Provider Briefing: The Testosterone Shortage in 2026

The Testosterone Cypionate injection shortage that began in early 2023 continues to affect patient care across the United States. As a prescriber, understanding the current supply landscape, available alternatives, and patient access tools is essential for minimizing treatment interruptions.

This article provides a clinical overview of the shortage, its causes, prescribing considerations, and resources to help your patients maintain access to therapy.

Timeline: How We Got Here

The shortage of injectable Testosterone — primarily Testosterone Cypionate — was first reported by the American Society of Health-System Pharmacists (ASHP) in early 2023. Key milestones include:

• Early 2023: ASHP reports initial shortage of Testosterone Cypionate injection. Multiple manufacturers — Pfizer (Depo-Testosterone), Cipla, Hikma, and Sun Pharma — report supply constraints.
• Mid-2023: Pfizer cites increased demand and manufacturing delays. Other manufacturers do not publicly disclose reasons for shortages.
• 2024: Shortage persists with intermittent supply. Telehealth TRT prescribing continues to expand rapidly, with an estimated 325+ new men's health clinics opening. Compounding pharmacies see increased demand.
• 2025: Pfizer's Depo-Testosterone 200 mg/mL 1 mL vials available in limited weekly releases. The 100 mg/mL 10 mL vials remain on back order. Some generic supply improvement, but not sufficient to meet demand.
• Early 2026: Shortage ongoing. Supply gradually improving but not normalized. Injectable formulations remain most affected.

Prescribing Implications

The shortage creates several clinical challenges for providers:

Formulation Switching

When Testosterone Cypionate injections are unavailable, providers may need to transition patients to alternative formulations. Key considerations:

• Testosterone Cypionate → Testosterone Enanthate: Pharmacokinetically similar. Can use equivalent dosing. Check availability — Enanthate has also experienced intermittent shortages.
• Injectable → Topical gel: Testosterone gel (generic 1.62% or brand-name) provides more stable serum levels but requires daily application. Starting dose typically 20.25–40.5 mg/day for 1.62% gel. Monitor levels at 14 days and adjust.
• Injectable → Oral (Jatenzo, Tlando, Kyzatrex): Oral Testosterone Undecanoate capsules are taken twice daily with food. Note the boxed warning regarding blood pressure elevation and cardiovascular risk. Monitor blood pressure at baseline and periodically. Not appropriate for patients with uncontrolled hypertension.
• Injectable → Xyosted (subcutaneous autoinjector): Available in 50, 75, and 100 mg weekly doses. Subcutaneous administration may be preferred by some patients.

Monitoring Considerations

When switching formulations, standard monitoring should include:

• Serum total Testosterone level (trough for injections, steady-state for gels — typically 2–4 weeks after initiation or dose change)
• Complete blood count (CBC) — monitor hematocrit, as polycythemia is a risk with all TRT formulations
• PSA and digital rectal exam as clinically indicated
• Lipid panel periodically
• Blood pressure (especially important with oral formulations)
• Liver function tests if using oral formulations

Fertility Preservation

For patients of reproductive age, discuss the fertility implications of TRT. All exogenous Testosterone suppresses spermatogenesis. If fertility preservation is important, consider:

• Clomiphene Citrate (off-label): Stimulates endogenous Testosterone production without suppressing spermatogenesis. Generic, inexpensive ($10–$30/month).
• hCG (Human Chorionic Gonadotropin): Can be used alongside or instead of TRT to maintain testicular function and fertility. Availability may be limited due to regulatory changes affecting compounding.
• Enclomiphene (off-label): Active isomer of Clomiphene with potentially fewer side effects. Available through some compounding pharmacies.

Current Availability Picture

As of early 2026, the availability landscape for Testosterone products:

• Testosterone Cypionate injection (generic): Intermittent availability. Supply improving but not reliable week-to-week.
• Depo-Testosterone (Pfizer brand): Limited weekly releases of 200 mg/mL 1 mL vials. 10 mL vials remain on back order.
• Testosterone gel (generic 1.62%): Generally available. Most accessible alternative.
• Brand-name gels (AndroGel, Testim, Fortesta): Available but expensive without insurance.
• Oral capsules (Jatenzo, Tlando, Kyzatrex): Available. Brand-name only, $500–$900/month.
• Androderm patches: Available. $200–$500/month.
• Xyosted autoinjector: Generally available.
• Compounded Testosterone Cypionate: Available through PCAB-accredited compounding pharmacies.

Cost and Access Considerations

Cost is a significant barrier, particularly when patients must switch from inexpensive generic injections ($14–$30 with coupon) to pricier alternatives.

Insurance and Prior Authorization

Many insurance plans cover generic Testosterone Cypionate injections with prior authorization. Requirements typically include:

• Documented serum total Testosterone below 300 ng/dL (two morning samples)
• Clinical signs and symptoms of hypogonadism
• For brand-name products: step therapy (trial of generic injection first) is common

Brand-name gels, oral formulations, and Xyosted frequently require prior authorization and may be denied without documented failure of or contraindication to injections.

Patient Savings Resources

• GoodRx / SingleCare: Testosterone Cypionate as low as $14–$30 per vial
• Manufacturer programs: AbbVie offers AndroGel savings cards. Aveed has a copay assistance program. Xyosted and Jatenzo also offer copay cards for commercially insured patients.
• Patient assistance programs (PAPs): AbbVie myAbbVie Assist, Pfizer RxPathways, NeedyMeds, and RxAssist list programs for uninsured or underinsured patients.

Direct patients to our cost-saving guide: How to Save Money on Testosterone.

Tools and Resources for Your Practice

Medfinder for Providers allows you to check real-time pharmacy availability for Testosterone and other medications. This can help your practice:

• Identify pharmacies with current stock before sending prescriptions
• Reduce patient callbacks and failed fill attempts
• Proactively route prescriptions to pharmacies with available supply

Additional resources:

• ASHP Drug Shortage Detail: Testosterone Cypionate
• FDA Drug Shortage Database
• State board of pharmacy — for compounding pharmacy directories

Looking Ahead

The Testosterone supply situation is gradually improving, but several factors suggest the shortage may persist through 2026:

• Demand continues to grow as telehealth TRT prescribing expands
• DEA production quotas may not fully account for demand increases
• Manufacturing scale-up takes time

Providers should plan for continued supply variability and maintain familiarity with alternative formulations and non-Testosterone options.

Final Thoughts

The Testosterone shortage requires a proactive approach from prescribers. Familiarize yourself with alternative formulations, monitor patients closely during switches, and leverage tools like Medfinder for Providers to help patients find their medication.

For a practical guide on helping patients navigate availability challenges, see our companion article: How to Help Your Patients Find Testosterone in Stock.