Injections. Gel. Cream. Pellets. Oral testosterone. Which one is “best?”

If you’ve spent any time researching testosterone online, you’ve probably noticed something.

Everyone has an opinion.

One person says injections are the only way to go. Someone else says gel provides steadier levels. Another person insists compounded cream changed everything for them. Then you find a Reddit thread where people are passionately debating SubQ versus IM injections, and somehow everyone seems absolutely convinced they’re right.

Sound familiar?

One of the most common questions we hear at QueerDoc is:

“What’s the best way to take testosterone?”

Sometimes it’s framed a little differently.

“Should I switch to gel?”

“Are injections stronger?”

“Does testosterone cream work?”

“Can I microdose testosterone?”

“Will gel change my voice more slowly?”

They’re all good questions.

The short answer?

We honestly don’t know.

I know.

That’s probably not the satisfying answer you were hoping for.

But one of the things we value most at QueerDoc is transparency. Sometimes transparency means explaining what the research shows. Sometimes it means explaining what experienced clinicians have learned after caring for thousands of transgender and gender diverse patients. Sometimes it means listening to the collective wisdom of our community.

And sometimes it means saying, “The research simply hasn’t caught up yet.”

This is one of those times.

A Quick Note About Our Language

You might notice that throughout this article we avoid terms like “masculinizing hormone therapy.” That’s intentional.

You’ll still see that language throughout research papers, medical guidelines, and everyday conversations, and we’re not saying it’s wrong. It just doesn’t quite fit how we think about gender affirming care.

Here’s why.

Hormones don’t have genders. People do.

Testosterone isn’t masculine.

It’s a hormone.

It doesn’t make someone a man, just as estradiol doesn’t make someone a woman.

What testosterone can do is support a wide range of physical, emotional, and physiological changes that help people feel more at home in their bodies and more aligned with their gender.

For many trans men, those changes feel deeply affirming of their identity as men. Testosterone can be an incredibly important part of reducing gender dysphoria and helping someone feel more fully themselves.

At the same time, testosterone isn’t only for men.

Nonbinary people, transmasculine people, gender expansive people, and people with many different gender identities use testosterone for many different reasons and with many different goals. Some are hoping for voice changes, some want menstrual suppression, some are looking for facial hair or changes in body composition, and some are seeking only subtle changes over time.

None of those goals are more valid than another.

They’re simply different.

That’s why you’ll usually hear us talk about testosterone, testosterone-related changes, changes associated with testosterone, or gender affirming treatment instead of “masculinizing hormone therapy.”

For us, that language leaves room for everyone who may benefit from testosterone without assuming what their gender is or what their goals should be.

Because there is no one way to be a man.

There is no one way to be nonbinary.

There is no one way to be trans.

And there is no one right reason to take testosterone.

We Don’t Have a “Best” Testosterone

Despite testosterone being one of the oldest and most commonly prescribed medications used in gender affirming care, we still don’t have high-quality research comparing all of the different ways of taking testosterone in transgender and gender diverse people.

We don’t have large clinical trials showing injections consistently help people achieve their gender affirming goals better than gel.

We don’t have convincing evidence that compounded cream produces different long-term outcomes than commercially available gel.

We don’t have research showing one injectable formulation consistently outperforms another.

And despite what social media might sometimes suggest, we don’t have evidence that one route of administration automatically produces a deeper voice, more facial hair, faster body changes, or “better” results.

Seriously.

Most of what we know comes from four places:

• Research in Cis people receiving testosterone therapy
• Our understanding of physiology and pharmacology
• Clinical experience
• Community wisdom

We think all four deserve a seat at the table.

Community Wisdom Matters

Transgender healthcare has always relied on community knowledge.

Long before many healthcare systems offered gender affirming care, transgender and gender diverse people were sharing information, comparing experiences, supporting one another, and figuring out how to navigate medications that were often difficult to access.

That history matters.

Community wisdom helps us recognize patterns. It helps us understand what living with a medication actually feels like day after day. It often raises important questions years before researchers begin studying them.

Sometimes community observations eventually become well-supported science.

Sometimes they don’t.

And sometimes the answer turns out to be more complicated than anyone expected.

That doesn’t make community experience less valuable.

It simply means lived experience and scientific evidence answer different kinds of questions.

If hundreds or thousands of people describe similar experiences after switching from injections to gel—or from gel to injections—that’s worth paying attention to.

It doesn’t necessarily tell us why it happened.

It doesn’t necessarily mean everyone will have the same experience.

But it absolutely deserves curiosity instead of dismissal.

At QueerDoc, we try to bring all of these perspectives together. We look at the available research. We think about physiology. We draw on our clinical experience. We listen carefully to what our patients and our community are telling us.

That’s often where the best conversations happen.

The Better Question Isn’t “What’s Best?”

We actually think there’s a better question.

