Testosterone enanthate vs. cypionate: Key differences, costs, and side effects

In this article:

• Key differences
• Insurance coverage and cost
• Side effects
• Interactions and warnings

In this article

• Key differences
• Insurance coverage and cost
• Side effects
• Interactions and warnings

Testosterone replacement therapy (TRT) has skyrocketed in prevalence over the past decade, and two of the most common drugs for it are testosterone enanthate and testosterone cypionate. They’re both injectable forms of the hormone prescribed for people with hypogonadism—aka low testosterone levels. Technically classified as androgenic hormones, these prescription drugs can help boost libido, increase energy, improve muscle mass, improve mood, and more. 

While both drugs are effective for balancing out hormone levels, they differ in their composition, dosage frequency, indications, and even sometimes their prices. Read on for the important details. 

Not necessarily—at least not in terms of effectiveness. In a study that compared intramuscular testosterone cypionate and subcutaneous testosterone enanthate, both formulations significantly raised total testosterone levels. The main difference, researchers found, was that enanthate was associated with lower levels of estradiol and hematocrit, giving it a marginally better safety profile. 

The two things that set these two medications apart are their duration and carrier oils. “​​Both are long-acting esters of testosterone with slightly different half-lives—cypionate is estimated to have a marginally longer half-life (~8 days vs. ~5–7 days for enanthate),” says Brian Moyer, PA, owner of Optimize U in Chula Vista. “But this rarely translates to a significant difference in patient outcomes. Most patients respond equally well to either ester.”

Additionally, testosterone enanthate is usually dissolved in sesame oil, while cypionate commonly uses olive oil, grapeseed oil, or cottonseed oil. The type of carrier oil doesn’t have a significant influence on the drug’s efficacy, but it might affect how long the testosterone lasts. Sesame oil is noticeably more viscous than the other oils used, which means the enanthate version takes longer to prepare and inject, and is more likely to cause lumps at the injection site.

While neither version is necessarily better than the other, one might be better for your particular medical condition. However, only a healthcare provider can make that call. They’ll determine which one might work best for you best on your medical history, other medications, personal preferences, and individual needs. So always consult a professional before starting testosterone treatment. 

Testosterone enanthate vs. cypionate: Insurance coverage and cost comparison

Some insurance plans may provide coverage for either testosterone medication when it’s considered medically necessary. Determining what qualifies as “medically necessary,” however, can get complicated. 

“Many men and women have low testosterone levels. However, the FDA has such a wide range of what is considered normal that many individuals who suffer from non-optimal testosterone levels do not qualify for coverage,” says Dr. Nic Kampfer,  clinic administrator at Advanced Care Specialists and Great Lakes Testosterone.  “The reference range for free testosterone is 6.8–21.5 ng/dL, and many symptomatic individuals will fall into that range when in reality higher levels (within reason) tend to help men feel much better.”  

“As a result, many patients with ‘low-normal’ testosterone levels may still suffer from significant symptoms but are denied coverage because their lab results fall within the accepted range,” Moyer adds. 

Even when an insurance plan does provide coverage, there’s no guarantee that it will also cover necessary supplemental medication. In other words, “they will cover your testosterone but will not cover anastrozole and/or Clomid to help control estrogen levels and maintain proper testicular function, respectively,” Dr. Kampfer says.  

For anyone paying completely out of pocket, testosterone enanthate can cost around $153, while testosterone cypionate often costs around $112. And SingleCare coupons can bring those prices down to $84 and $31, respectively. 

Testosterone enanthate and cypionate side effects

Side effects are possible with either type of testosterone. However, “the majority of patients on TRT experience few or no side effects when appropriately dosed and monitored. Most side effects occur when testosterone levels are too high or when dosing frequency isn’t optimized,” Moyer says. 

According to the Xyosted label, the most common side effects of testosterone enanthate are an increase in red blood cell volume (hematocrit), hypertension, an increase in prostatic specific antigen (PSA), injection site bruising, mood swings, and headache. 

The most common side effects for testosterone cypionate are injection site redness and reactions, but it may also cause headaches, mood changes, anxiety, nausea, changes in libido, and more.

Acne and hair loss are also typically listed as potential side effects of both types of testosterone, and while they’re possible, they might not be quite as common. “Generally a medically prescribed dosage will not cause acne, and some men notice improvement of their overall skin,” Dr. Kampfer says. Similarly, “medically prescribed administration of HRT should not cause significant hair loss. Off-label use or cycling of up to 700 mg of testosterone weekly can cause hair loss.”  

Testosterone enanthate and cypionate drug interactions and warnings

Many side effects can be bothersome, but tolerable. Drug interactions, however, can be fairly serious. Both testosterone enanthate and cypionate might interact with the following drugs, so be sure to inform a healthcare provider if you’re taking any of them when discussing hormone treatment options. 

• Anticoagulants
• Antidiabetic drugs or insulin
• Corticosteroids
• Adrenocorticotropic hormones (ACTH)
• Hypertension agents

Additionally, precautions for either drug are necessary for people with the following conditions:

• Certain cancers: Testosterone treatment might increase the risk of prostate cancer or breast cancer.
• Pregnancy or breastfeeding: Testosterone may harm the unborn or breastfeeding baby. 

• Heart problems: Testosterone can raise blood pressure and increase the risk of blood clots, heart attack, stroke, and other cardiovascular issues. 

• Liver issues: Long-term use of testosterone can lead to potentially serious liver problems. 
• Kidney disease: In patients with existing renal issues, testosterone treatment may cause edema—swelling from excess fluid retention.

Children who are taking it for delayed puberty may also experience accelerated bone maturation, so the healthcare provider will need to monitor their bone growth regularly. 

Important Note: Testosterone injections should never be used to improve athletic performance or muscle growth. They’re not FDA-approved for those uses, and they also present serious risks, including heart and liver issues, infertility, mental health issues, and much more.