Does oral testosterone have a boxed warning?

Not any more, and this is the single most out-of-date claim in circulation about these products. JATENZO carried a boxed warning for blood-pressure increases; its own Recent Major Changes table records it as "Removed 07/2025", and the current SPL contains no boxed-warning section at all — checked against the structured document rather than the marketing copy. KYZATREX has never carried one, and neither has Depo-Testosterone. Exactly one testosterone undecanoate product has a boxed warning today and it is AVEED, the injection, for serious pulmonary oil microembolism reactions and anaphylaxis. Blood pressure is still on the oral labels — as Warnings and Precautions 5.4 — but it is no longer boxed.

Do I really have to take it with food?

Yes, and the amount of fat changes the dose you actually absorb. Both oral labels say "take with food" in their dosage sections and both quantify what happens otherwise. KYZATREX: "When KYZATREX® was given with breakfast containing 16%, 33%, and 45% fat, the exposure (AUC 0-24 hr) of testosterone was increased by 37%, 87%, and 94%, respectively, compared to when given under fasted conditions." JATENZO: "The 15 g fat breakfast had a 25% decrease in testosterone exposure compared to the 30 g fat breakfast." Testosterone undecanoate is absorbed largely through the intestinal lymphatics, which requires dietary fat, so a capsule taken on an empty stomach is a smaller dose than the same capsule taken after a cooked breakfast. That variability is the reason the labels tie the dose to a blood level drawn at a fixed number of hours after the morning capsule. An injection has no equivalent variable — the cypionate label says nothing about food anywhere.

Is injectable testosterone safer than oral?

The labels do not support a general answer, and the one difference most often cited turns out not to exist. Blood pressure appears on all three: JATENZO 5.4, KYZATREX 5.4, and the Depo-Testosterone WARNINGS section, which reads "Testosterone can increase blood pressure which can increase cardiovascular (CV) risk over time. Monitor blood pressure periodically in men using testosterone products, especially in men with hypertension. Testosterone products are not recommended for use in patients with uncontrolled hypertension." All three say the product is not recommended in uncontrolled hypertension. Where the labels genuinely differ is in specificity rather than in risk — the oral products report ambulatory figures from their own trials (4.9/2.5 mmHg at 4 months, and 5.4/3.2 in men already on antihypertensives on JATENZO) while the injection states the class effect with no number, and the oral labels name a haematocrit monitoring interval of approximately three months where the injection says only "periodically". More detail on a label is not the same as more risk.

How much does oral testosterone cost compared with injections?

On invoice, around 138× as much. In the CMS NADAC file dated 2026-09-16, a year of JATENZO at its labelled starting dose of 237 mg twice daily costs a pharmacy $13,093, while a year of generic testosterone cypionate at 200 mg every two weeks — squarely inside the labelled range — is $94.92 of drug. Across the whole labelled cypionate range the year costs between $11.87 and $189.84. The reason is not complexity or quality: cypionate is generic many times over and no generic oral testosterone undecanoate exists. None of these figures is a price you can pay — NADAC records invoice cost before any dispensing fee, markup or rebate, and the cypionate figures are drug only, excluding needles, syringes and alcohol swabs.

Why is there no price for Kyzatrex here?

Because the only price the US government publishes does not contain it. No KYZATREX NDC appears in the 16 September 2026 NADAC file. There is no generic oral testosterone undecanoate either, so nothing in the file corresponds to this capsule. Applying JATENZO’s rate to it would be inventing a price for a different manufacturer’s product. Its label names a starting dose — 200 mg orally twice daily — so the regimen is perfectly well defined; what is missing is any published acquisition cost to attach to it. This page prints the gap rather than filling it, on the same principle that governs every other number here: a figure that cannot be sourced is omitted and the omission is stated where a reader would otherwise expect the number.

Are Jatenzo, Kyzatrex and Tlando the same drug?

