts. If you have a mental health condition, talk with your doctor to determine whether Xyosted is safe for you.
  • Sleep apnea. Xyosted can cause or worsen sleep apnea. If you have this condition or are at risk for it, talk with your doctor about whether Xyosted is safe for you.
  • Allergic reaction. If you’ve had an allergic reaction to Xyosted or any of its ingredients, your doctor will likely not prescribe Xyosted. Ask them what other medications are better options for you.

Xyosted and alcohol

There’s no known interaction between alcohol and Xyosted.

However, studies have found that alcohol can reduce testosterone production. This effect was found to be related to the amount of alcohol consumed. People who reported drinking more alcohol in these studies tended to produce less natural testosterone.

It’s possible that drinking alcohol could affect how well Xyosted works to raise testosterone levels. If you drink alcohol, talk with your doctor about how much is safe to have during your Xyosted treatment.

Pregnancy and breastfeeding

Xyosted should not be used during pregnancy because it may cause fetal harm. It also shouldn’t be used while breastfeeding. This drug is only approved for use in males.*

* In this article, we use the term “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

Xyosted is sometimes misused. This refers to using the drug in a way that’s not prescribed.

Misuse can lead to dependence on Xyosted. (With dependence, your body can’t function like usual without the drug.) This may cause your body to make less natural testosterone or stop making it.

Drug dependence can result in withdrawal symptoms. These are negative effects that can occur if you stop taking a drug. Withdrawal symptoms reported after misusing Xyosted at higher doses than recommended include:

Testosterone products like Xyosted are sometimes misused by athletes or bodybuilders to help improve performance. Doing this can lead to serious effects. These may include heart attack or mental health effects such as depression.

Xyosted is a controlled substance. This means there are additional legal requirements for prescribing and taking it, due to the risk of misuse. Your doctor or pharmacist can provide more information about this.

Never share your Xyosted prescription with anyone else. And only use Xyosted exactly as your doctor tells you to.

Do not use more Xyosted than your doctor prescribes. Doing so can lead to serious side effects.

What to do in case you use too much Xyosted

Call your doctor if you think you’ve injected too much Xyosted. You can also call 800-222-1222 to reach the American Association of Poison Control Centers, or use its online resource. But if you have severe symptoms, immediately call 911 or your local emergency number. Or go to the nearest emergency room.

Talk with your doctor or pharmacist if you’re considering treatment with Xyosted. Ask questions that help you feel comfortable about the risks and benefits of taking the medication. Some examples to help you get started are:

  • What should I know about alternatives to Xyosted?
  • Does my medical history put me at higher risk of side effects with Xyosted?
  • How will I know if Xyosted is working for me?
  • Will I have withdrawal symptoms if I stop treatment with Xyosted?

You may also be interested in learning more about:

Q:

Are testosterone replacement drugs like Xyosted safe for my liver?

Anonymous

A:

Yes, in general. Liver side effects haven’t been reported with Xyosted.

Liver problems have been linked to long-term use of high doses of testosterone that’s taken by mouth, though. One example of this type of drug is methyltestosterone (Android-25). Liver problems from this form of testosterone include hepatitis (a type of liver infection) and jaundice (yellowing of the skin and whites of the eyes).

Also, testosterone enanthate given as an injection into a muscle can cause benign liver tumors (noncancerous growths). Testosterone enanthate is the active drug in Xyosted. But Xyosted is injected under your skin. It should not be injected into a muscle or vein or taken by mouth.

Your doctor will make sure that Xyosted is safe for you, given your medical history and other factors. And they may monitor your liver function during treatment if needed.

It’s still important to contact your doctor right away if you notice any symptoms of liver problems during your treatment with Xyosted. Symptoms to watch for include:

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Xyosted Images