Instead of asking:

“What’s the best testosterone?”

We usually ask:

“What are your goals?”

Because that’s really what gender affirming care is about.

Some people are hoping for deeper voice changes as quickly as reasonably possible.

Some people want gradual changes over several years.

Some people are primarily interested in menstrual suppression.

Some people want more energy or improved mood.

Some people are hoping for facial hair growth.

Some people want lower doses because they’re looking for subtle or slower changes.

Some people simply want their hormone levels to feel stable throughout the week.

All of those are valid goals.

Your gender identity doesn’t automatically tell us what your treatment goals are.

A Nonbinary person may choose exactly the same testosterone regimen as a trans man.

A trans man may choose lower doses than another trans man.

Someone may be primarily focused on voice changes, while someone else is more interested in body composition or menstrual suppression.

There is no one way to be trans.

There is no one way to be Nonbinary.

And there is definitely no one right way to take testosterone.

We Treat People, Not Laboratory Values

One of the biggest misconceptions we see online is the idea that higher testosterone levels automatically produce better outcomes.

We wish it were that simple.

Hormones are only one piece of a much bigger picture.

Your genetics influence things like facial hair growth, body hair, acne, voice changes, and body composition. Age matters. Previous hormone exposure matters. Overall health matters. Time matters. Things we probably haven’t even identified yet almost certainly matter too.

Laboratory values help us understand what’s happening inside your body.

They don’t tell the whole story.

At QueerDoc, we’re usually asking questions like:

• Are you moving toward your gender affirming goals?
• How do you feel?
• Are you experiencing side effects?
• Are your testosterone levels where we’d expect them to be?
• Does this treatment fit into your everyday life?
• Is it affordable?
• Can you realistically continue it long term?

Those conversations often tell us much more than a laboratory result by itself.

Things We Think About When Choosing How You Take Testosterone

Every person is different, but these are some of the conversations we have most often.

One thing you’ll notice missing from that table?

We never ask which testosterone is the “strongest.”

Because that’s usually the wrong question.

The best testosterone isn’t the one with the biggest online fan club.

It’s the one that best fits your goals, your body, and your life.

Before We Compare the Different Options…

If you’ve been taking testosterone one way for years and it’s working beautifully for you, this article is not trying to convince you to switch.

Seriously.

One of the easiest ways to create unnecessary anxiety is to spend an evening reading social media posts insisting there’s only one “correct” way to take testosterone.

If your goals are being met, you’re tolerating your medication well, your laboratory results look appropriate, and your treatment fits your life, that’s a wonderful place to be.

Sometimes the best treatment isn’t the newest one or the one with the loudest advocates.

Sometimes it’s simply the one that’s helping you feel more at home in your body.

On the other hand, if you’re wondering whether another option might fit your life a little better, that’s okay too.

One of the biggest sources of anxiety we see is people feeling like they have to choose the “right” testosterone from day one—as though they’re making a lifelong commitment.

You’re not.

Gender affirming care is a process, not a single decision.

Your goals may change.

Your body may change.

Your health may change.

Your life almost certainly will.

Maybe you start with injections because they’re inexpensive and widely available. A few years later, you realize a daily gel fits your routine better.

Maybe gel works beautifully until insurance stops covering it.

Maybe your work schedule changes.

Maybe you travel frequently.

Maybe your goals evolve.

There’s no rule that says the way you start testosterone has to be the way you take it forever.

Changing medications doesn’t mean the first choice was wrong.

It usually means you’ve learned more about your body, your priorities, or your life.

That’s good medicine.

With that in mind, let’s walk through the different ways of taking testosterone. Rather than trying to rank them from “best” to “worst,” we’ll talk about where each one may shine, where it may have limitations, and the kinds of goals or lifestyles they may fit particularly well.

Think of these as conversation starters—not scorecards.

Injectable Testosterone Cypionate

When most people picture testosterone, they’re usually picturing an injection.

Testosterone cypionate is one of the most commonly prescribed forms of testosterone for transgender and gender diverse people in the United States, and for good reason. It’s widely available, relatively inexpensive, and gives us a great deal of flexibility when adjusting doses.

Many people appreciate only needing to think about their medication once every week or every couple of weeks. Others simply prefer injections over remembering a daily medication.

Community wisdom around injectable testosterone is extensive.

Some people tell us injections were life-changing. Others appreciate the routine of a weekly injection and like that they don’t have to think about testosterone every morning. Some feel injections better support the changes they’re hoping for.

Others feel exactly the opposite.

Some dislike the emotional ups and downs they experience throughout an injection cycle. Others simply don’t enjoy giving themselves injections every week.

Both experiences are real.

What we don’t know is whether injections consistently help people achieve their goals better than other ways of taking testosterone.

At this point, the research simply doesn’t answer that question.

