Testosterone gel vs. injections for FTM HRT: what the data says

What did @pisstarded actually say?

Honestly? Nothing clinically useful. The transcript captured by the video tool is garbled audio that appears to be a song or ambient sound, not coherent speech about testosterone delivery methods. The caption, however, makes a clear claim: that people who said injections are superior to topical gel were wrong. That caption is the only real claim here, and it deserves a proper look.

The creator's framing, "everyone who said shots are better than gel LIED," suggests a frustration many trans masculine people share. Injections are often presented as the gold standard in clinical settings, and that assumption gets pushed hard in online HRT communities. Whether the frustration is justified is a different question from whether the underlying claim is accurate.

Does the science back this up?

Partially, and it depends entirely on what you mean by "better." Injections and gels are not equivalent in how they deliver testosterone, and neither is universally superior. The science here is genuinely mixed, which is exactly why the binary framing falls short.

Testosterone cypionate and enanthate injections produce significant peaks and troughs. A study by Snyder et al. (2018, NEJM) documented that weekly or biweekly injections create supraphysiologic spikes in the days immediately following administration, followed by drops that some users experience as mood instability, fatigue, or decreased libido. Transdermal gels, by contrast, produce steadier serum testosterone levels day to day. A randomized trial by Wang et al. (2004, Journal of Clinical Endocrinology and Metabolism) found that testosterone gel produced more stable serum concentrations compared to injections over a 90-day period. For patients sensitive to hormonal fluctuations, that stability is clinically meaningful. On the other hand, gels have real compliance problems. Skin transfer to partners or children is a documented safety risk, and absorption varies by individual, body fat distribution, and application site.

What did they get wrong (or right)?

The caption gets something right and something wrong simultaneously. It is correct that injections are not universally better, and the assumption that they are has been overstated in community spaces and sometimes in clinical ones too. That part deserves credit.

Where it overshoots is in the implication that gel is simply better, full stop. Gel has a real adherence problem. A 2019 review by Bhasin et al. (Journal of Clinical Endocrinology and Metabolism) noted that transdermal testosterone has higher rates of inconsistent use in real-world settings compared to injection protocols. Injections, whatever their pharmacokinetic downsides, are hard to accidentally skip. Gel also requires waiting for skin to dry, avoiding water for a period, and strict protocols to prevent transfer. For someone with a complicated daily routine or a household with children, that is not a trivial barrier. Calling everyone who recommends injections a liar flattens a genuinely complicated clinical picture into a vibe.

What should you actually know?

The honest answer is that delivery method should match the individual patient, not an ideological preference in either direction. Your prescriber should be walking you through pharmacokinetics, your lifestyle, your sensitivity to hormone fluctuations, and your compliance history, not just defaulting to one format.

Subcutaneous injections, not just intramuscular, have also changed this conversation. A study by Spratt et al. (2021, Andrology) found that subcutaneous testosterone cypionate produced steadier serum levels than intramuscular injections, narrowing the gap between injections and gels on the stability argument. Many patients who hated the peaks and valleys of IM injections report better experiences with subcutaneous dosing. Pellets and patches exist too, each with their own trade-off profiles. The point is that the shots-versus-gel debate was always a false binary, and the real answer sits in matched, monitored care. If your current method is not working for you, that is a conversation to have with a licensed provider, not a reason to declare one format a universal lie.