If swallowing a pill could replace the needle, why do so many men still choose to jab themselves with testosterone when modern science offers a smoother path?

Story Snapshot

• Oral testosterone pills like Jatenzo are now FDA-approved but injections still dominate therapy for men with low testosterone.
• Patient preference, medical inertia, and nuanced pharmacological differences drive this paradoxical trend.
• Long-term safety concerns and insurance hurdles slow the adoption of oral testosterone despite its convenience.
• The future of testosterone therapy hinges on balancing efficacy, safety, cost, and patient experience.

Why the Pill Isn’t Winning: The Strange Loyalty to Needles

Testosterone replacement therapy has evolved dramatically since the 1930s, yet the sight of a needle remains the weekly ritual for millions of men. Even in 2025, after the FDA greenlit oral options like Jatenzo in 2019, injections retain a near-sacred status among patients and doctors. Men who once envied the hassle-free promise of a pill now hesitate at the pharmacy counter, questioning whether a capsule can deliver what a syringe always has. The answer, it turns out, is more complicated than “old habits die hard.”

The injectable forms—cypionate, enanthate, undecanoate—boast a legacy of predictable results and low cost. For decades, attempts at oral testosterone failed due to poor absorption and dangerous liver toxicity. The arrival of Jatenzo, which bypasses the liver via lymphatic absorption, solved that technical hurdle but introduced a new problem: trust. Doctors know what injections do; the pill, despite FDA backing, feels like the new kid in class who hasn’t yet passed the final exam.

Testosterone Pills Are Here. Why Are Guys Still Injecting? https://t.co/vfheQDRKqG

— Men's Health Mag (@MensHealthMag) November 25, 2025

Safety, Side Effects, and the Insurance Maze

Oral testosterone delivers on convenience, but every benefit comes with a caveat. Jatenzo and its peers must be taken twice daily with food, demanding strict adherence. The boxed FDA warning for raised blood pressure and cardiovascular risk looms large, even as studies suggest oral and injectable testosterone are similarly effective at restoring normal hormone levels. For older men with comorbidities, even a small uptick in blood pressure is enough for caution. Insurance companies, meanwhile, often balk at covering the higher cost of oral meds, making injectables the pragmatic choice for the budget-conscious.

Patient Experience and the Culture of Testosterone

For some men, the ritual of injection is a badge of seriousness—a small, private act of agency that pills cannot replicate. Online forums and patient groups echo this sentiment, with veterans of TRT sharing tips on painless administration and dosing tweaks. Medical societies urge individualized care, but the inertia of habit and the camaraderie of the “injector club” are not easily overcome. This cultural factor, rarely acknowledged in medical journals, shapes the landscape as much as any double-blind trial.

The Road Ahead: Will Pills Ever Overtake Shots?

Oral testosterone prescriptions are rising, but injections still reign—a testament to the stubborn interplay between medical caution, economic realities, and patient psychology. If ongoing research confirms that oral testosterone is as safe and effective in the long run, and if insurance hurdles fall, the needle’s grip may finally loosen. In the meantime, the paradox persists: modern men, armed with choice, still opt for the old ways, clinging to the familiar sting of the needle even as a new era of therapy beckons.

Watch:

The evolution of testosterone therapy will be shaped not just by medical innovation, but by the lived realities and values of the men who depend on it. The next chapter belongs to those willing to weigh evidence against habit—and perhaps, finally, to swallow their doubts along with the pill.

Sources:

Low T Center
Hone Health
Maximus Tribe
GoodRx
Cleveland Clinic