Same ester, three different medicines in every way that matters to a prescription. Two of the three labels say so outright — "KYZATREX® is not substitutable with other oral testosterone undecanoate products" and TLANDO carries the identical sentence about itself. The numbers make the point on their own: JATENZO starts at 237 mg twice daily and titrates between 158 and 396 mg twice daily against a level drawn 6 hours after the morning dose; KYZATREX starts at 200 mg twice daily and titrates between 100 mg once daily and 400 mg twice daily against a level drawn at 3 to 5 hours; TLANDO is a fixed 225 mg twice daily with no titration scheme at all and a draw at 8 to 9 hours. Three dose scales, three draw windows, and no route between them.

Is AVEED the injectable version of Jatenzo?

It is the same ester by a different route, and treating it as "the injection of the same drug" is the mistake this page most wants to prevent. AVEED is the only product mentioned here with a boxed warning, and it is for serious pulmonary oil microembolism reactions and anaphylaxis, which "can occur after any injection of testosterone undecanoate during the course of therapy, including after the first dose". Its label adds: "Because of the risks of serious POME reactions and anaphylaxis, AVEED is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the AVEED REMS Program." and "Following each injection of AVEED, observe patients in the healthcare setting for 30 minutes in order to provide appropriate medical treatment in the event of serious POME reactions or anaphylaxis." Its regimen is 750 mg intramuscularly, again at four weeks, then every ten weeks — five injections a year, each in a certified healthcare setting. None of that applies to a capsule swallowed at breakfast, and none of it applies to cypionate either.

Head to head

Oral vs Injectable Testosterone

Oral testosterone undecanoate against cypionate in oil, from all four labels. Two of them differ on food, on monitoring and on an eye-watering price gap — and neither of them carries the boxed warning most articles attribute to them.

Reviewed September 2026

The short answer

The real difference is not the needle, it is how much of your day the medicine occupies. Oral testosterone undecanoate is two capsules a day, both with food, with the dose set by a blood level drawn at a specific number of hours after the morning one — 6 hours after the morning dose on JATENZO, 3 to 5 hours after the morning dose on KYZATREX, 8 to 9 hours after the morning dose on TLANDO. A level drawn on the wrong schedule is not interpretable. Cypionate is one injection every two to four weeks and has no food rule, no timing rule and no draw window.

The food requirement is not a comfort measure and both oral labels quantify it. KYZATREX reports testosterone exposure increasing by 37%, 87% and 94% over fasted with breakfasts of 16%, 33% and 45% fat; JATENZO reports 25% less exposure from a 15 g fat breakfast than from a 30 g one. Undecanoate is absorbed through the lymphatics and needs dietary fat to get there. An injection of oil into muscle does not care what you ate.

Two things widely said about oral testosterone are out of date or wrong. Neither JATENZO nor KYZATREX carries a boxed warning — JATENZO's blood-pressure box was removed in July 2025 and its own Recent Major Changes table says so. And the blood-pressure warning is not unique to the capsules: the Depo-Testosterone label carries one too, in almost the same words. What the oral labels add is a number for it, from their own trials.

Then the money, and it is not close. A year of JATENZO at its labelled starting dose costs a pharmacy $13,093 on invoice; a year of generic cypionate at 200 mg every two weeks costs $94.92 — a factor of 138×. KYZATREX cannot be priced at all: no KYZATREX NDC appears in the national acquisition-cost file, and there is no generic oral testosterone undecanoate of any kind.

4 of 16 dimensions are materially the same. They are marked below rather than dressed up as differences.

Oral testosterone undecanoate

Jatenzo · Kyzatrex · Tlando

Liquid-filled capsules taken twice a day with food, absorbed largely through the lymphatics, with the dose titrated against a blood level drawn at a fixed number of hours after breakfast.

Dosing protocol →

Testosterone cypionate

Depo-Testosterone · generic testosterone cypionate

An ester in cottonseed oil, injected deep into gluteal muscle every two to four weeks, with a labelled half-life of about eight days and no food, timing or draw-window requirement at all.

