Short answer: Both are testosterone replacement for adult men with low testosterone from primary or hypogonadotropic hypogonadism.12 Aveed is 750 mg of testosterone undecanoate injected into the buttock in a certified clinic at the start, 4 weeks later, then every 10 weeks. Xyosted is testosterone enanthate injected under the skin of the abdomen once a week with an autoinjector. Only Aveed has a boxed warning.
| Aveed | Xyosted | |
|---|---|---|
| Drug | Testosterone undecanoate1 | Testosterone enanthate2 |
| Where and how | Deep into the buttock muscle, slowly over 60 to 90 seconds, in a certified healthcare setting1 | Under the skin of the abdomen, with a single-dose autoinjector2 |
| Schedule | 750 mg at the start, 750 mg at 4 weeks, then 750 mg every 10 weeks1 | Once a week2 |
| Dose changes | None needed1 | Start 75 mg; up or down 25 mg based on a trough testosterone 7 days after a dose; 50, 75 or 100 mg2 |
| After each injection | 30 minutes of observation in the clinic1 | No observation period in the label2 |
| Most common in label studies | 84 weeks, 153 men: acne 5.2%, injection site pain 4.6%, PSA increased 4.6%1 | 1 year, 150 men: hematocrit increased 14.0%, hypertension 12.7%, PSA increased 12.0%2 |
| Average blood pressure change | +3.1/2.0 mm Hg after 16 weeks1 | +3.9/1.5 mm Hg after 12 weeks2 |
| Hematocrit checks | Before starting, 3 to 6 months later, then yearly1 | Before starting and about every 3 months2 |
| Boxed warning | Serious pulmonary oil microembolism (POME) reactions and anaphylaxis; available only through the Aveed REMS Program1 | None2 |
Because of the boxed warning. Serious POME reactions, with an urge to cough, shortness of breath, throat tightening, chest pain, dizziness and fainting, and anaphylaxis have been reported during or right after testosterone undecanoate injections, including the first one. Each Aveed injection is followed by 30 minutes of observation, and prescribers and settings must be certified in the Aveed REMS Program. Across 18 trials, 9 POME events in 8 men and 2 anaphylaxis events were judged to have occurred among 3,556 men.1
Both labels warn about high red blood cell counts, blood clots, worsening BPH and possible prostate cancer risk, blood pressure rises, abuse, fluid retention, breast enlargement, sleep apnea, lipid changes and lower sperm counts with high doses, and both say the product is not for women.12 The Xyosted label also warns about depression and suicidal thoughts: across its trials, 4 of 283 men (1.4%) stopped for depression or had a suicide attempt.2 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Aveed side effects, Xyosted side effects, the Aveed and Xyosted dosing schedules, the Xyosted missed-dose page, Aveed vs testosterone cypionate: what is different? and Xyosted vs Depo-Testosterone: how do they differ?.