Testosterone Enanthate Alcohol Interaction Profile

Does the testosterone enanthate label list alcohol as an interaction?

The drug interactions section of the generic intramuscular testosterone enanthate label (Hikma) lists oral anticoagulants, which need close monitoring when androgens are started or stopped; insulin and antidiabetic drugs, where the metabolic effects of androgens may decrease blood glucose and insulin requirements; ACTH and corticosteroids, with an enhanced tendency toward edema and caution advised, especially in hepatic or cardiac disease; and oxyphenbutazone, whose serum levels may be elevated [1]. Alcohol is not among them.

The label has no boxed warning. It warns about blood pressure increases, venous thromboembolism, edema in patients with cardiac, renal or hepatic disease, gynecomastia, and abuse at doses above those recommended [1].

What alcohol does to testosterone in men not on replacement

A 2023 review concluded that a low-to-moderate acute alcohol dose increases testosterone concentrations in men, a large volume is associated with a fall in serum testosterone, and chronic excess negatively affects testosterone production [3]. In one study, 66 men who drank at least 180 mL of spirits a day on five or more days a week for a year or more had significantly higher FSH, LH and estradiol and significantly lower testosterone than 30 non-drinking controls [4].

Separately, the enanthate label states that during exogenous androgen administration, endogenous testosterone release is inhibited through feedback inhibition of pituitary LH [1].

Blood pressure and heart rhythm

The enanthate label warns that testosterone can increase blood pressure, which can increase cardiovascular risk over time [1].

TRAVERSE, the large cardiovascular safety trial, tested a 1.62% testosterone gel, not testosterone enanthate injections [5]. Binge drinking has been associated with acute heart rhythm disturbances, most often atrial fibrillation, in people without known heart disease [6].

Hematocrit and liver

A network meta-analysis of 29 placebo-controlled randomized trials (3,393 men) found intramuscular testosterone enanthate and cypionate raised mean hematocrit by 4.0% (95% CI 2.9 to 5.1) versus placebo [2]. A review of testosterone-induced erythrocytosis reports that short-acting injectables have the highest incidence [7], and polycythemia is a listed adverse reaction on the enanthate label [1].

The label warns that prolonged use of high doses of androgens has been associated with peliosis hepatis and hepatic neoplasms including hepatocellular carcinoma, and says the androgen should be discontinued if cholestatic hepatitis with jaundice appears or liver function tests become abnormal [1]. Heavy drinking induces the liver enzyme CYP2E1, and the free radical production that accompanies this induction contributes to liver injury in people who drink heavily [8].