Testosterone Enanthate: Uses, Legal Status and Risks

Testosterone enanthate is a long-acting form of testosterone, the main male sex hormone, given by injection. It is a real, FDA-approved medicine for men with low testosterone. Testosterone is also the steroid bodybuilders misuse most often. This page explains both sides, using the drug's official label and published research.

Key facts: Testosterone enanthate is testosterone joined to a fatty acid called enanthic acid. It is sold in the United States as a prescription medicine for low testosterone. It is also a Schedule III controlled substance, and using it without a prescription is illegal.

What testosterone enanthate is

On its own, testosterone is broken down by the body very quickly. To make it last longer, drug makers attach a fatty acid to the molecule. This is called an ester. The Endocrine Connections review explains that this makes the hormone last longer after a shot.

Testosterone enanthate uses a fatty acid with seven carbon atoms. That is why it is also called testosterone heptanoate. Once in the body, the ester is removed and the result is ordinary testosterone.

Approved medical uses

It is an FDA-approved prescription drug, sold as a generic shot and as an autoinjector called Xyosted. According to the FDA-approved label, it is used for:

• Men with low testosterone, whether the cause is in the testicles or in the brain signals that control them.
• Delayed puberty in carefully selected boys.
• Advanced breast cancer in some postmenopausal women, as a secondary treatment.

How it is misused

Testosterone is the base of most steroid use for muscle. In a Dutch study of 100 steroid users, 96% used testosterone during a cycle, usually alongside other steroids. The review notes that injected testosterone esters are among the most used steroids.

It does build muscle. A 1996 trial in the New England Journal of Medicine gave healthy men injections of testosterone enanthate for 10 weeks. Men who also lifted weights gained about 6 kg (13 lb) of lean mass. But the trial used doses far above normal levels, lasted only 10 weeks and was not built to measure long-term harm.

The label itself warns about misuse. It notes that testosterone is abused by athletes and bodybuilders, often with other steroids, and that some men take more than their prescribed dose.

Health risks

The FDA label for testosterone enanthate lists the serious problems reported in people who misuse steroids. They include heart attack, heart failure, stroke, liver damage and serious mental health problems such as major depression, mania, paranoia and aggression. Men can get shrunken testicles and become infertile. Women can get a deeper voice, more facial and body hair, male-pattern baldness and changes to their periods. In teens, bones can stop growing too early.

Large studies back this up. In a Danish study, men who tested positive for steroids had three times the death rate of similar men. A heart study found weaker heart muscle and more plaque in the arteries of long-term users.

The label also warns that misuse can be hard to detect. Testosterone levels may look normal in men using other synthetic steroids.

Illicit products carry another risk. When Dutch researchers tested steroids used by 100 people, only about half held the drug named on the label, according to a review in Endocrine Connections. Some held no active drug at all.

Legal status

In the United States, testosterone enanthate is a Schedule III controlled substance. It is named in the federal list of anabolic steroids, 21 CFR 1308.13. It is a federal crime to have or sell it without a valid prescription.

In sport, it is banned at all times, in and out of competition, by the World Anti-Doping Agency.

Frequently asked questions

Is testosterone enanthate legal?

Yes, with a prescription. It is an FDA-approved medicine for men with low testosterone and certain other conditions. Without a prescription, it is illegal to have or sell.

What is the difference between testosterone and testosterone enanthate?

Testosterone enanthate is testosterone with a fatty acid attached. The fatty acid makes it last longer after an injection. In the body, it becomes ordinary testosterone.

Is testosterone enanthate a steroid?

Yes. Testosterone is the original anabolic-androgenic steroid, and all the others in this guide are based on it.

What are the risks of misusing testosterone?

The FDA label lists heart attack, stroke, heart failure, liver damage, depression, aggression, shrunken testicles and infertility among the reactions reported with misuse.

Sources

• Bhasin S, et al. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med. 1996
• FDA-approved label: testosterone enanthate injection (Drug Abuse and Dependence)
• de Ronde W, Smit DL. Anabolic androgenic steroid abuse in young males. Endocr Connect. 2020
• Horwitz H, et al. Health consequences of androgenic anabolic steroid use. J Intern Med. 2019
• Baggish AL, et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation. 2017
• U.S. Code of Federal Regulations: 21 CFR 1308.13, Schedule III
• World Anti-Doping Agency: Prohibited List