Testosterone Enanthate and Autoimmune Disease: What Clinicians and Patients Need to Know

Does testosterone enanthate treat autoimmune disease?

No. Testosterone enanthate injection is labeled for replacement in men with primary or hypogonadotropic hypogonadism [2], and none of the FDA-approved testosterone products are approved for men with low testosterone who lack an associated medical condition [1]. A 2014 review lists hypoandrogenemia among the hormonal changes that accompany chronic inflammatory disease [4]; that describes a hormonal pattern in disease and is not evidence that enanthate treats it.

What the label warns about

These label warnings apply to any man given enanthate, including men who also have an autoimmune condition. In a network meta-analysis of 29 placebo-controlled randomized trials in 3,393 men, intramuscular enanthate or cypionate raised mean hematocrit by 4.0% over placebo (95% CI 2.9 to 5.1) [3]. The label lists polycythemia as a reaction. It also reports venous thromboembolism, including deep vein thrombosis and pulmonary embolism, with testosterone products, and says to discontinue treatment and begin a workup if one is suspected [2].

The label also lists sodium and water retention and warns that edema, with or without congestive heart failure, can be a serious complication in patients with preexisting cardiac, renal or hepatic disease [2]. It says ACTH and corticosteroids show an enhanced tendency toward edema and that caution is needed when they are given together [2]. The label states that testosterone can increase blood pressure and that testosterone products are not recommended in uncontrolled hypertension [2]. FDA said in February 2025 that ambulatory blood pressure studies confirmed a blood pressure increase with all testosterone products [5].

Is there any autoimmune evidence for testosterone?

One pilot crossover study gave 10 men with relapsing-remitting multiple sclerosis 12 months of daily testosterone gel (10 g containing 100 mg) after a 6-month pretreatment period. Brain atrophy slowed (P<.001) and cognitive performance improved (P=.008), with no significant effect on gadolinium-enhancing lesion numbers (P=.31) or volumes (P=.94) [6]. That was gel, not enanthate, and the authors called the findings exploratory.

What the label requires before treatment

The label directs that hypogonadism be confirmed with morning serum testosterone measured on at least two separate days and below the normal range before starting, and gives 50 to 400 mg every 2 to 4 weeks for male hypogonadism [2]. The 2018 Endocrine Society guideline recommends against starting testosterone therapy in men with elevated hematocrit [7].