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  <title>These highlights do not include all the information needed to use XYOSTED<sup>®</sup> safely and effectively. See full prescribing information for XYOSTED.<br/>
    <br/>XYOSTED (testosterone enanthate) injection, for subcutaneous use<br/>CIII<br/>Initial U.S. approval: 1953</title>
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          <effectiveTime value="20250722"/>
          <excerpt>
            <highlight>
              <text>
                <table cellpadding="0" cellspacing="0" width="100%">
                  <tbody>
                    <tr>
                      <td align="left">
                        <paragraph>Boxed Warnings, Blood Pressure Increases</paragraph>
                      </td>
                      <td align="right">
                        <paragraph>Removed 03/2025</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td align="left">
                        <paragraph>Warnings and Precautions, Venous Thromboembolism (<linkHtml href="#Ld31b5bf1-c5b4-4772-865a-998a394e99ad">5.2</linkHtml>)</paragraph>
                      </td>
                      <td align="right">
                        <paragraph>03/2025</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td align="left">
                        <paragraph>Warnings and Precautions, Blood Pressure Increases (<linkHtml href="#L05f614a7-22dc-41c3-a2a6-d59762e37bb5">5.4</linkHtml>)</paragraph>
                      </td>
                      <td align="right">
                        <paragraph>03/2025</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td align="left">
                        <paragraph>Warnings and Precautions, Cardiovascular Risk (<linkHtml href="#L05f614a7-22dc-41c3-a2a6-d59762e37bb5">5.4</linkHtml>)</paragraph>
                      </td>
                      <td align="right">
                        <paragraph>Removed 03/2025</paragraph>
                      </td>
                    </tr>
                  </tbody>
                </table>
                <paragraph/>
              </text>
            </highlight>
          </excerpt>
        </section>
      </component>
      <component>
        <section ID="Ld7fcc3ed-20f1-4fe7-be70-4a8793e2b643">
          <id root="15b74e23-c11e-44f6-9158-f2114bc43a90"/>
          <code code="34067-9" codeSystem="2.16.840.1.113883.6.1" displayName="INDICATIONS &amp; USAGE SECTION"/>
          <title>1 INDICATIONS AND USAGE</title>
          <text>
            <paragraph>XYOSTED (testosterone enanthate) injection is an androgen indicated for testosterone replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone.</paragraph>
            <list listType="unordered">
              <item>Primary hypogonadism (congenital or acquired): testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter's syndrome, chemotherapy, or toxic damage from alcohol or heavy metals. These men usually have low serum testosterone concentrations and gonadotropins (follicle-stimulating hormone [FSH], luteinizing hormone [LH]) above the normal range.</item>
              <item>Hypogonadotropic hypogonadism (congenital or acquired): gonadotropin or luteinizing hormone-releasing hormone (LHRH) deficiency or pituitary-hypothalamic injury from tumors, trauma, or radiation. These men have low testosterone serum concentrations but have gonadotropins in the normal or low range.</item>
            </list>
            <paragraph>
              <content styleCode="bold">Limitations of Use:</content>
            </paragraph>
            <list listType="unordered">
              <item>Safety and efficacy of XYOSTED in men with “age-related hypogonadism” has not been established.</item>
              <item>Safety and efficacy of XYOSTED in males less than 18 years old have not been established <content styleCode="italics">[see Use in Specific Populations (<linkHtml href="#L9589bd8e-c2e7-4c6a-b3f9-16ab01b5dfe6">8.4</linkHtml>)]</content>.</item>
            </list>
          </text>
          <effectiveTime value="20250304"/>
          <excerpt>
            <highlight>
              <text>
                <paragraph>XYOSTED (testosterone enanthate) injection is an androgen indicated for testosterone replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone (<linkHtml href="#L06dd4819-049c-4cec-964f-adae042158a7">1</linkHtml>).</paragraph>
                <paragraph/>
                <paragraph>
                  <content styleCode="bold">Limitations of Use:</content>
                </paragraph>
                <list listType="unordered">
                  <item>Safety and efficacy of XYOSTED in men with “age-related hypogonadism” has not been established (<linkHtml href="#Ld7fcc3ed-20f1-4fe7-be70-4a8793e2b643">1</linkHtml>).</item>
                  <item>Safety and efficacy of XYOSTED in males less than 18 years old have not been established (<linkHtml href="#Ld7fcc3ed-20f1-4fe7-be70-4a8793e2b643">1</linkHtml>, <linkHtml href="#L9589bd8e-c2e7-4c6a-b3f9-16ab01b5dfe6">8.4</linkHtml>).</item>
                </list>
              </text>
            </highlight>
          </excerpt>
        </section>
      </component>
      <component>
        <section ID="L0590761e-db09-4f29-b350-76e1f248f62e">
          <id root="2d357afa-a2b7-42f9-9611-ef53dda5d3ac"/>
          <code code="34068-7" codeSystem="2.16.840.1.113883.6.1" displayName="DOSAGE &amp; ADMINISTRATION SECTION"/>
          <title>2 DOSAGE AND ADMINISTRATION</title>
          <text>
            <paragraph/>
          </text>
          <effectiveTime value="20250129"/>
          <excerpt>
            <highlight>
              <text>
                <list listType="unordered">
                  <item>
                    <content styleCode="bold">Prior to initiating XYOSTED</content>: confirm the diagnosis of hypogonadism by ensuring that serum testosterone has been measured in the morning on at least two separate days and that these concentrations are below the normal range (<linkHtml href="#Lde4d5ea3-37ac-4829-83a5-921e5e1be75d">2.1</linkHtml>).</item>
                  <item>
                    <content styleCode="bold">Starting dose:</content> 75 mg subcutaneously in the abdominal region once weekly. Avoid intramuscular and intravascular administration (<linkHtml href="#L5d2a2c68-b3cf-47d5-a1a2-65acec70f06d">2.2</linkHtml>, <linkHtml href="#L01fd5477-6a1e-4e2f-afdf-5c498275a429">2.3</linkHtml>).</item>
                  <item>
                    <content styleCode="bold">Dose Adjustment: </content>Based upon total testosterone trough concentrations (measured 7 days after most recent dose) obtained following 6 weeks of dosing and periodically thereafter (<linkHtml href="#L5d2a2c68-b3cf-47d5-a1a2-65acec70f06d">2.2</linkHtml>).</item>
                  <item>Discard unused portion (<linkHtml href="#L01fd5477-6a1e-4e2f-afdf-5c498275a429">2.3</linkHtml>)</item>
                </list>
              </text>
            </highlight>
          </excerpt>
          <component>
            <section ID="Lde4d5ea3-37ac-4829-83a5-921e5e1be75d">
              <id root="e988dabd-7d1e-4847-ad57-39c6c3afdc37"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>2.1 Confirmation of Hypogonadism Before Initiation of XYOSTED</title>
              <text>
                <paragraph>Prior to initiating XYOSTED, confirm the diagnosis of hypogonadism by ensuring that serum testosterone concentrations have been measured in the morning on at least two separate days and that these serum testosterone concentrations are below the normal range.</paragraph>
              </text>
              <effectiveTime value="20250129"/>
            </section>
          </component>
          <component>
            <section ID="L5d2a2c68-b3cf-47d5-a1a2-65acec70f06d">
              <id root="09dbd725-04ce-411d-bb8f-1a067645d574"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>2.2 Starting Dose and Dose Adjustment</title>
              <text>
                <paragraph>The starting dose of XYOSTED is 75 mg, administered subcutaneously in the abdominal region once a week.</paragraph>
                <paragraph>
                  <content styleCode="underline">Dose adjustment</content>
                </paragraph>
                <paragraph>Measure total testosterone trough concentrations (measured 7 days after the most recent dose) following 6 weeks of dosing, following 6 weeks after dose adjustment, and periodically while on treatment with XYOSTED. A trough concentration between 350 ng/dL and 650 ng/dL generally provides testosterone exposures in the normal range during the entire dosing interval.</paragraph>
                <paragraph>Decrease the dose by 25 mg if the total testosterone trough concentration (C<sub>trough</sub>) is ≥650 ng/dL.<br/>Increase the dose by 25 mg if the total testosterone C<sub>trough</sub> is &lt;350 ng/dL.<br/>Maintain the same dose if the total testosterone C<sub>trough</sub> is ≥350 ng/dL and &lt;650 ng/dL.</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
          <component>
            <section ID="L01fd5477-6a1e-4e2f-afdf-5c498275a429">
              <id root="b7d2df62-9e08-4301-abd0-a0e896e1d43c"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>2.3 Important Administration Instructions</title>
              <text>
                <paragraph>XYOSTED is for subcutaneous injection in the abdominal region only. Avoid intramuscular or intravascular injection.</paragraph>
                <paragraph>Instruct patients on the proper use of XYOSTED and direct them to use the proper injection site. Refer to the Instructions for Use for proper use of XYOSTED.</paragraph>
                <paragraph>Visually inspect XYOSTED for particulate matter and discoloration prior to administration. Do not use if the liquid is cloudy or if visible particles are present.</paragraph>
                <paragraph>Do not use XYOSTED if the seal is broken. Discard unused portion.</paragraph>
              </text>
              <effectiveTime value="20250129"/>
            </section>
          </component>
        </section>
      </component>
      <component>
        <section ID="Lfea9e0fd-a34b-44ca-9066-9627aeb4402a">
          <id root="0847dccc-091b-4377-83c9-36352b49bc21"/>
          <code code="43678-2" codeSystem="2.16.840.1.113883.6.1" displayName="DOSAGE FORMS &amp; STRENGTHS SECTION"/>
          <title>3 DOSAGE FORMS AND STRENGTHS</title>
          <text>
            <paragraph>XYOSTED injection is available as 0.5 mL of a sterile, preservative-free and nonpyrogenic, clear, colorless to yellow solution containing testosterone enanthate. It is supplied in a single-dose syringe assembled in an autoinjector for subcutaneous administration. XYOSTED is available in three dosage strengths:</paragraph>
            <paragraph>50 mg/0.5 mL</paragraph>
            <paragraph>75 mg/0.5 mL</paragraph>
            <paragraph>100 mg/0.5 mL</paragraph>
          </text>
          <effectiveTime value="20250129"/>
          <excerpt>
            <highlight>
              <text>
                <list listType="unordered">
                  <item>XYOSTED (testosterone enanthate) Injection is supplied as 0.5 mL of sterile solution in a single-dose autoinjector for subcutaneous administration in three strengths (<linkHtml href="#Lfea9e0fd-a34b-44ca-9066-9627aeb4402a">3</linkHtml>):<list listType="unordered">