Dosing protocol →

Side by side

Every row carries how well supported it is. A claim that only reflects common practice is labelled as such rather than presented as fact.

Dimension	Oral testosterone undecanoate	Testosterone cypionate	Basis
Route and frequency	Two capsules a day, morning and evening, every day — 730 doses a year	Intramuscular, deep in the gluteal muscle, every two to four weeks — 13 to 26 injections a year	labelThe cypionate label is explicit that there is no alternative route: "DEPO-Testosterone Injection is for intramuscular use only. It should not be given intravenously. Intramuscular injections should be given deep in the gluteal muscle." Subcutaneous weekly dosing is common practice and is not what this label describes.
Food requirement	"Take JATENZO with food" / "Take KYZATREX® with food" — and the fat content changes the dose you absorb	None stated anywhere on the label	labelQuantified on both oral labels. KYZATREX, verbatim: "When KYZATREX® was given with breakfast containing 16%, 33%, and 45% fat, the exposure (AUC 0-24 hr) of testosterone was increased by 37%, 87%, and 94%, respectively, compared to when given under fasted conditions." JATENZO: "The 15 g fat breakfast had a 25% decrease in testosterone exposure compared to the 30 g fat breakfast." A capsule taken with toast is not the same dose as the same capsule taken with a cooked breakfast, and no equivalent variable exists for an injection.
When the monitoring blood is drawn	A fixed window per brand — 6 hours after the morning dose (JATENZO), 3 to 5 hours after the morning dose (KYZATREX), 8 to 9 hours after the morning dose (TLANDO)	No draw window stated	labelOn the oral labels the draw time is part of the dose specification, not a convenience: JATENZO titrates against a 425–970 ng/dL window measured at 6 hours and KYZATREX against 460–971 ng/dL at 3 to 5 hours. Three brands, three different windows. A level taken at the wrong hour cannot be used to set the dose.
Are the brands interchangeable?	No — "KYZATREX® is not substitutable with other oral testosterone undecanoate products", and TLANDO says the same of itself	Yes in effect — every cypionate label carries the same 50–400 mg range	labelThree oral products, three dose scales (JATENZO 158–396 mg twice daily, KYZATREX 100–400 mg twice daily, TLANDO a fixed 225 mg twice daily with no titration at all) and three draw windows. Cypionate is the opposite case: For replacement in the hypogonadal male, 50–400 mg should be administered every two to four weeks.
Labelled dose	JATENZO 237 mg twice daily to start, 158–396 mg twice daily thereafter; KYZATREX 200 mg twice daily to start	50 to 400 mg every two to four weeks	labelThese milligram figures are not comparable in either direction. A different ester, a different route and a different absorption pathway; no label, guideline or trial states an equivalence between an oral undecanoate dose and a cypionate dose, and nothing on this page converts one into the other.
Blood pressure warningsame	Yes — Warnings and Precautions 5.4; not recommended in uncontrolled hypertension	Yes — WARNINGS; not recommended in uncontrolled hypertension	labelWidely reported as an oral-only problem, and it is not. The cypionate label says: "Testosterone can increase blood pressure which can increase cardiovascular (CV) risk over time. Monitor blood pressure periodically in men using testosterone products, especially in men with hypertension. Testosterone products are not recommended for use in patients with uncontrolled hypertension." What the oral labels add is a figure from their own ambulatory monitoring — 4.9/2.5 mmHg at 4 months, and 5.4/3.2 in men already on antihypertensives on JATENZO, 1.7/0.6 mmHg at 4 months, and 3.4 systolic in men already on antihypertensives on KYZATREX — where the injection label states the class effect and leaves it unquantified. More detail, not more risk.
Boxed warningsame	None — JATENZO's blood-pressure box was removed in July 2025; KYZATREX has never had one	None	labelChecked against the SPL XML rather than taken on trust: no boxed-warning section appears in the current JATENZO, KYZATREX or Depo-Testosterone documents. JATENZO's own Recent Major Changes table records "Boxed Warning, Increases in Blood Pressure — Removed 07/2025". A great many articles still say otherwise.