One thing we hear a lot is that injections are the “strongest” testosterone.

We’d probably say they’re simply different.

Different isn’t automatically better.

It’s just different.

Testosterone Enanthate

Testosterone enanthate is another injectable form of testosterone that works very similarly to cypionate.

People often ask which one is better.

Honestly?

For most people, probably neither.

Some people notice they feel better on one than the other. Others notice no difference at all. Insurance coverage, pharmacy availability, cost, and previous experience often end up influencing the decision more than any meaningful differences between the medications themselves.

If one formulation has worked well for you, there’s usually no compelling reason to switch simply because someone online prefers the other one.

Intramuscular (IM) vs Subcutaneous (SubQ) Injections

This is probably one of the most common questions we hear.

“Is SubQ as good as IM?”

Short answer?

Yes.

Years ago, testosterone was traditionally given as an intramuscular (IM) injection, meaning the medication was injected into a muscle.

Over time, many clinicians and patients began using subcutaneous (SubQ) injections instead, where testosterone is injected into the fatty tissue just underneath the skin.

Research has shown that SubQ testosterone works well for many people and achieves testosterone levels comparable to IM injections.

For many patients, SubQ injections are simply easier.

The needles are often smaller.

The injections may be less uncomfortable.

Some people find them less intimidating.

Others have used IM injections for years and have no interest in changing.

That’s okay too.

At QueerDoc, we think this is another place where there doesn’t need to be a winner.

If one approach works well for you, wonderful.

If another approach fits your body better, that’s wonderful too.

Some People Are Really Sensitive to Peaks and Valleys

This is something we wish got talked about more often.

Not everyone notices changes in testosterone levels throughout their injection cycle.

Some people honestly couldn’t tell you whether they’re one day or six days after their injection.

Other people absolutely can.

Some people notice changes in:

• Mood
• Irritability
• Emotional regulation
• Energy
• Motivation
• Focus
• Libido
• Overall sense of well-being

You might notice feeling fantastic for a few days after your injection and then gradually feeling more tired, irritable, or emotionally “flat” as your next dose approaches.

Or…

You may never notice any difference at all.

Both experiences are completely normal.

We don’t fully understand why some people are much more sensitive to hormone fluctuations than others, but it’s something we hear often enough—from our own patients and throughout the community—that we take it seriously.

Fortunately, there are lots of ways to address this.

Sometimes giving smaller injections more frequently smooths out those peaks and valleys beautifully.

Sometimes switching from every two weeks to every week—or even twice weekly—makes a tremendous difference.

Sometimes another route, like gel or cream, provides the consistency someone has been looking for.

The answer isn’t always changing medications.

Sometimes it’s simply changing the schedule.

Microdosing Testosterone Isn’t a Route of Administration

This is another point that causes a lot of confusion online.

People often talk about “microdosing gel” or “microdosing injections” as though microdosing is a specific type of testosterone.

It isn’t.

Microdosing is simply a dosing strategy.

You can use lower doses with injections.

You can use lower doses with gel.

You can use lower doses with compounded cream.

The route of administration and the dose are two different decisions.

Some people choose lower doses because they want slower changes.

Some are exploring what feels right for them.

Some are looking for specific changes while hoping to minimize others.

Some simply feel best on lower doses.

All of those are valid reasons.

Just like with any other testosterone regimen, the “right” dose is the one that best aligns with your goals while balancing benefits, side effects, and your overall health.

There isn’t one correct way to do it.

That’s another conversation we individualize together.

Testosterone Gel

If injections are the route that gets talked about the most, testosterone gel is probably the one that gets misunderstood the most.

One of the biggest myths we hear is:

“Gel doesn’t work as well as injections.”

The evidence we have simply doesn’t support that.

Testosterone gel absolutely works.

The goal with any route of testosterone is to achieve testosterone levels that support your gender affirming goals while minimizing unwanted side effects. Gel can absolutely do that for many people.

Rather than delivering testosterone all at once, gel is applied to the skin every day. The testosterone is absorbed gradually through the skin into the bloodstream, creating relatively stable hormone levels over time.

For some people, that consistency is one of the biggest advantages.

Community wisdom reflects this, too. Many people who switch from injections to gel describe feeling emotionally steadier or noticing fewer ups and downs in their energy or focus. Others simply appreciate making testosterone part of a morning routine instead of thinking about injections every week.

Of course, not everyone loves gel.

Some people find daily application annoying. Others have difficulty remembering a medication every morning. Insurance coverage can also be frustrating, and depending on where you live, cost may become a barrier.

Like every other option, gel isn’t better.

It’s different.

Compounded Testosterone Cream

Compounded testosterone cream deserves its own conversation because it’s often grouped together with gel, even though they’re not exactly the same thing.

Compounded creams are prepared by compounding pharmacies and can be customized in different concentrations and formulations. That flexibility can be incredibly valuable for people who need doses or preparations that aren’t commercially available.