                      <item>50 mg/0.5 mL</item>
                      <item>75 mg/0.5 mL</item>
                      <item>100 mg/0.5 mL</item>
                    </list>
                  </item>
                </list>
              </text>
            </highlight>
          </excerpt>
        </section>
      </component>
      <component>
        <section ID="L2bedf3eb-b289-4fd9-976b-faf6f61acb3f">
          <id root="42a7faa3-b1d8-4c17-9458-36a1094bb631"/>
          <code code="34070-3" codeSystem="2.16.840.1.113883.6.1" displayName="CONTRAINDICATIONS SECTION"/>
          <title>4 CONTRAINDICATIONS</title>
          <text>
            <paragraph>XYOSTED is contraindicated in:</paragraph>
            <list listType="unordered">
              <item>Men with carcinoma of the breast or known or suspected carcinoma of the prostate <content styleCode="italics">[see Warnings and Precautions (<linkHtml href="#L5ab4d15a-f0a1-4660-9beb-fd6ec1531055">5.4</linkHtml>)]</content>.</item>
              <item>Women who are pregnant. Testosterone can cause virilization of the female fetus when administered to a pregnant woman <content styleCode="italics">[see Use in Specific Populations (<linkHtml href="#L1c717e0d-bd5f-4656-81de-a0db50ec4f09">8.1</linkHtml>)]</content>.</item>
              <item>Men with known hypersensitivity to XYOSTED or any of its ingredients (testosterone enanthate and sesame oil).</item>
            </list>
          </text>
          <effectiveTime value="20250722"/>
          <excerpt>
            <highlight>
              <text>
                <list listType="unordered">
                  <item>Men with carcinoma of the breast or known or suspected carcinoma of the prostate (<linkHtml href="#L2bedf3eb-b289-4fd9-976b-faf6f61acb3f">4</linkHtml>, <linkHtml href="#L5ab4d15a-f0a1-4660-9beb-fd6ec1531055">5.4</linkHtml>).</item>
                  <item>Women who are pregnant (<linkHtml href="#L2bedf3eb-b289-4fd9-976b-faf6f61acb3f">4</linkHtml>, <linkHtml href="#L1c717e0d-bd5f-4656-81de-a0db50ec4f09">8.1</linkHtml>). Testosterone may cause fetal harm (<linkHtml href="#L2bedf3eb-b289-4fd9-976b-faf6f61acb3f">4</linkHtml>, <linkHtml href="#L03bd2f5a-0ed8-410e-aeca-13bd914f88e0">5.7</linkHtml>, <linkHtml href="#L1c717e0d-bd5f-4656-81de-a0db50ec4f09">8.1</linkHtml>, and <linkHtml href="#L50a543ee-555f-4d49-8bac-c9c60da85c34">8.2</linkHtml>).</item>
                  <item>Known hypersensitivity to XYOSTED or its ingredients (<linkHtml href="#L2bedf3eb-b289-4fd9-976b-faf6f61acb3f">4</linkHtml>).</item>
                </list>
              </text>
            </highlight>
          </excerpt>
        </section>
      </component>
      <component>
        <section ID="L49d5898a-5391-473b-a9dc-61e585091e94">
          <id root="6de5eb0a-3771-463b-a403-1aad9b076d82"/>
          <code code="43685-7" codeSystem="2.16.840.1.113883.6.1" displayName="WARNINGS AND PRECAUTIONS SECTION"/>
          <title>5 WARNINGS AND PRECAUTIONS</title>
          <text/>
          <effectiveTime value="20250722"/>
          <excerpt>
            <highlight>
              <text>
                <list listType="unordered">
                  <item>Polycythemia: Monitor hematocrit approximately every 3 months to detect increased red blood cell mass and polycythemia (<linkHtml href="#L8882fc9d-6267-4975-bfd3-ec2d3b900e04">5.1</linkHtml>).</item>
                  <item>Venous thromboembolism (VTE): VTE including deep vein thrombosis (DVT) and pulmonary embolism (PE), have been reported in patients using testosterone products. Evaluate patients with signs or symptoms consistent with DVT or PE (<linkHtml href="#Ld31b5bf1-c5b4-4772-865a-998a394e99ad">5.2</linkHtml>).</item>
                  <item>Worsening of Benign Prostatic Hyperplasia (BPH) and Potential Risk of Prostate Cancer: Monitor patients with BPH for worsening signs and symptoms of BPH (<linkHtml href="#L02d8b693-f853-4d79-bc47-1b61c96c59e9">5.3</linkHtml>).</item>
                  <item>Blood Pressure Increases: Testosterone can increase blood pressure, which can increase cardiovascular risk over time. Measure blood pressure periodically. Not recommended for use in men with uncontrolled hypertension (<linkHtml href="#L5ab4d15a-f0a1-4660-9beb-fd6ec1531055">5.4</linkHtml>).</item>
                  <item>Abuse of Testosterone: Testosterone has been subject to abuse, typically at doses higher than recommended for the approved indication and in combination with other anabolic androgenic steroids (<linkHtml href="#Lcf56050e-14bf-406c-a66b-0896d6884df3">5.5</linkHtml>).</item>
                  <item>Potential for Adverse Effects on Spermatogenesis: Exogenous administration of androgens may lead to azoospermia (<linkHtml href="#L03bd2f5a-0ed8-410e-aeca-13bd914f88e0">5.7</linkHtml>).</item>
                  <item>Edema: Edema with or without congestive heart failure may be a complication in patients with preexisting cardiac, renal, or hepatic disease (<linkHtml href="#Lef78e3df-cca3-4e53-84c3-c0eb97d9901a">5.9</linkHtml>).</item>
                  <item>Sleep apnea: Sleep apnea may occur in those with risk factors (<linkHtml href="#Lf54ce004-00c5-4bb3-b871-853faf0d94b4">5.11</linkHtml>).</item>
                  <item>Monitor prostatic specific antigen (PSA) and lipid concentrations periodically (<linkHtml href="#L02d8b693-f853-4d79-bc47-1b61c96c59e9">5.3</linkHtml>, <linkHtml href="#L30006bc8-19d7-4833-a9f3-340ff6891d3e">5.12</linkHtml>).</item>
                  <item>Depression and suicidal ideation and behavior, including completed suicide, have occurred during clinical trials in patients treated with XYOSTED (<linkHtml href="#Ld80dde09-401c-4a02-9aa7-334174c1b00d">5.15</linkHtml>).</item>
                </list>
              </text>
            </highlight>
          </excerpt>
          <component>
            <section ID="L8882fc9d-6267-4975-bfd3-ec2d3b900e04">
              <id root="dd65d2db-3474-4cbe-bebe-158544c6daec"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>5.1 Polycythemia</title>
              <text>
                <paragraph>Increases in hematocrit reflective of increases in red blood cell mass may require discontinuation of XYOSTED.</paragraph>
                <paragraph>Check that hematocrit is not elevated prior to initiating XYOSTED. Evaluate hematocrit approximately every 3 months while the patient is on XYOSTED. If hematocrit becomes elevated, stop XYOSTED until the hematocrit decreases to an acceptable level. If XYOSTED is restarted and again causes hematocrit to become elevated, stop XYOSTED permanently. An increase in red blood cell mass may increase the risk of thromboembolic events.</paragraph>
              </text>
              <effectiveTime value="20250722"/>
            </section>
          </component>
          <component>
            <section ID="Ld31b5bf1-c5b4-4772-865a-998a394e99ad">
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              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>5.2 Venous Thromboembolism</title>
              <text>
                <paragraph>There have been postmarketing reports of venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), in patients using testosterone products, such as XYOSTED.</paragraph>
                <paragraph>In the Testosterone Replacement therapy for Assessment of long-term Vascular Events and efficacy Response in hypogonadal men (TRAVERSE) Study, a randomized, double-blind, placebo-controlled, cardiovascular (CV) outcomes study, compared to placebo, topical testosterone gel was associated with a numerically higher incidence of VTE (1.7% vs 1.2%) which included DVT (0.6% vs 0.5%) and PE events (0.9% vs 0.5%) <content styleCode="italics">[see Adverse Reactions (<linkHtml href="#L9e4b00e0-4fb3-4474-a5fe-94b4e6c82249">6.1</linkHtml>)]</content>.</paragraph>
                <paragraph>Evaluate patients who report symptoms of pain, edema, warmth and erythema in the lower extremity for DVT and those who present with acute shortness of breath for PE. If a venous thromboembolic event is suspected, discontinue treatment with XYOSTED and initiate appropriate workup and management.</paragraph>
              </text>
              <effectiveTime value="20250722"/>
            </section>
          </component>
          <component>
            <section ID="L02d8b693-f853-4d79-bc47-1b61c96c59e9">
              <id root="c100d834-cb86-43e1-95bf-a49509f6db0d"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>5.3 Worsening of Benign Prostatic Hyperplasia (BPH) and Potential Risk of Prostate Cancer</title>
              <text>
                <paragraph>Patients with BPH treated with androgens are at an increased risk of worsening of signs and symptoms of BPH. Monitor patients with BPH for worsening signs and symptoms.</paragraph>
                <paragraph>Patients treated with androgens may be at an increased risk for prostate cancer. Evaluate patients for prostate cancer prior to initiating and during treatment with androgens <content styleCode="italics">[see Contraindications (<linkHtml href="#L2bedf3eb-b289-4fd9-976b-faf6f61acb3f">4</linkHtml>)]</content>.</paragraph>
              </text>
              <effectiveTime value="20250722"/>
            </section>
          </component>
          <component>
            <section ID="L5ab4d15a-f0a1-4660-9beb-fd6ec1531055">
              <id root="b357a209-5b7b-46d3-84a2-79095a021a4e"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>5.4 Blood Pressure Increases</title>
              <text>
                <paragraph>XYOSTED can increase blood pressure. Ambulatory blood pressure monitoring (ABPM) demonstrated XYOSTED increased systolic/diastolic BP by an average of 3.9/1.5 mm Hg from baseline after 12 weeks of treatment in clinical trials<content styleCode="italics"> [see Adverse Reactions (<linkHtml href="#L9e4b00e0-4fb3-4474-a5fe-94b4e6c82249">6.1</linkHtml>)]. </content>In patients with hypertension on antihypertensive therapy, XYOSTED increased the mean systolic/diastolic BP by 3.9/1.3 mm Hg from baseline.</paragraph>
                <paragraph>The CV risk associated with topical testosterone gel was evaluated in TRAVERSE, a randomized, double-blind, placebo-controlled, CV outcomes study in men with a history of CV disease or multiple CV risk factors. In TRAVERSE, topical testosterone gel increased mean systolic blood pressure by 1.0 mm Hg from baseline to 36 months, whereas a mean decrease from baseline of 0.5 mm Hg was observed in the placebo group at this timepoint, for a mean between-group difference of 1.5 mm Hg. However, the incidences of major adverse cardiovascular events (MACE), including cardiovascular death, nonfatal myocardial infarction [MI] and non-fatal stroke, were similar between treatment groups (7% for topical testosterone gel vs 7.3% for placebo)<content styleCode="italics"> [See Adverse Reactions (<linkHtml href="#L9e4b00e0-4fb3-4474-a5fe-94b4e6c82249">6.1</linkHtml>)]</content>.</paragraph>
                <paragraph>Monitor blood pressure periodically in men using XYOSTED, especially men with hypertension. XYOSTED is not recommended for use in patients with uncontrolled hypertension.</paragraph>