AVEED — the other undecanoate	Not applicable to the capsules: no REMS, no observation period, no boxed warning	Not applicable to cypionate either	labelAVEED is testosterone undecanoate injected, and it is the one product in this field with all three. Its label: "Because of the risks of serious POME reactions and anaphylaxis, AVEED is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the AVEED REMS Program." and "Following each injection of AVEED, observe patients in the healthcare setting for 30 minutes in order to provide appropriate medical treatment in the event of serious POME reactions or anaphylaxis." Its regimen is five injections a year after the first month: "The recommended dose of AVEED is 3 mL (750 mg) injected intramuscularly, followed by 3 mL (750 mg) injected after 4 weeks, then 3 mL (750 mg) injected every 10 weeks thereafter." Nothing in that paragraph applies to a capsule or to a cypionate vial, and the row exists because "testosterone undecanoate carries a REMS" is true of exactly one product and gets repeated about all four.
Labelled half-life	Not stated on either oral label	"approximately eight days"	labelThe cypionate label states it once, in CLINICAL PHARMACOLOGY: "The half-life of testosterone cypionate when injected intramuscularly is approximately eight days." That figure is what the two-to-four-week interval is built on. Neither JATENZO nor KYZATREX states a half-life or a time to peak anywhere in its document — the string does not appear — and this page will not supply one from elsewhere.
Haematocrit monitoring	"Evaluate hematocrit approximately every 3 months while the patient is on" the drug — and check it before starting	"Hemoglobin and hematocrit levels (to detect polycythemia) should be checked periodically"	labelThe same risk, two different degrees of specificity. Both oral labels name an interval; the cypionate label says "periodically" and leaves it there. Neither names a haematocrit number at which to stop — every approved testosterone label says only "if hematocrit becomes elevated", and none defines the word.
Diagnosis required before startingsame	Morning serum testosterone on at least two separate days, both below the normal range	Morning serum testosterone on at least two separate days, both below the normal range	labelIdentical on all four labels, and it is the requirement most often skipped. Neither product is indicated on symptoms alone, and neither is indicated for "age-related hypogonadism" — all of these labels state that safety and efficacy in that group have not been established.
Generic available	No — no generic oral testosterone undecanoate is priced in the CMS NADAC file	Yes — cypionate is generic many times over	literatureThe single largest driver of the cost gap. Every oral undecanoate row in the file is a brand row; the cheapest cypionate presentation in the same file is a 200 mg/mL, 10 mL vial at $3.65 per mL across 10 NDCs.
A year of the labelled starting regimen	$13,093 — JATENZO at 237 mg twice daily	$94.92 — 200 mg every two weeks	literatureA factor of 138×, computed rather than asserted. Across the full labelled cypionate range — 50 mg every four weeks to 400 mg every two — a year of drug costs between $11.87 and $189.84. CMS NADAC, file dated 2026-09-16: invoice cost to a retail pharmacy, drug only, before any dispensing fee, markup, rebate or the cost of the injection supplies.
A year of KYZATREX	Not priced — its labelled starting dose is 200 mg orally twice daily	Not applicable — the cypionate figures are in the row above	literatureNo KYZATREX NDC appears in the 16 September 2026 NADAC file. There is no generic oral testosterone undecanoate either, so nothing in the file corresponds to this capsule. Applying JATENZO’s rate to it would be inventing a price for a different manufacturer’s product. The blank is the finding: a product with a labelled starting dose and no published acquisition cost at all.
Does a higher dose cost more?	No — a year at JATENZO's labelled maximum ($13,078) costs less than a year at its labelled starting dose ($13,093)	Yes — cypionate is priced per millilitre of oil, so cost tracks milligrams exactly	literatureGenuinely perverse and entirely real. JATENZO's 237 mg capsule is priced at almost exactly twice its 198 mg capsule while carrying 20% more drug, so two 198s — which is how the label words the 396 mg maximum — undercut one 237. Computed by cheaperAtTheCeiling(), which is currently true, so the claim cannot survive a price file in which it stops being true. The labelled minimum, 158 mg twice daily, is $6,548.
Can anyone else be exposed?same	No transfer risk stated	No transfer risk stated	labelNeither a swallowed capsule nor an intramuscular injection leaves drug on skin. This is where both of these differ from testosterone gel, whose label carries a boxed warning for secondary exposure and virilisation in children — a risk that does not exist for either product on this page.