Many patients also simply prefer creams.

Community members sometimes report that creams absorb well for them, fit naturally into their daily routine, or better support their goals. Others appreciate the flexibility that compounded formulations can provide.

At the same time, compounded medications come with a little more uncertainty.

Unlike commercially manufactured testosterone products, compounded medications generally don’t go through the same FDA approval process or large-scale manufacturing standardization. Many compounding pharmacies produce excellent medications, but absorption and consistency can vary depending on the formulation and the pharmacy.

That doesn’t make compounded cream “better” or “worse.”

It’s another tool.

For the right person, it may be an excellent one.

Testosterone Pellets

Pellets are probably one of the least commonly used forms of testosterone, but they’re worth talking about because many people are curious about them.

Tiny pellets containing testosterone are placed underneath the skin during a brief office procedure. Over the following several months, they slowly release testosterone into the bloodstream.

The biggest advantage is convenience.

There’s no weekly injection.

No daily gel.

No remembering medication every morning.

For some people, that’s a huge improvement in quality of life.

Others appreciate that pellets provide relatively steady testosterone levels over time.

On the other hand, pellets aren’t easy to adjust once they’re placed.

If your testosterone levels end up higher than expected, lower than expected, or your goals change, you can’t simply stop taking tomorrow’s dose.

The pellets continue releasing testosterone until they’re depleted.

We also have relatively limited research evaluating testosterone pellets specifically in transgender and gender diverse populations.

Community experiences vary quite a bit.

Some people absolutely love them.

Others prefer having more flexibility.

Both are reasonable.

Oral Testosterone

Many people are surprised to learn that oral testosterone exists.

Historically, oral testosterone wasn’t widely used because earlier formulations were associated with liver toxicity. More recently, testosterone undecanoate capsules have become available and work differently than older oral preparations.

For some people, taking a capsule is incredibly appealing.

No injections.

No gels.

No creams.

Just a pill.

Like every medication, though, there are tradeoffs.

Oral testosterone often needs to be taken with food containing fat for consistent absorption, can be more expensive, and isn’t always covered by insurance. We also have less clinical experience using it in transgender and gender diverse populations than we do with injections or topical formulations.

That doesn’t mean it isn’t a reasonable option.

It simply means we still have more to learn.

What About Voice Changes?

This deserves its own section because it’s probably one of the most common questions we hear.

“Will injections deepen my voice faster?”

“Does gel work more slowly?”

“Should I switch routes if my voice hasn’t changed?”

The honest answer is…

We don’t know.

What we do know is that voice changes vary tremendously from person to person.

Genetics matter.

Time matters.

Age matters.

Dose matters.

Individual biology matters.

Whether the route itself makes a meaningful difference is much less clear.

Many people achieve significant voice changes using injections.

Many people achieve significant voice changes using gel.

Many people using lower doses notice gradual changes over a longer period of time.

Right now, we don’t have convincing evidence that one route consistently produces better voice outcomes than another.

If voice changes are one of your highest priorities, that’s absolutely something to discuss with your healthcare provider.

It just probably isn’t as simple as choosing one formulation over another.

So…Which Testosterone Does QueerDoc Recommend?

People ask us this all the time.

Our answer probably won’t surprise you by now.

All of them.

And none of them.

We don’t have a clinic-wide favorite because we don’t believe there should be one.

Instead, we try to find the testosterone that best fits your goals, your health, your neurotype, your lifestyle, your budget, your access to care, and your preferences.

Sometimes that’s injections.

Sometimes it’s gel.

Sometimes it’s compounded cream.

Sometimes it’s pellets.

Sometimes your insurance company makes the decision before either of us gets much say.

Sometimes your goals change, and your testosterone changes with them.

That’s not a setback.

That’s individualized medicine.

The Bottom Line

If you’ve made it this far, you were probably hoping we’d eventually tell you which testosterone is the best.

We’re still not going to do that.

Not because we’re avoiding the question.

Because we honestly don’t think that’s how good gender affirming care works.

Good care isn’t about finding the medication with the biggest online fan club or the most dramatic stories on social media.

It’s about finding the treatment plan that helps you move toward your goals while fitting your body, your health, your finances, your daily routine, and your life.

Some of that decision comes from research.

Some comes from physiology.

Some comes from clinical experience.

Some comes from the collective wisdom of a community that has been teaching itself about gender affirming care long before most healthcare systems were paying attention.

We think all of those perspectives matter.

Our job isn’t to tell you which one is “right.”

Our job is to help you understand the options, weigh the tradeoffs together, and build a treatment plan that supports your goals today while leaving room for those goals to evolve tomorrow.

Because there is no one way to be trans.

There is no one way to be Nonbinary.

And there is definitely no one right way to take testosterone.