              </text>
              <effectiveTime value="20250722"/>
            </section>
          </component>
          <component>
            <section ID="Lcf56050e-14bf-406c-a66b-0896d6884df3">
              <id root="adcf3dd9-296a-4826-88e5-503a620e39e6"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>5.5 Abuse of Testosterone and Monitoring of Serum Testosterone Concentrations</title>
              <text>
                <paragraph styleCode="First Paragraph">Testosterone has been subject to abuse, typically at doses higher than recommended for the approved indication and in combination with other anabolic androgenic steroids.  Anabolic androgenic steroid abuse can lead to serious cardiovascular and psychiatric adverse reactions <content styleCode="italics">[see Drug Abuse and Dependence (<linkHtml href="#L97acf396-4bfd-4386-ac56-87ffa98911f3">9</linkHtml>)]</content>.</paragraph>
                <paragraph styleCode="Paragraph">If testosterone abuse is suspected, check serum testosterone concentrations to ensure they are within therapeutic range.  However, testosterone levels may be in the normal or subnormal range in men abusing synthetic testosterone derivatives. Counsel patients concerning the serious adverse reactions associated with abuse of testosterone and anabolic androgenic steroids.  Conversely, consider the possibility of testosterone and anabolic androgenic steroid abuse in suspected patients who present with serious cardiovascular or psychiatric adverse events.</paragraph>
              </text>
              <effectiveTime value="20250722"/>
            </section>
          </component>
          <component>
            <section ID="L887cf58e-09a1-434f-a9ea-e7a89c56bd97">
              <id root="527d9d2d-adaf-4bbc-a046-311cddb67d04"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>5.6 Not for Use in Women</title>
              <text>
                <paragraph styleCode="000fulltxt First">Due to lack of controlled studies in women and potential virilizing effects, XYOSTED is not indicated for use in women <content styleCode="italics">[see Contraindications (</content>
                  <content styleCode="italics">
                    <linkHtml href="#L2bedf3eb-b289-4fd9-976b-faf6f61acb3f">4</linkHtml>) and Use in Specific Populations (</content>
                  <content styleCode="italics">
                    <linkHtml href="#L1c717e0d-bd5f-4656-81de-a0db50ec4f09">8.1</linkHtml>, <linkHtml href="#L50a543ee-555f-4d49-8bac-c9c60da85c34">8.2</linkHtml>)]</content>.</paragraph>
              </text>
              <effectiveTime value="20250304"/>
            </section>
          </component>
          <component>
            <section ID="L03bd2f5a-0ed8-410e-aeca-13bd914f88e0">
              <id root="1bd600cc-9de9-4d71-a34d-07cea1deadcf"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>5.7 Potential for Adverse Effects on Spermatogenesis</title>
              <text>
                <paragraph>With large doses of exogenous androgens, including XYOSTED, spermatogenesis may be suppressed through feedback inhibition of pituitary follicle-stimulating hormone (FSH) which could possibly lead to adverse effects on semen parameters including sperm count <content styleCode="italics">[see Use in Specific Populations (<linkHtml href="#Lebaa420f-3d24-4a5d-b076-df0853b3d79d">8.3</linkHtml>)]</content>. Patients should be informed of this possible risk when deciding whether to use or to continue to use XYOSTED.</paragraph>
              </text>
              <effectiveTime value="20250304"/>
            </section>
          </component>
          <component>
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              <title>5.8 Hepatic Adverse Effects</title>
              <text>
                <paragraph>Prolonged use of high doses of orally active 17-alpha-alkyl androgens (e.g., methyltestosterone) has been associated with serious hepatic adverse effects (peliosis hepatis, hepatic neoplasms, cholestatic hepatitis, and jaundice). Peliosis hepatis can be a life-threatening or fatal complication. Long-term therapy with intramuscular testosterone enanthate, which elevates blood levels for prolonged periods, has produced multiple hepatic adenomas. XYOSTED is not known to produce these adverse effects. Nonetheless, patients should be instructed to report any signs or symptoms of hepatic dysfunction (e.g., jaundice). If these occur, promptly discontinue XYOSTED while the cause is evaluated.</paragraph>
              </text>
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              <title>5.9 Edema</title>
              <text>
                <paragraph>Androgens, including XYOSTED, may promote retention of sodium and water. Edema with or without congestive heart failure may be a serious complication in patients with preexisting cardiac, renal, or hepatic disease. In addition to discontinuation of the drug, diuretic therapy may be required.</paragraph>
              </text>
              <effectiveTime value="20250304"/>
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              <title>5.10 Gynecomastia</title>
              <text>
                <paragraph styleCode="First Paragraph">Gynecomastia may develop and may persist in patients being treated for hypogonadism.</paragraph>
              </text>
              <effectiveTime value="20250304"/>
            </section>
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              <title>5.11 Sleep Apnea</title>
              <text>
                <paragraph>Treatment with testosterone products including XYOSTED may potentiate sleep apnea in some patients, especially those with risk factors such as obesity or chronic lung disease.</paragraph>
              </text>
              <effectiveTime value="20250304"/>
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              <title>5.12 Lipid Changes</title>
              <text>
                <paragraph>Changes in the serum lipid profile may require dose adjustment of lipid lowering drugs or discontinuation of testosterone therapy. Monitor the lipid profile periodically, particularly after starting testosterone therapy.</paragraph>
              </text>
              <effectiveTime value="20250304"/>
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              <title>5.13 Hypercalcemia</title>
              <text>
                <paragraph>Androgens, including XYOSTED, should be used with caution in cancer patients at risk of hypercalcemia (and associated hypercalciuria). Monitor serum calcium concentrations regularly during treatment with XYOSTED in these patients.</paragraph>
              </text>
              <effectiveTime value="20250304"/>
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              <title>5.14 Decreased Thyroxine-binding Globulin</title>
              <text>
                <paragraph>Androgens, including XYOSTED, may decrease concentrations of thyroxine-binding globulin, resulting in decreased total T4 serum concentrations and increased resin uptake of T3 and T4. Free thyroid hormone concentrations remain unchanged, however, and there is no clinical evidence of thyroid dysfunction.</paragraph>
              </text>
              <effectiveTime value="20250304"/>
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              <title>5.15 Risk of Depression and Suicide</title>
              <text>
                <paragraph>Depression and suicidal ideation and behavior, including completed suicide, have occurred during clinical trials in patients treated with XYOSTED. Advise patients and caregivers to seek medical attention for manifestations of suicidal ideation or behavior, new onset or worsening depression, anxiety, or other mood changes.</paragraph>
              </text>
              <effectiveTime value="20250722"/>
            </section>
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          <code code="34084-4" codeSystem="2.16.840.1.113883.6.1" displayName="ADVERSE REACTIONS SECTION"/>
          <title>6 ADVERSE REACTIONS</title>
          <text/>
          <effectiveTime value="20250722"/>
          <excerpt>
            <highlight>
              <text>
                <paragraph>The most commonly reported adverse reactions (&gt;5%) were: hematocrit increased, hypertension, PSA increased, injection site bruising, and headache. (<linkHtml href="#L9e4b00e0-4fb3-4474-a5fe-94b4e6c82249">6.1</linkHtml>)</paragraph>
                <paragraph>
                  <content styleCode="bold">To report SUSPECTED ADVERSE REACTIONS, contact Antares at 1-844-XYOSTED (1-844-996-7833) or FDA at 1-800-FDA-1088 or <linkHtml href="www.fda.gov/medwatch">www.fda.gov/medwatch</linkHtml>.</content>
                </paragraph>
              </text>
            </highlight>
          </excerpt>
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              <title>6.1 Clinical Trials Experience</title>
              <text>
                <paragraph>Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.</paragraph>
                <paragraph>The safety of XYOSTED was evaluated in 2 clinical studies in a total of 283 men who received weekly subcutaneous doses for up to one year. All patients were started on 75 mg weekly, then the dose was titrated to 50 mg or 100 mg weekly, as needed, to achieve pre-dose total testosterone concentrations of ≥350 ng/dL and &lt;650 ng/dL.</paragraph>
                <paragraph>Table 1 summarizes adverse reactions (≥2%) reported in a one-year study with XYOSTED.</paragraph>
                <paragraph>
                  <content styleCode="bold">Table 1. Number (%) of Patients with Adverse Reactions ≥2% in a 1 Year study with XYOSTED</content>
                </paragraph>
                <table border="1" cellpadding="2" cellspacing="0" width="75%">
                  <colgroup>
                    <col width="50%"/>
                    <col width="50%"/>
                  </colgroup>
                  <tbody>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>
                          <content styleCode="bold">Preferred Term</content>
                        </paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>
                          <content styleCode="bold">Overall (N=150)</content>
                        </paragraph>
                        <paragraph>
                          <content styleCode="bold">n (%)</content>
