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Testosterone esters injection


Injection of testosterone esters.

Drugs List

  • SUSTANON 250mg/1ml solution for injection ampoule
  • testosterone esters 250mg/1ml oily injection
  • Therapeutic Indications


    Supportive therapy for female-to-male transsexuals
    Testosterone replacement therapy associated with hypogonadism in males


    Adjust dose according to individual response.


    Testosterone replacement therapy in primary and secondary hypogonadal disorders
    250mg testosterone esters injected once every 3 weeks is often considered adequate.

    Female-to-male transsexuals
    Dosage recommendations vary from one 250mg injection given every two weeks, to one 250mg injection every four weeks.


    For deep intramuscular injection.


    Children under 3 years
    Suspected prostate cancer
    Androgen-dependent neoplasm
    Breast cancer
    History of hepatic neoplasm
    Prostate cancer

    Precautions and Warnings

    Children aged 3 to 18 years
    Family history of breast cancer
    Pre-pubertal children
    Predisposition to hypercalcaemia
    Predisposition to venous thromboembolism
    Bronchial carcinoma
    Cardiac impairment
    Diabetes mellitus
    Epileptic disorder
    Hepatic impairment
    History of endometrial cancer
    Ischaemic heart disease
    Psychiatric disorder
    Renal cell carcinoma
    Renal impairment
    Skeletal metastasis
    Sleep apnoea

    Contains arachis (peanut) oil
    Contains benzyl alcohol
    Monitor testosterone levels at baseline and periodically during treatment
    Monitor blood glucose closely in patients with diabetes mellitus
    Monitor calcium levels in patients at risk of hypercalcaemia
    Monitor female to male transsexuals for hormone dependent neoplasms
    Monitor hepatic function, haematocrit and haemoglobin in long term therapy
    Monitor serum lipids profile regularly in long term therapy
    Patients at risk of osteoporosis should have bone density assessed
    Regular examination of prostate advised to exclude prostatic cancer
    Abuse may cause serious adverse events, dependence and withdrawal symptoms
    Increased risk of premature sexual development+epiphyseal closure in boys
    Reinitiate therapy at lower dose once androgen dependent effects resolve
    May interfere with thyroid function tests
    Discontinue if oedema progresses or signs of cardiac failure occur

    Cases of venous thromboembolism have been reported even under anticoagulant treatment, testosterone treatment requires careful evaluation after the first thrombotic event.

    Female-to-male transsexual supportive therapy
    Hysterectomy and bilateral oophorectomy should be considered 18 to 24 months after treatment of testosterone, to reduce risk of endometrial and ovarian cancer. Continued monitoring is required for patients on long term treatment who did not proceed with such interventions.

    Pregnancy and Lactation


    Testosterone esters are contraindicated during pregnancy.

    The manufacturer advises treatment with testosterone esters should be discontinued during pregnancy. Human data have shown teratogenic effects. Testosterone rapidly crosses the placenta and causes masculinisation of the female foetus.


    Testosterone esters are contraindicated during breastfeeding.

    The manufacturer advises testosterone esters should not be used during breastfeeding. There is no clear data on whether testosterone, given by oily injection, appears in breast milk after maternal exposure during breast feeding.

    Side Effects

    Abnormal clotting factor
    Altered glucose tolerance
    Altered serum lipid profile
    Changes in libido
    Cholestatic jaundice
    Decreased ejaculate volume
    Electrolyte disturbances
    Fluid retention
    Frequent or persistent erections
    Hepatic impairment
    Hepatic tumours
    Increase in haematocrit
    Increase in haemoglobin
    Increase in prostate specific antigen (PSA)
    Increased bone growth
    Injection site reactions
    Irregular menstruation
    Male pattern baldness
    Mood changes
    Muscle cramps
    Peliosis hepatis
    Phallic enlargement in prepubertal males
    Precocious sexual development (pre-pubertal males)
    Premature closure of epiphyses (in pre-pubertal males)
    Prostate abnormalities
    Prostate cancer
    Sleep apnoea
    Sodium retention
    Spermatogenesis suppression
    Testicular atrophy
    Virilism in females
    Voice changes
    Weight gain

    Effects on Laboratory Tests

    Athletes should be advised that testosterone replacement therapy contains an active substance which may produce a positive reaction in an anti-doping test.

    May decrease thyroxine-binding globulin levels. Free thyroid levels and thyroid function remain unchanged.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: December 2019

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Sustanon 250, 250mg/ml solution for injection. Aspen. Revised June 2020.

    NICE Evidence Services Available at: Last accessed: 12 November 2019

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Testosterone Last revised: 3 December 2018
    Last accessed: 14 November 2019

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