label: Stated on the FDA label
guideline: Clinical practice guideline
literature: Published literature
practice: Common practice, not documented

Which one

Choose Oral testosterone undecanoate if

You will not inject, and a capsule is the difference between being treated and not being treated. That is a legitimate reason and it outranks everything else on this page.
You eat a real breakfast and a real dinner at roughly the same times every day. The food requirement is the hardest part of these products to keep, and if your meals are already regular it costs you nothing.
Your insurer covers one of them. At list prices these capsules are not a cash-pay proposition for most people, and coverage is what decides it.
You want peaks and troughs smoothed out across the day rather than across a fortnight. Twice-daily dosing is the only labelled testosterone regimen that short.

Choose Testosterone cypionate if

Cost matters at all. A year of the drug is a two-figure sum against a five-figure one, and the gap is not quality — it is that one molecule went generic decades ago and the other has not.
You would rather think about this twice a month than fourteen times a week. Fewer administrations is the whole appeal, and the label asks nothing of your meals or your blood-draw timing.
You need a level that can be interpreted whenever it is drawn. The oral labels tie the dose to a level at a specific hour after breakfast; cypionate has no such window.
You want the product with a stated half-life. Cypionate's label gives one — approximately eight days — and neither oral label gives any pharmacokinetic figure at all.

Do not convert between them. No label states what 237 mg of oral undecanoate twice a day corresponds to in cypionate, or the reverse, and the two are not different presentations of one dose: different ester, different route, different absorption pathway. If you are switching, the new product starts at its own labelled starting dose and is titrated on its own terms. And keep AVEED out of it — it is the same ester as the capsules, but it is the only product mentioned on this page with a boxed warning, a REMS and a thirty-minute observation requirement after every injection, and none of that transfers to a capsule or to a cypionate vial.