                        </paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Hematocrit increased</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>21 (14.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Hypertension</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>19 (12.7)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Prostatic specific antigen (PSA) increased</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>18 (12.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Injection site bruising</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>10 (6.7)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Headache</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>8 (5.3)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Back pain</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>5 (3.3)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Blood creatine phosphokinase increased</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>5 (3.3)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Injection site hemorrhage</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>5 (3.3)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Acne</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>4 (2.7)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Blood testosterone increased</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>4 (2.7)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Cough</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>4 (2.7)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Edema peripheral</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>4 (2.7)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Injection site erythema</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>4 (2.7)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Prostatitis</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>4 (2.7)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Urinary tract infection</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>4 (2.7)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Abdominal pain</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>3 (2.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Arthralgia</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>3 (2.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Fatigue</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>3 (2.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Hematuria</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>3 (2.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Polycythemia</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>3 (2.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Sleep apnea syndrome</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>3 (2.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td colspan="2" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>Note: Includes events that started on or after the first dosing, or existed prior to the first dose and worsened in severity or relatedness after dosing. Percentage was calculated using the number of patients in the column heading as the denominator.</paragraph>
                      </td>
                    </tr>
                  </tbody>
                </table>
                <paragraph>Table 2 summarizes the adverse reactions (≥2%) reported in a 6-month study with XYOSTED.</paragraph>
                <paragraph>
                  <content styleCode="bold">Table 2. Number (%) of Patients with Adverse Reactions ≥2% in a 6-Month Study with XYOSTED</content>
                </paragraph>
                <table border="1" cellpadding="2" cellspacing="0" width="75%">
                  <colgroup>
                    <col width="50%"/>
                    <col width="50%"/>
                  </colgroup>
                  <tbody>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>
                          <content styleCode="bold">Preferred Term</content>
                        </paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>
                          <content styleCode="bold">Overall (N = 133)</content>
                        </paragraph>
                        <paragraph>
                          <content styleCode="bold">n (%)</content>
                        </paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Hematocrit increased</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>11 (8.3)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Injection site hemorrhage</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>8 (6.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Blood creatine phosphokinase increased</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>5 (3.8)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Injection site bruising</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>5 (3.8)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Prostatitis</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>4 (3.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Prostatic specific antigen (PSA) increased</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>4 (3.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Urinary tract infection</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>4 (3.0)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Fatigue</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>3 (2.3)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Hypertension</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>3 (2.3)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Insomnia</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>3 (2.3)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>   Nausea</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>3 (2.3)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td colspan="2" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                        <paragraph>Note: Includes events that started on or after the first dosing, or existed prior to the first dose and worsened in severity or relatedness after dosing. Percentage was calculated using the number of patients in the column heading as the denominator.</paragraph>
                      </td>
                    </tr>
                  </tbody>
                </table>
                <paragraph>
                  <content styleCode="italics">BP Increases in the 6-Month Clinical Study</content>
                </paragraph>
                <paragraph>In the 6-month clinical study, 24-hour ambulatory blood pressure monitoring (ABPM) was conducted in 133 patients, 113 of whom completed the study. ABPM was conducted at 3 distinct 24-hour time periods: at Baseline and following 6 and 12 weeks of XYOSTED therapy. A total of 62 patients had acceptable ABPM recordings at baseline and Week 12. In that group, the mean change in systolic and diastolic BP from baseline to Week 12 was + 3.9 mm Hg (95% CI 1.4-6.4) and + 1.5 mm Hg (95% CI 0.4-2.6), respectively. In patients with a history of hypertension who were receiving antihypertensive therapy, the mean ABPM systolic and diastolic BP increased by +3.9 mm Hg [95% CI 0.19-7.7] and +1.3 mm Hg [95% CI -0.37-3.0], respectively [n=33]). In patients with no history of hypertension, the mean ABPM systolic and diastolic blood pressure increased by +4.1 mm Hg [95% CI 0.43-7.8] and +1.9 mm Hg [95% CI 0.055-3.7], respectively [n=28]).</paragraph>
                <paragraph>10% of XYOSTED-treated patients were either started on antihypertensive medications or required changes to their antihypertensive medication regimen during the 1-year study.</paragraph>
                <paragraph>A total of 3 patients were reported to have an adverse reaction of hypertension (2 patients with hypertension and 1 patient with worsening hypertension), and 1 was reported to have an adverse reaction of increased blood pressure.</paragraph>
                <paragraph>
                  <content styleCode="italics">Increases in Hematocrit</content>
                </paragraph>
                <paragraph>Increases in hematocrit to ≥55% were reported for 12 of the 283 patients in the 2 clinical studies, representing 4.2% of patients who received XYOSTED for up to one year. While the studies did not pre-define clinical adverse events related to increased hematocrit, polycythemia was reported as a medically significant adverse event in the investigator’s clinical judgment in 1.8% of treated patients. XYOSTED dosing resulted in mean hemoglobin increases of 1.0 ± 1.1 g/dL at 6 months and 1.1 ± 1.4 g/dL at 1 year and mean hematocrit increases of 3.8 ± 3.4% at 6 months and 5.4 ± 3.4% at 1 year.</paragraph>
                <paragraph>
                  <content styleCode="italics">Injection Site Reactions</content>
                </paragraph>
                <paragraph>Injection site reactions, including injection site bruising, injection site hemorrhage, injection site erythema and injection site induration were reported in 36 of the 283 patients in the 2 clinical studies, representing 12.7% of patients who received XYOSTED for up to one year. No patients discontinued XYOSTED because of injection site reactions.</paragraph>
                <paragraph>
                  <content styleCode="italics">Depression and Suicide Attempts</content>
                </paragraph>
                <paragraph>Depression requiring discontinuation was reported in 2 of the 283 patients in the two clinical studies and suicide attempts (one complete and one incomplete) were reported in 2 additional patients, comprising a total of 4 patients, representing 1.4% of patients who received XYOSTED for up to one year.</paragraph>
                <paragraph>
                  <content styleCode="italics">Increases in Serum PSA</content>
                </paragraph>
                <paragraph>Increases in serum PSA concentrations, defined as an increase from baseline of at least 1.4 ng/mL, or PSA greater than 4 ng/mL, led to discontinuation in 4.6% of the 283 patients in the 2 clinical studies.</paragraph>
                <paragraph>
                  <content styleCode="italics">Cardiovascular Outcomes</content>
                </paragraph>
                <paragraph>TRAVERSE was a randomized, double-blind, cardiovascular outcomes study to assess the cardiovascular (CV) safety of topical testosterone gel compared to placebo in 5198 hypogonadal men aged 45 to 80 years with a history of CV disease or with multiple CV risk factors. The primary outcome was the incidence of the composite endpoint of major adverse cardiovascular events (MACE), consisting of CV death, non-fatal myocardial infarction (MI), and non-fatal stroke.</paragraph>
                <paragraph>The mean duration of therapy was approximately 22 months. The mean duration of follow-up was 33 months. <content>Approximately 61% of all patients discontinued topical testosterone gel or placebo therapy.</content>
                </paragraph>
                <paragraph>The mean patient age (±SD) was 63.3 (7.9) years, with 2452 patients aged 65 years or more (47%); 2847 (about 55%) patients had pre-existing cardiovascular disease, whereas 2357 patients (about 45%) had an elevated cardiovascular risk at baseline, and mean BMI was 35 kg/m<sup>2</sup>. Approximately 80% of patients were White, 17% were Black, and 3% were of other races or ethnic groups. Approximately 69%, 84%, and 93% had diabetes mellitus, hyperlipidemia, and hypertension, respectively.</paragraph>
                <paragraph>The mean serum testosterone concentration at baseline in patients receiving topical testosterone gel was 220.4 ng/dL (n=2596). The mean serum testosterone concentrations at 12 months, 24 months, 36 months, and 48 months in patients receiving topical testosterone gel were 440.5 ng/dL (n=1683), 420.9 ng/dl (n=1125), 428.7 ng/dL (n=731), and 365.2 ng/dL (n=220), respectively.</paragraph>
