Oral testosterone: What is Jatenzo and how is it used for TRT?

Jatenzo: what it is

Jatenzo is an oral form of testosterone undecanoate for men with confirmed low testosterone. It comes as softgel capsules taken twice daily with food. Unlike older alkylated oral steroids, it’s designed for lymphatic absorption rather than direct first-pass liver metabolism. That design helps achieve therapeutic testosterone levels without the classic cholestatic liver toxicity seen with older oral androgens.

In more simple terms, it is significantly safer for the liver than traditional oral steroids.

How it’s used and how often

Most treatment plans start at 237 mg by mouth, morning and evening, with meals. Your dose is then adjusted based on follow-up blood work drawn at a consistent time after the morning dose. Food improves absorption; you don’t need a “high-fat” meal, just a normal meal pattern you can stick with. As with any testosterone therapy, diagnosis comes first: symptoms plus two low morning testosterone values on separate days.

Pros

Jatenzo avoids needles and avoids the skin-to-skin transfer issues of topical gels. Because it’s taken twice daily and clears relatively quickly, dose adjustments can be evaluated over days rather than weeks. For men who travel or prefer oral dosing, the routine is simple: morning and evening with food. Pharmacokinetic studies also show systemic delivery primarily through the lymphatic pathway, which is how the drug sidesteps classic 17-alpha-alkylated liver injury.

Cons and safety notes

Jatenzo carries a boxed warning for raising blood pressure. In clinical testing, average systolic blood pressure rose—small on paper but important for men with hypertension or cardiovascular risk. Blood pressure should be controlled before starting and monitored during therapy. As with other testosterone therapies, red blood cell counts can rise and need periodic checks. Men with normal testosterone levels aren’t candidates; therapy is for confirmed hypogonadism, with monitoring and informed consent.

Fertility: Jatenzo versus injections (and where Natesto fits)

Any external testosterone whether it is oral, injectable, or topical; can suppress the pituitary hormones (LH/FSH) that drive sperm production. Long-acting injectables tend to suppress more consistently because levels stay high between doses. Jatenzo, taken twice daily, still behaves like replacement therapy and can reduce sperm counts while on treatment; recovery after stopping is variable and patient-specific. For men who prioritize preserving fertility during symptom treatment, short-acting intranasal testosterone (Natesto) has shown smaller average drops in LH/FSH and better maintenance of semen parameters in published studies, which is why some clinics consider it in that specific context.

This is a classic reason why every treatment plan is personalized.

Who might consider Jatenzo

Men with documented low testosterone who prefer to avoid injections and skin gels, who can take a capsule with breakfast and dinner, and who can attend to blood pressure and lab monitoring. Quite simple! It’s not ideal for men with uncontrolled hypertension. As always, the choice of route (oral vs injectable vs transdermal) should match your goals, medical history, and day-to-day life.

Bottom line

Jatenzo gives men with confirmed hypogonadism a needle-free, evidence-based option. The trade-offs are straightforward: twice-daily dosing with meals and careful attention to blood pressure and labs. For fertility preservation, it behaves like other replacement therapies and can suppress spermatogenesis while in use; men actively trying to protect sperm production may discuss short-acting alternatives with their clinician. The right choice is the one that fits your diagnosis, health profile, and routine—and that you can monitor properly over time.

Currently it is not approved in Canada.

True North Metabolic serves patients across Kitchener, Waterloo, Cambridge, Guelph, and surrounding communities including the Toronto/GTA corridor and London, Ontario.

References

1. U.S. FDA. Jatenzo (testosterone undecanoate) Prescribing Information and Medication Guide (boxed warning: blood pressure). FDA Access Data

2. Swerdloff RS, et al. A new oral testosterone undecanoate formulation: safety, efficacy, pharmacokinetics. Andrology. 2020. PMC

3. Goldstein I, et al. Newer formulations of oral testosterone undecanoate. Sexual Medicine Reviews. 2025. Oxford Academic

4. FDA Medical Review, NDA 206089: ambulatory blood pressure signal with Jatenzo. 2019. FDA Access Data

5. Ramasamy R, et al. Natesto and preservation of semen parameters in hypogonadal men (comparative fertility context). AUA Journals. 2020.