TRT delivery methods compared: what the evidence actually shows

What did @kmartfit actually say?

@kmartfit, a self-described two-year TRT user, ranked the three main testosterone delivery methods and came out swinging. Gels are "absolute crap," pellets scared him off entirely, and injectable testosterone wins because of better absorption rates and dosing flexibility. He held up what appeared to be a vial of injectable testosterone to make his point.

This is personal experience dressed up as general medical guidance, and it got 42,000 views. That matters, because the framing implies his n=1 experience should inform your treatment decisions. It shouldn't, but some of what he said is actually defensible, and some of it is murkier than he made it sound.

Does the science back this up?

Partly. Injectable testosterone does have strong pharmacokinetic data behind it, but the claim that gels are universally inferior is not what the clinical literature shows.

Testosterone cypionate and enanthate injections are the most studied TRT formulations and produce reliable, measurable serum testosterone levels. A 2018 review by Ramasamy et al. in Urology Clinics of North America confirmed that intramuscular injections produce supraphysiologic peaks followed by troughs, which is the opposite of the stable levels most endocrinologists actually prefer. That peak-and-trough pattern is a real limitation of weekly or biweekly injections, and @kmartfit did not mention it.

Testosterone gels, by contrast, produce more stable daily serum levels. A 2004 RCT by Wang et al. in the Journal of Clinical Endocrinology and Metabolism found that testosterone gel (AndroGel) normalized testosterone levels in the majority of hypogonadal men. Absorption variability is a real problem, but "absolute crap" is not a clinical assessment. It is a one-week anecdote.

What did they get wrong (or right)?

He got one thing right: injectable testosterone does offer greater dosing flexibility. Frequency and volume can be adjusted, and many patients do report stronger symptom relief with injections. That part is fair.

What he got wrong is the one-week gel dismissal. Testosterone therapy of any kind takes weeks to months to show full symptomatic effect. One week is not enough time to evaluate any TRT formulation. His experience of feeling worse in week one is consistent with what can happen during the transition period on any method, not evidence that gels fail as a category.

On pellets, his concern about not knowing "how I was going to react to it long term" is understandable but overstated as a clinical risk. Subcutaneous pellets have a legitimate evidence base. A 2014 study by Edelstein et al. in Aging Male found that pellet implants maintained stable testosterone levels over 3 to 6 months with high patient satisfaction. The inability to reverse or adjust mid-cycle is a real drawback, but it is not a safety crisis.

His absorption rate claim is the weakest. Injectable testosterone does not inherently have "a lot higher" absorption than gels in a way that is clinically decisive. Gels have absorption variability, yes. But injectable formulations are not absorbed more efficiently in a pharmacokinetic sense; they are delivered differently, bypassing the skin entirely.

What should you actually know?

No single TRT delivery method is best for everyone. That is the actual clinical consensus, and it is not a cop-out. Different formulations suit different patients based on lifestyle, adherence patterns, lab results, and individual pharmacokinetics.

• Injections are cost-effective and highly controllable, but they require technique, regular administration, and produce hormonal fluctuations that some men find difficult to tolerate.
• Gels offer daily stability but carry real transfer risk to partners and children, and absorption varies significantly between individuals.
• Pellets eliminate the burden of frequent administration and maintain stable levels, but dose corrections mid-cycle are not possible if levels run too high or too low.

The Endocrine Society's 2018 clinical practice guidelines recommend individualizing TRT formulation based on patient preference, cost, and tolerability, not on blanket rankings. If you are considering TRT, the right delivery method is the one chosen with your prescribing clinician based on your actual labs, not a TikTok ranking.

Is there anything missing from this video?

Yes, and it is significant. @kmartfit never mentioned that TRT suppresses the hypothalamic-pituitary-gonadal axis in all forms, not just gels. He framed the gel's suppression of natural testosterone production as a flaw specific to gels. That suppression happens with injections and pellets too. It is a property of exogenous testosterone, full stop.

He also did not address fertility implications, hematocrit monitoring, cardiovascular considerations, or the importance of baseline bloodwork before starting any TRT protocol. These are not minor footnotes. A 2023 trial published in NEJM (Lincoff et al.) found that testosterone therapy in middle-aged and older men with hypogonadism was non-inferior to placebo for major cardiovascular events, but the safety data still requires clinical monitoring. That context is absent here.