                <paragraph>For patients treated with topical testosterone gel, the incidence of MACE was 7.0% (n=182 events) and for those receiving placebo, the incidence of MACE was 7.3% (n=190 events). The study demonstrated noninferiority of topical testosterone gel versus placebo because the upper bound of 95% CI was less than the prespecified risk margin, of 1.5 for MACE (Hazard Ratio 0.96 [95% CI: 0.78, 1.17]).</paragraph>
                <paragraph>
                  <content styleCode="italics">Additional Adverse Reactions Reported in TRAVERSE</content>
                </paragraph>
                <paragraph>Additional adverse reactions reported in TRAVERSE at an incidence rate &gt;2% in either treatment group and greater in topical testosterone gel versus placebo included: nonfatal arrythmias warranting intervention (5.2% vs 3.3%), atrial fibrillation (3.5% vs 2.4%), acute kidney injury (2.3% vs 1.5%) and bone fracture (3.5% vs 2.5%). For the adverse reaction of bone fracture, each event was adjudicated by clinical review.</paragraph>
              </text>
              <effectiveTime value="20250722"/>
            </section>
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      </component>
      <component>
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          <id root="58f34481-745c-482c-9f62-fb12eeb2490a"/>
          <code code="34073-7" codeSystem="2.16.840.1.113883.6.1" displayName="DRUG INTERACTIONS SECTION"/>
          <title>7 DRUG INTERACTIONS</title>
          <text>
            <paragraph/>
          </text>
          <effectiveTime value="20250326"/>
          <excerpt>
            <highlight>
              <text>
                <list listType="unordered">
                  <item>Androgens may decrease blood glucose, and therefore may decrease insulin requirements in diabetic patients (<linkHtml href="#L4b6b3132-f40e-48d4-b54c-f47a81bf7cf0">7.1</linkHtml>).</item>
                  <item>Changes in anticoagulant activity may be seen with androgens. More frequent monitoring of international normalized ratio (INR) and prothrombin time is recommended in patients taking warfarin (<linkHtml href="#Lcdca2e67-c348-42ca-8ab3-cb1b36b5eb91">7.2</linkHtml>).</item>
                  <item>Use of testosterone with corticosteroids may result in increased fluid retention. Use with caution, particularly in patients with cardiac, renal, or hepatic disease (<linkHtml href="#L2c38db3c-413e-4309-809f-cc7101741e66">7.3</linkHtml>).</item>
                  <item>Concomitant administration of medications that are known to increase BP with XYOSTED may lead to additional increases in BP (<linkHtml href="#L8672ed06-445c-4110-94b9-3b83dab0a75d">7.4</linkHtml>).</item>
                </list>
              </text>
            </highlight>
          </excerpt>
          <component>
            <section ID="L4b6b3132-f40e-48d4-b54c-f47a81bf7cf0">
              <id root="3ec3c771-4d67-41ec-a45d-cf2ad369beae"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>7.1 Insulin</title>
              <text>
                <paragraph>Changes in insulin sensitivity or glycemic control may occur in patients treated with androgens. In diabetic patients, the metabolic effects of androgens may decrease blood glucose and, therefore, may necessitate a decrease in the dose of anti-diabetic medication.</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
          <component>
            <section ID="Lcdca2e67-c348-42ca-8ab3-cb1b36b5eb91">
              <id root="18988e40-5a08-4893-8d50-df561b2f17ee"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>7.2 Oral Anticoagulants</title>
              <text>
                <paragraph>Changes in anticoagulant activity may be seen with androgens, therefore more frequent monitoring of international normalized ratio (INR) and prothrombin time are recommended in patients taking warfarin, especially at the initiation and termination of androgen therapy.</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
          <component>
            <section ID="L2c38db3c-413e-4309-809f-cc7101741e66">
              <id root="5036aaa5-1c4c-4ac1-9ef1-654cd9fb8829"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>7.3 Corticosteroids</title>
              <text>
                <paragraph>The concurrent use of testosterone with corticosteroids may result in increased fluid retention and requires careful monitoring, particularly in patients with cardiac, renal or hepatic disease.</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
          <component>
            <section ID="L8672ed06-445c-4110-94b9-3b83dab0a75d">
              <id root="ec960682-16a1-4370-9dfa-3b1093a82f62"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>7.4 Medications that May Also Increase Blood Pressure</title>
              <text>
                <paragraph>Some prescription medications and nonprescription analgesic and cold medications contain drugs known to increase blood pressure. Concomitant administration of these medications with XYOSTED may lead to additional increases in blood pressure.
                        </paragraph>
              </text>
              <effectiveTime value="20250326"/>
            </section>
          </component>
        </section>
      </component>
      <component>
        <section ID="Lcc723690-ea79-4548-b176-b37890f152be">
          <id root="ea664826-3a73-48da-a3d2-8eadb494e8f6"/>
          <code code="43684-0" codeSystem="2.16.840.1.113883.6.1" displayName="USE IN SPECIFIC POPULATIONS SECTION"/>
          <title>8 USE IN SPECIFIC POPULATIONS</title>
          <text/>
          <effectiveTime value="20180928"/>
          <excerpt>
            <highlight>
              <text>
                <list listType="unordered">
                  <item>Geriatric Patients: There are insufficient long-term safety data to assess the potential risks of cardiovascular disease and prostate cancer (<linkHtml href="#Lbe187e69-5c20-4585-874e-7aa84f4b0536">8.5</linkHtml>).</item>
                </list>
              </text>
            </highlight>
          </excerpt>
          <component>
            <section ID="L1c717e0d-bd5f-4656-81de-a0db50ec4f09">
              <id root="66426806-220e-420d-b42a-47d9320cadde"/>
              <code code="42228-7" codeSystem="2.16.840.1.113883.6.1" displayName="PREGNANCY SECTION"/>
              <title>8.1 Pregnancy</title>
              <text>
                <paragraph styleCode="Default First">
                  <content styleCode="underline">Risk Summary</content>
                </paragraph>
                <paragraph styleCode="Default First">XYOSTED is contraindicated in pregnant women. Testosterone is teratogenic and may cause fetal harm when administered to a pregnant woman based on data from animal studies and its mechanism of action<content styleCode="italics"> [see Contraindications (<linkHtml href="#L2bedf3eb-b289-4fd9-976b-faf6f61acb3f">4</linkHtml>) and Clinical Pharmacology (<linkHtml href="#L67aad8b3-e764-4818-8730-df6991df932e">12.1</linkHtml>)]</content>. Exposure of a female fetus to androgens may result in varying degrees of virilization. In animal developmental studies, exposure to testosterone in utero resulted in hormonal and behavioral changes in offspring and structural impairments of reproductive tissues in female and male offspring. These studies did not meet current standards for nonclinical development toxicity studies.</paragraph>
                <paragraph>
                  <content styleCode="underline">Data</content>
                  <br/>
                  <content styleCode="italics">Animal Data</content>
                </paragraph>
                <paragraph>In developmental studies conducted in rats, rabbits, pigs, sheep and rhesus monkeys, pregnant animals received intramuscular injection of testosterone during the period of organogenesis. Testosterone treatment at doses that were comparable to those used for testosterone replacement therapy resulted in structural impairments in both female and male offspring. Structural impairments observed in females included increased ano-genital distance, phallus development, empty scrotum, no external vagina, intrauterine growth retardation, reduced ovarian reserve, and increased ovarian follicular recruitment. Structural impairments seen in male offspring included increased testicular weight, larger seminal tubular lumen diameter, and higher frequency of occluded tubule lumen. Increased pituitary weight was seen in both sexes.</paragraph>
                <paragraph>Testosterone exposure in utero also resulted in hormonal and behavioral changes in offspring. Hypertension was observed in pregnant females and offspring in rats exposed to doses approximately twice those used for testosterone replacement therapy.</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
          <component>
            <section ID="L50a543ee-555f-4d49-8bac-c9c60da85c34">
              <id root="c3c4aa3a-d079-4034-883a-2440d85344b6"/>
              <code code="77290-5" codeSystem="2.16.840.1.113883.6.1" displayName="LACTATION SECTION"/>
              <title>8.2 Lactation</title>
              <text>
                <paragraph styleCode="DefaultCxSpFirst First">
                  <content styleCode="underline">Risk Summary </content>
                </paragraph>
                <paragraph styleCode="DefaultCxSpMiddle">XYOSTED is not indicated for use in females.</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
          <component>
            <section ID="Lebaa420f-3d24-4a5d-b076-df0853b3d79d">
              <id root="34282e90-0c4b-462f-afca-e8204fb85c9c"/>
              <code code="77291-3" codeSystem="2.16.840.1.113883.6.1" displayName="FEMALES &amp; MALES OF REPRODUCTIVE POTENTIAL SECTION"/>
              <title>8.3 Females and Males of Reproductive Potential</title>
              <text>
                <paragraph styleCode="000fulltxt First">
                  <content styleCode="underline">Infertility </content>
                </paragraph>
                <paragraph styleCode="Paragraph">During treatment with large doses of exogenous androgens, including XYOSTED, spermatogenesis may be suppressed through feedback inhibition of the hypothalamic-pituitary-testicular axis <content styleCode="italics">[</content>
                  <content styleCode="italics">see Warnings and Precautions (<linkHtml href="#L03bd2f5a-0ed8-410e-aeca-13bd914f88e0">5.8</linkHtml>)</content>
                  <content styleCode="italics">]</content>. Reduced fertility is observed in some men taking testosterone replacement therapy. The impact on fertility may be irreversible.</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
          <component>
            <section ID="L9589bd8e-c2e7-4c6a-b3f9-16ab01b5dfe6">
              <id root="d169e41f-3e78-4178-bbd0-ab741a76179c"/>
              <code code="34081-0" codeSystem="2.16.840.1.113883.6.1" displayName="PEDIATRIC USE SECTION"/>
              <title>8.4 Pediatric Use</title>
              <text>
                <paragraph>Safety and effectiveness of XYOSTED in pediatric patients less than 18 years old have not been established. Improper use may result in acceleration of bone age and premature closure of epiphyses.</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
          <component>