Frequently asked questions

Does oral testosterone have a boxed warning?: Not any more, and this is the single most out-of-date claim in circulation about these products. JATENZO carried a boxed warning for blood-pressure increases; its own Recent Major Changes table records it as "Removed 07/2025", and the current SPL contains no boxed-warning section at all — checked against the structured document rather than the marketing copy. KYZATREX has never carried one, and neither has Depo-Testosterone. Exactly one testosterone undecanoate product has a boxed warning today and it is AVEED, the injection, for serious pulmonary oil microembolism reactions and anaphylaxis. Blood pressure is still on the oral labels — as Warnings and Precautions 5.4 — but it is no longer boxed.
Do I really have to take it with food?: Yes, and the amount of fat changes the dose you actually absorb. Both oral labels say "take with food" in their dosage sections and both quantify what happens otherwise. KYZATREX: "When KYZATREX® was given with breakfast containing 16%, 33%, and 45% fat, the exposure (AUC 0-24 hr) of testosterone was increased by 37%, 87%, and 94%, respectively, compared to when given under fasted conditions." JATENZO: "The 15 g fat breakfast had a 25% decrease in testosterone exposure compared to the 30 g fat breakfast." Testosterone undecanoate is absorbed largely through the intestinal lymphatics, which requires dietary fat, so a capsule taken on an empty stomach is a smaller dose than the same capsule taken after a cooked breakfast. That variability is the reason the labels tie the dose to a blood level drawn at a fixed number of hours after the morning capsule. An injection has no equivalent variable — the cypionate label says nothing about food anywhere.
Is injectable testosterone safer than oral?: The labels do not support a general answer, and the one difference most often cited turns out not to exist. Blood pressure appears on all three: JATENZO 5.4, KYZATREX 5.4, and the Depo-Testosterone WARNINGS section, which reads "Testosterone can increase blood pressure which can increase cardiovascular (CV) risk over time. Monitor blood pressure periodically in men using testosterone products, especially in men with hypertension. Testosterone products are not recommended for use in patients with uncontrolled hypertension." All three say the product is not recommended in uncontrolled hypertension. Where the labels genuinely differ is in specificity rather than in risk — the oral products report ambulatory figures from their own trials (4.9/2.5 mmHg at 4 months, and 5.4/3.2 in men already on antihypertensives on JATENZO) while the injection states the class effect with no number, and the oral labels name a haematocrit monitoring interval of approximately three months where the injection says only "periodically". More detail on a label is not the same as more risk.
How much does oral testosterone cost compared with injections?: On invoice, around 138× as much. In the CMS NADAC file dated 2026-09-16, a year of JATENZO at its labelled starting dose of 237 mg twice daily costs a pharmacy $13,093, while a year of generic testosterone cypionate at 200 mg every two weeks — squarely inside the labelled range — is $94.92 of drug. Across the whole labelled cypionate range the year costs between $11.87 and $189.84. The reason is not complexity or quality: cypionate is generic many times over and no generic oral testosterone undecanoate exists. None of these figures is a price you can pay — NADAC records invoice cost before any dispensing fee, markup or rebate, and the cypionate figures are drug only, excluding needles, syringes and alcohol swabs.
Why is there no price for Kyzatrex here?: Because the only price the US government publishes does not contain it. No KYZATREX NDC appears in the 16 September 2026 NADAC file. There is no generic oral testosterone undecanoate either, so nothing in the file corresponds to this capsule. Applying JATENZO’s rate to it would be inventing a price for a different manufacturer’s product. Its label names a starting dose — 200 mg orally twice daily — so the regimen is perfectly well defined; what is missing is any published acquisition cost to attach to it. This page prints the gap rather than filling it, on the same principle that governs every other number here: a figure that cannot be sourced is omitted and the omission is stated where a reader would otherwise expect the number.
Are Jatenzo, Kyzatrex and Tlando the same drug?: Same ester, three different medicines in every way that matters to a prescription. Two of the three labels say so outright — "KYZATREX® is not substitutable with other oral testosterone undecanoate products" and TLANDO carries the identical sentence about itself. The numbers make the point on their own: JATENZO starts at 237 mg twice daily and titrates between 158 and 396 mg twice daily against a level drawn 6 hours after the morning dose; KYZATREX starts at 200 mg twice daily and titrates between 100 mg once daily and 400 mg twice daily against a level drawn at 3 to 5 hours; TLANDO is a fixed 225 mg twice daily with no titration scheme at all and a draw at 8 to 9 hours. Three dose scales, three draw windows, and no route between them.
Is AVEED the injectable version of Jatenzo?: It is the same ester by a different route, and treating it as "the injection of the same drug" is the mistake this page most wants to prevent. AVEED is the only product mentioned here with a boxed warning, and it is for serious pulmonary oil microembolism reactions and anaphylaxis, which "can occur after any injection of testosterone undecanoate during the course of therapy, including after the first dose". Its label adds: "Because of the risks of serious POME reactions and anaphylaxis, AVEED is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the AVEED REMS Program." and "Following each injection of AVEED, observe patients in the healthcare setting for 30 minutes in order to provide appropriate medical treatment in the event of serious POME reactions or anaphylaxis." Its regimen is 750 mg intramuscularly, again at four weeks, then every ten weeks — five injections a year, each in a certified healthcare setting. None of that applies to a capsule swallowed at breakfast, and none of it applies to cypionate either.

Sources

Next steps

Compare online TRT providersWhich platforms prescribe which form, what the labs cost, and who will write an oral product at all.TRT: how it works and what it costsDiagnosis, the first six months, monitoring, and what happens if you stop.

Other comparisons

Educational reference, not medical advice. Which medication suits you is a decision for your prescriber.