            <section ID="Lbe187e69-5c20-4585-874e-7aa84f4b0536">
              <id root="9b79a2b7-5def-46a5-9d28-5bcbdf366485"/>
              <code code="34082-8" codeSystem="2.16.840.1.113883.6.1" displayName="GERIATRIC USE SECTION"/>
              <title>8.5 Geriatric Use</title>
              <text>
                <paragraph>There have not been sufficient numbers of geriatric patients in controlled clinical studies with XYOSTED to determine whether efficacy or safety in those over 65 years of age differs from younger subjects. Of the 283 patients enrolled in the 6-month and one-year efficacy and safety clinical study utilizing XYOSTED, 49 (17%) were over 65 years of age. Additionally, there are insufficient long-term safety data in geriatric patients to assess the potentially increased risk of cardiovascular disease and prostate cancer.</paragraph>
                <paragraph>Geriatric patients treated with androgens may also be at risk for worsening of signs and symptoms of BPH <content styleCode="italics">[see Warnings and Precautions (<linkHtml href="#L05f614a7-22dc-41c3-a2a6-d59762e37bb5">5.4</linkHtml>)].</content>
                </paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
        </section>
      </component>
      <component>
        <section ID="L97acf396-4bfd-4386-ac56-87ffa98911f3">
          <id root="d65ce406-89d3-4eb3-9f31-d3aaf11d15c9"/>
          <code code="42227-9" codeSystem="2.16.840.1.113883.6.1" displayName="DRUG ABUSE AND DEPENDENCE SECTION"/>
          <title>9. DRUG ABUSE AND DEPENDENCE</title>
          <text/>
          <effectiveTime value="20180928"/>
          <component>
            <section ID="Lf05c376a-3003-4dd3-b30f-106467eb9c5c">
              <id root="4e689262-6378-4d67-8a2d-cf31e03252af"/>
              <code code="34085-1" codeSystem="2.16.840.1.113883.6.1" displayName="CONTROLLED SUBSTANCE SECTION"/>
              <title>9.1 Controlled Substance</title>
              <text>
                <paragraph>XYOSTED contains testosterone, a Schedule III controlled substance in the Controlled Substances Act.</paragraph>
              </text>
              <effectiveTime value="20180927"/>
            </section>
          </component>
          <component>
            <section ID="Lfe375be8-56f2-45e4-bb65-d4f535218eb9">
              <id root="7df89ec7-4c40-428f-8338-29d618e40a6e"/>
              <code code="34086-9" codeSystem="2.16.840.1.113883.6.1" displayName="ABUSE SECTION"/>
              <title>9.2 Abuse</title>
              <text>
                <paragraph styleCode="First ParagraphCxSpFirst">Drug abuse is intentional non-therapeutic use of a drug, even once, for its rewarding psychological and physiological effects. Abuse and misuse of testosterone are seen in male and female adults and adolescents. Testosterone, often in combination with other anabolic androgenic steroids (AAS), and not obtained by prescription through a pharmacy, may be abused by athletes and bodybuilders. There have been reports of misuse of men taking higher doses of legally obtained testosterone than prescribed and continuing testosterone despite adverse events or against medical advice.</paragraph>
                <paragraph styleCode="ParagraphCxSpMiddle">
                  <content styleCode="italics">
                    <content styleCode="underline">Abuse-Related Adverse Reactions</content>
                  </content>
                </paragraph>
                <paragraph styleCode="ParagraphCxSpMiddle">Serious adverse reactions have been reported in individuals who abuse anabolic androgenic steroids, and include cardiac arrest, myocardial infarction, hypertrophic cardiomyopathy, congestive heart failure, cerebrovascular accident, hepatotoxicity, and serious psychiatric manifestations, including major depression, mania, paranoia, psychosis, delusions, hallucinations, hostility and aggression.</paragraph>
                <paragraph>The following adverse reactions have also been reported in men: transient ischemic attacks, convulsions, hypomania, irritability, dyslipidemias, testicular atrophy, subfertility, and infertility.</paragraph>
                <paragraph>The following additional adverse reactions have been reported in women: hirsutism, virilization, deepening of voice, clitoral enlargement, breast atrophy, male-pattern baldness, and menstrual irregularities.</paragraph>
                <paragraph>The following adverse reactions have been reported in male and female adolescents: premature closure of bony epiphyses with termination of growth, and precocious puberty.</paragraph>
                <paragraph>Because these reactions are reported voluntarily from a population of uncertain size and may include abuse of other agents, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
          <component>
            <section ID="L3962cfc8-2998-4777-85fb-3eef566d7265">
              <id root="7d11d277-a4ba-455f-af4f-405ddf0b4cfb"/>
              <code code="34087-7" codeSystem="2.16.840.1.113883.6.1" displayName="DEPENDENCE SECTION"/>
              <title>9.3 Dependence</title>
              <text>
                <paragraph styleCode="First ParagraphCxSpFirst">
                  <content styleCode="italics">
                    <content styleCode="underline">Behaviors Associated with Addiction</content>
                  </content>
                </paragraph>
                <paragraph styleCode="ParagraphCxSpMiddle">Continued abuse of testosterone and other anabolic steroids, leading to addiction is characterized by the following behaviors:</paragraph>
                <list listType="unordered">
                  <item>Taking greater doses than prescribed</item>
                  <item>Continued drug use despite medical and social problems due to drug use</item>
                  <item>Spending significant time to obtain the drug when supplies of the drug are interrupted</item>
                  <item>Giving a higher priority to drug use than other obligations</item>
                  <item>Having difficulty in discontinuing the drug despite desires and attempts to do so</item>
                  <item>Experiencing withdrawal symptoms upon abrupt discontinuation of use</item>
                </list>
                <paragraph styleCode="ParagraphCxSpMiddle">Physical dependence is characterized by withdrawal symptoms after abrupt drug discontinuation or a significant dose reduction of a drug. Individuals taking supratherapeutic doses of testosterone may experience withdrawal symptoms lasting for weeks or months which include depressed mood, major depression, fatigue, craving, restlessness, irritability, anorexia, insomnia, decreased libido and hypogonadotropic hypogonadism.</paragraph>
                <paragraph>Drug dependence in individuals using approved doses of testosterone for approved indications has not been documented.</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
        </section>
      </component>
      <component>
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          <id root="08f16517-1c1d-4adf-a7e9-480794a3f4cb"/>
          <code code="34088-5" codeSystem="2.16.840.1.113883.6.1" displayName="OVERDOSAGE SECTION"/>
          <title>10 OVERDOSAGE</title>
          <text>
            <paragraph>There have been no reports of overdosage in the XYOSTED clinical trials. There is a single report of acute overdosage with use of an approved injectable testosterone product. This subject had serum testosterone concentrations of up to 11,400 ng/dL, which were implicated in a cerebrovascular accident.</paragraph>
            <paragraph>Treatment of overdosage consists of discontinuation of XYOSTED together with appropriate symptomatic and supportive care.</paragraph>
          </text>
          <effectiveTime value="20180928"/>
        </section>
      </component>
      <component>
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          <code code="34089-3" codeSystem="2.16.840.1.113883.6.1" displayName="DESCRIPTION SECTION"/>
          <title>11 DESCRIPTION</title>
          <text>
            <paragraph styleCode="First Paragraph">XYOSTED (testosterone enanthate) injection contains testosterone enanthate, an ester derivative of an endogenous androgen, testosterone. Testosterone enanthate is a white to creamy white crystalline powder described by the chemical name (17β)-17-[(1-Oxoheptyl) oxy]-androst-4-en-3-one.  Testosterone enanthate has the molecular formula C<sub>26</sub>H<sub>40</sub>O<sub>3</sub>, the molecular weight 400.59, and the molecular structure with the chemical formula:</paragraph>
            <paragraph>
              <renderMultiMedia referencedObject="L4da9b67f-e736-4a2d-9633-ecafc04d83aa"/>
            </paragraph>
            <paragraph styleCode="Paragraph">XYOSTED (testosterone enanthate) injection is a sterile, preservative-free, and nonpyrogenic colorless to pale yellow solution supplied in a single-dose syringe assembled in a pressure-assisted autoinjector for subcutaneous administration. Each XYOSTED autoinjector contains 50 mg, 75 mg, or 100 mg of testosterone in sesame oil to form 0.5 mL solution providing three product strengths of 50 mg/0.5 mL, 75 mg/0.5 mL, and 100 mg/0.5 mL.</paragraph>
          </text>
          <effectiveTime value="20250722"/>
          <component>
            <observationMedia ID="L4da9b67f-e736-4a2d-9633-ecafc04d83aa">
              <text>Testosterone enanthate structure</text>
              <value mediaType="image/jpeg" xsi:type="ED">
                <reference value="structure.jpg"/>
              </value>
            </observationMedia>
          </component>
        </section>
      </component>
      <component>
        <section ID="L96f657e1-32b4-4053-b242-d61240a16936">
          <id root="06a5762f-a151-4b11-96e7-8ca76b09190b"/>
          <code code="34090-1" codeSystem="2.16.840.1.113883.6.1" displayName="CLINICAL PHARMACOLOGY SECTION"/>
          <title>12 CLINICAL PHARMACOLOGY</title>
          <text/>
          <effectiveTime value="20250305"/>
          <component>
            <section ID="L67aad8b3-e764-4818-8730-df6991df932e">
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              <code code="43679-0" codeSystem="2.16.840.1.113883.6.1" displayName="MECHANISM OF ACTION SECTION"/>
              <title>12.1 Mechanism of Action</title>
              <text>
                <paragraph>Endogenous androgens, including testosterone and dihydrotestosterone (DHT) are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics. These effects include the growth and maturation of the prostate, seminal vesicles, penis, and scrotum; the development of male hair distribution, such as facial, pubic, chest, and axillary hair; laryngeal enlargement, vocal cord thickening, and alterations in body musculature and fat distribution.</paragraph>
                <paragraph>Male hypogonadism, a clinical syndrome resulting from insufficient secretion of testosterone, has two main etiologies. Primary hypogonadism is caused by defects of the gonads, such as Klinefelter’s syndrome or Leydig cell aplasia, whereas secondary hypogonadism is the failure of the hypothalamus (or pituitary) to produce sufficient gonadotropins (FSH, LH).</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
          <component>
            <section ID="Laa8f5650-a3ba-4845-947b-a111174edac0">
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              <code code="43681-6" codeSystem="2.16.840.1.113883.6.1" displayName="PHARMACODYNAMICS SECTION"/>
              <title>12.2 Pharmacodynamics</title>
              <text>
                <paragraph>No specific pharmacodynamic studies were conducted using XYOSTED.</paragraph>
              </text>
              <effectiveTime value="20180928"/>
            </section>
          </component>
          <component>
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              <code code="43682-4" codeSystem="2.16.840.1.113883.6.1" displayName="PHARMACOKINETICS SECTION"/>
              <title>12.3 Pharmacokinetics</title>
              <text>
                <paragraph>
                  <content styleCode="underline">Absorption and Bioavailability</content>
                </paragraph>
                <paragraph styleCode="Paragraph">XYOSTED delivers physiologic amounts of testosterone, producing circulating testosterone concentrations that approximate normal concentrations (300-1100 ng/dL) seen in healthy men.</paragraph>
                <paragraph>Following weekly subcutaneous injection of XYOSTED for 12 weeks, serum testosterone concentrations reached a maximum after a median of 11.9 hours post-dose (range: 5.8-168.7 hours) then slowly declined (Figure 1). In this study, the starting dose of XYOSTED was 75 mg weekly then the XYOSTED dose was adjusted based upon total testosterone trough concentrations obtained following 6 weeks of dosing<content styleCode="italics"> [see Dosage and Administration (<linkHtml href="#L5d2a2c68-b3cf-47d5-a1a2-65acec70f06d">2.2</linkHtml>)]</content>.  Steady state serum testosterone concentration was achieved by Week 6.</paragraph>
                <paragraph>
                  <content styleCode="bold">Figure 1. Mean (±SD) of Total Testosterone (TT) Concentration (ng/dL) Following Weekly Administration of XYOSTED for 12 Weeks (N=137)</content>
                </paragraph>
                <paragraph>
                  <renderMultiMedia referencedObject="Lb11d548a-190d-4be4-8fd5-b8593d5a10d4"/>
                </paragraph>
                <paragraph styleCode="Paragraph">At Week 12, total testosterone concentrations were measured before and at specified times up to 168 hours after XYOSTED administration then analyzed for pharmacokinetic (PK) parameters (Table 3).</paragraph>
                <paragraph styleCode="Paragraph">
                  <content styleCode="bold">Table 3.  Arithmetic Mean (SD) and Range for Total Testosterone Pharmacokinetic Parameters at Week 12 Following Weekly Administration of 50 mg, 75 mg, or 100 mg XYOSTED (N=137)</content>
                </paragraph>
                <table border="1" cellpadding="2" cellspacing="0" width="75%">
                  <tbody>
                    <tr>
                      <td styleCode="Botrule Lrule Rrule Toprule"/>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">C<sub>avg (0-168 hr)</sub>
                        </paragraph>
                        <paragraph styleCode="Paragraph">(ng/dL)</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">C<sub>max</sub>
                        </paragraph>
                        <paragraph styleCode="Paragraph">(ng/dL)</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">T<sub>max</sub>
                        </paragraph>
                        <paragraph styleCode="Paragraph">(hr)<sup>a</sup>
                        </paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">C<sub>min</sub>
                        </paragraph>
                        <paragraph styleCode="Paragraph">(ng/dL)</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">AUC (0-168 hr)</paragraph>
                        <paragraph styleCode="Paragraph">(ng·hr/dL)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">Mean (SD)</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">553 (127)</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">790 (215)</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">11.9</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">436 (109)</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">92,955 (21,385)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">Min - Max</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph>276 - 1036</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph>389 - 1410</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">6 - 168</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">166 - 788</paragraph>
                      </td>
                      <td align="center" styleCode="Botrule Lrule Rrule Toprule">
                        <paragraph styleCode="First Paragraph">46432 - 173,987</paragraph>
                      </td>
                    </tr>
                  </tbody>
                </table>
                <paragraph>
                  <sup>a</sup> Reported as median</paragraph>
                <paragraph styleCode="Paragraph">
                  <content styleCode="underline">Distribution</content>
                </paragraph>
                <paragraph styleCode="Paragraph">Circulating testosterone is primarily bound in serum to sex hormone-binding globulin (SHBG) and albumin. Approximately 40% of testosterone in plasma is bound to SHBG, 2% remains unbound (free), and the rest is loosely bound to albumin and other proteins.</paragraph>
                <paragraph styleCode="Paragraph">
                  <content styleCode="underline">Elimination</content>
                </paragraph>
                <paragraph styleCode="Paragraph">
                  <content styleCode="italics">Metabolism</content>
                </paragraph>
                <paragraph styleCode="Paragraph">Testosterone enanthate is metabolized to testosterone via ester cleavage of the enanthate group. The mean (SD) maximum concentration of testosterone enanthate was 169 (68) ng/dL at Week 12 following weekly administration of XYOSTED.</paragraph>
                <paragraph styleCode="Paragraph">Testosterone is metabolized to various 17-keto steroids through two different pathways. The major active metabolites of testosterone are estradiol and dihydrotestosterone (DHT). At pre-dose of Week 12 treatment, the mean DHT/testosterone ratio was 0.07 which was within the normal range.</paragraph>
                <paragraph styleCode="Paragraph">
                  <content styleCode="italics">Excretion</content>
                </paragraph>
                <paragraph styleCode="Paragraph">About 90% of a testosterone dose given intramuscularly is excreted in the urine as glucuronic and sulfuric acid-conjugates of testosterone or as metabolites. About 6% of a dose is excreted in the feces, mostly in the unconjugated form. Inactivation of testosterone occurs primarily in the liver.</paragraph>
              </text>
              <effectiveTime value="20250305"/>
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                  <text>Figure 1</text>
                  <value mediaType="image/jpeg" xsi:type="ED">
                    <reference value="figure1.jpg"/>
                  </value>
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          <code code="43680-8" codeSystem="2.16.840.1.113883.6.1" displayName="NONCLINICAL TOXICOLOGY SECTION"/>
          <title>13 NONCLINICAL TOXICOLOGY</title>
          <text>
            <paragraph/>
          </text>
          <effectiveTime value="20180928"/>
          <component>
            <section ID="Ld251ab33-176b-47c6-90d3-b9b9265b1ff4">
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              <code code="34083-6" codeSystem="2.16.840.1.113883.6.1" displayName="CARCINOGENESIS &amp; MUTAGENESIS &amp; IMPAIRMENT OF FERTILITY SECTION"/>
              <title>13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility</title>
              <text>
                <paragraph styleCode="First Paragraph">
                  <content styleCode="italics">Carcinogenicity</content>
                </paragraph>
                <paragraph styleCode="Paragraph">Testosterone has been tested by subcutaneous injection and implantation in mice and rats. In mice, the implant induced cervical-uterine tumors, which metastasized in some cases. There is suggestive evidence that injection of testosterone into some strains of female mice increases their susceptibility to hepatoma. Testosterone is also known to increase the number of tumors and decrease the degree of differentiation of chemically induced carcinomas of the liver in rats.</paragraph>
                <paragraph>
                  <content styleCode="italics">Mutagenicity</content>
                </paragraph>
                <paragraph styleCode="Paragraph">Testosterone was negative in the <content styleCode="italics">in vitro</content> Ames and in the <content styleCode="italics">in vivo</content> mouse micronucleus assays.</paragraph>
                <paragraph>
                  <content styleCode="italics">Impairment of Fertility</content>
                </paragraph>
                <paragraph styleCode="Paragraph">The administration of exogenous testosterone suppresses spermatogenesis in the rat, dog and non-human primates, which was reversible on cessation of the treatment.</paragraph>
              </text>
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          <code code="34092-7" codeSystem="2.16.840.1.113883.6.1" displayName="CLINICAL STUDIES SECTION"/>
          <title>14 CLINICAL STUDIES</title>
          <text>
            <paragraph>XYOSTED was evaluated in a 52-week, open-label study (NCT02159469) to evaluate its efficacy and safety when administered subcutaneously once weekly to 150 adult males with hypogonadism. The study included a Screening Phase, a Treatment Titration Phase, and an Extended Treatment Phase.
                  </paragraph>
            <paragraph>Patients were trained on proper use of XYOSTED to self-administer the initial dose of 75 mg once weekly on the same day of the week and at approximately the same time (7:00 am ± 2 hours). The dose was increased by 25 mg at Week 7 if the Week 6 serum total testosterone concentration at the end of the dosing interval (C<sub>trough</sub>) was &lt;350 ng/dL, and was decreased by 25 mg if the C<sub>trough</sub> was ≥650 ng/dL.
                  </paragraph>
            <paragraph>The primary endpoint was the percentage of patients with a time-averaged serum total testosterone concentration (C<sub>avg</sub>) over the 7-day dosing interval (0 to 168 hours) within the normal range (300 to 1100 ng/dL) at Week 12. 
                  </paragraph>
            <paragraph>Secondary endpoints were the percentage of patients with a maximum total testosterone concentration (Cmax) above three predetermined limits: greater than 1500 ng/dL, between 1800 and 2500 ng/dL, and greater than 2500 ng/dL.</paragraph>
            <paragraph>One hundred and thirty five (90%) of the 150 hypogonadal men who received XYOSTED had a serum total testosterone concentration C<sub>avg(0-168h)</sub> within the normal range (300 to 1100 ng/dL) at Week 12.  There were no patients (0%) with C<sub>max</sub>&gt;1500 ng/dL at Week 12.
                  </paragraph>
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          <title>16 HOW SUPPLIED/STORAGE AND HANDLING</title>
          <text/>
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              <code code="34069-5" codeSystem="2.16.840.1.113883.6.1" displayName="HOW SUPPLIED SECTION"/>
              <title>16.1 How Supplied</title>
              <text>
                <paragraph styleCode="First Paragraph">XYOSTED (testosterone enanthate) injection is provided as 0.5 mL of a sterile, preservative-free, and nonpyrogenic colorless to pale yellow solution in a single-dose syringe pre-assembled in an autoinjector for a single subcutaneous administration. XYOSTED is packaged in cartons containing four (4) or one (1) autoinjectors. XYOSTED is available in the following strengths and configurations.</paragraph>
                <list listType="unordered">
                  <item>XYOSTED (testosterone enanthate) injection, USP, 50 mg/0.5 mL<list listType="unordered">
                      <item>Carton of 4 autoinjectors NDC 54436-250-04</item>
                      <item>Autoinjector NDC 54436-250-02</item>
                    </list>
                  </item>
                  <item>XYOSTED (testosterone enanthate) injection, USP, 75 mg/0.5 mL<list listType="unordered">
                      <item>Carton of 4 autoinjectors NDC 54436-275-04</item>
                      <item>Carton of 1 autoinjector NDC 54436-275-05</item>
                      <item>Autoinjector NDC 54436-275-02</item>
                    </list>
                  </item>
                  <item>XYOSTED (testosterone enanthate) injection, USP, 100 mg/0.5 mL<list listType="unordered">
                      <item>Carton of 4 autoinjectors NDC 54436-200-04</item>
                      <item>Carton of 1 autoinjector NDC 54436-200-05</item>
                      <item>Autoinjector NDC 54436-200-02</item>
                    </list>
                  </item>
                </list>
                <paragraph>Before use, each autoinjector should be visually inspected. XYOSTED should be clear to light yellow in color and free of visible particles. Do not use if the liquid is cloudy or if visible particles are present. You may notice an air bubble, this is normal.</paragraph>
              </text>
              <effectiveTime value="20250129"/>
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              <code code="44425-7" codeSystem="2.16.840.1.113883.6.1" displayName="STORAGE AND HANDLING SECTION"/>
              <title>16.2 Storage and Handling</title>
              <text>
                <paragraph>Do Not refrigerate or freeze. Use at room temperature.</paragraph>
                <list listType="unordered">
                  <item>Store at controlled room temperature, 20°C to 25°C (68°F - 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).</item>
                  <item>Protect from light (keep in carton until time of use).</item>
                </list>
              </text>
              <effectiveTime value="20180928"/>
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          <code code="34076-0" codeSystem="2.16.840.1.113883.6.1" displayName="INFORMATION FOR PATIENTS SECTION"/>
          <title>17 PATIENT COUNSELING INFORMATION</title>
          <text>
            <paragraph>
              <content styleCode="bold">Advise the patient to read the FDA-approved patient labeling (<linkHtml href="#L5dc96ad4-fbb6-4475-8b78-9cadc026964c">Medication Guide</linkHtml> and <linkHtml href="#L870d8da5-8c5a-4a33-b3d2-9583663488e3">Instructions for Use</linkHtml>).</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">Venous Thromboembolism</content>
            </paragraph>
            <list listType="unordered">
              <item>Inform patients that XYOSTED can cause venous thromboembolism. Advise patients of the signs and symptoms of venous thromboembolism, which may include the following: lower limb pain, edema, or erythema; and dyspnea or chest pain. Advise patients to promptly report the signs and symptoms of venous thromboembolism, discontinue use of XYOSTED, and seek urgent medical care.</item>
            </list>
            <paragraph>
              <content styleCode="bold">Increased Blood Pressure and Risk for Major Adverse Cardiovascular Events (MACE)</content>
            </paragraph>
            <list listType="unordered">
              <item>Inform patients that XYOSTED can increase BP which can increase cardiovascular risk over time.</item>
              <item>Instruct patients about the importance of monitoring BP periodically while on XYOSTED. If BP increases while on XYOSTED, antihypertensive medications may need to be started, added, or adjusted to control BP, or XYOSTED may need to be discontinued.</item>
            </list>
            <paragraph>
              <content styleCode="bold">Other Adverse Reactions</content>
              <br/>Inform patients that treatment with androgens may lead to adverse reactions which include:</paragraph>
            <list listType="unordered">
              <item styleCode="First Paragraph">Changes in urinary habits related to effects on prostate size, such as increased urination at night, hesitancy, urinary frequency, urinary urgency, having a urine accident, or being unable to pass urine or weak urine flow.</item>
              <item styleCode="First Paragraph">Breathing disturbances that may reflect obstructive sleep apnea, including those associated with sleep or excessive daytime sleepiness.</item>
              <item styleCode="First Paragraph">Too frequent or persistent erections of the penis.</item>
              <item styleCode="First Paragraph">Ankle swelling that may reflect peripheral edema.</item>
              <item styleCode="First Paragraph">Red blood cell count increase, PSA increase, injection site bruising, injection site bleeding.</item>
            </list>
            <paragraph>Instruct patients to report any changes in their state of health, such as changes in urinary habits, breathing, sleep, and mood, including new onset or worsening of depression, or suicidal ideation.</paragraph>
            <paragraph>Keep XYOSTED out of the reach of children</paragraph>
            <paragraph>For more information call: 1-844-XYOSTED (1-844-996-7833) or visit <linkHtml href="http://www.xyosted.com">www.XYOSTED.com</linkHtml>
            </paragraph>
            <paragraph>Manufactured For: Antares Pharma, Inc. Ewing, NJ 08628</paragraph>
            <paragraph>XYOSTED and the XYOSTED logo are trademarks of Antares Pharma, Inc. All rights reserved.</paragraph>
            <paragraph>©2025 Antares Pharma, Inc. All rights reserved</paragraph>
          </text>
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          <text>
            <paragraph/>
            <table border="1" cellpadding="2" cellspacing="0" width="85%">
              <colgroup>
                <col align="left" valign="top" width="80%"/>
                <col align="right" valign="top" width="20%"/>
              </colgroup>
              <tfoot>
                <tr styleCode="First Last">
                  <td align="left">This Medication Guide has been approved by the U.S. Food and Drug Administration.<br/>
                    <br/>For controlled substances, Antares Pharma, Inc. will provide a one-time replacement medication to the patient if the original product is damaged or is unusable due to unforeseen circumstances.<paragraph>                                                                                                                     Issued: 07/2025</paragraph>
                  </td>
                  <td align="right"/>
                </tr>
              </tfoot>
              <tbody>
                <tr>
                  <td align="center" colspan="2" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                    <paragraph>MEDICATION GUIDE</paragraph>
                    <paragraph>XYOSTED<sup>®</sup> (ZYE-oh-sted)</paragraph>
                    <paragraph>(testosterone enanthate) injection, for subcutaneous use CIII</paragraph>
                  </td>
                </tr>
                <tr>
                  <td align="left" colspan="2" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                    <paragraph>
                      <content styleCode="bold">What is XYOSTED?</content>
                    </paragraph>
                    <paragraph>XYOSTED is a prescription medicine that contains testosterone. XYOSTED is used to treat adult men who have low or no testosterone due to certain medical conditions.</paragraph>
                    <paragraph>It is not known if XYOSTED is safe and effective in children younger than 18 years old. Improper use of XYOSTED may affect bone growth in children.</paragraph>
                    <paragraph>It is not known if XYOSTED is safe or effective to treat men who have low testosterone due to aging.</paragraph>
                    <paragraph>XYOSTED is a controlled substance (CIII) because it contains testosterone that can be a target for people who abuse prescription medicines. Keep your XYOSTED in a safe place to protect it. Never give your XYOSTED to anyone else, even if they have the same symptoms you have. Selling or giving away this medicine may harm others and it is against the law.</paragraph>
                    <paragraph>XYOSTED is not meant for use by women.</paragraph>
                  </td>
                </tr>
                <tr>
                  <td align="left" colspan="2" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                    <paragraph>
                      <content styleCode="bold">Do not take XYOSTED if you:</content>
                    </paragraph>
                    <list listType="unordered">
                      <item>are a man who has breast cancer.</item>
                      <item>have or might have prostate cancer.</item>
                      <item>are a woman who is pregnant. XYOSTED may harm your unborn baby.</item>
                      <item>are allergic to XYOSTED or to any ingredients in XYOSTED including testosterone or sesame oil. </item>
                    </list>
                  </td>
                </tr>
                <tr>
                  <td align="left" colspan="2" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                    <paragraph>
                      <content styleCode="bold">Before you use XYOSTED, tell your healthcare provider about all your medical conditions, including, if you:</content>
                    </paragraph>
                    <list listType="unordered">
                      <item>have high blood pressure or are being treated for high blood pressure.</item>
                      <item>have heart problems.</item>
                      <item>have high red blood cell count (hematocrit) or high hemoglobin laboratory value.</item>
                      <item>have urinary problems due to an enlarged prostate.</item>
                      <item>have kidney or liver problems.</item>
                      <item>have a history of mental health illness including suicidal thoughts or actions, depression, anxiety or mood disorder.</item>
                      <item>have problems breathing while you sleep (sleep apnea).</item>
                    </list>
                    <paragraph/>
                    <paragraph>Tell your healthcare provider about all the medicines you take, including prescription and non­prescription medicines, vitamins, and herbal supplements.</paragraph>
                    <paragraph>Using XYOSTED with other medicines can affect each other. Especially, tell your healthcare provider if you take:</paragraph>
                    <list listType="unordered">
                      <item>insulin</item>
                      <item>medicines that decrease blood clotting (blood thinners)</item>
                      <item>corticosteroids</item>
                      <item>medicines for pain and cold.</item>
                    </list>
                    <paragraph>Know the medicines you take. Ask your healthcare provider or pharmacist for a list of all your medicines if you are not sure. Keep a list of them and show it to your healthcare provider and pharmacist when you get a new medicine.</paragraph>
                  </td>
                </tr>
                <tr>
                  <td align="left" colspan="2" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                    <paragraph>
                      <content styleCode="bold">How should I use XYOSTED?</content>
                    </paragraph>
                    <list listType="unordered">
                      <item>
                        <content styleCode="bold">See the detailed Instructions for Use for information about how to use XYOSTED.</content>
                      </item>
                      <item>Use XYOSTED exactly as your healthcare provider tells you to take it.</item>
                      <item>Your healthcare provider will show you or your caregiver how to inject XYOSTED. You should not inject XYOSTED until you have been trained on the proper way to use it.</item>
                    </list>
                  </td>
                </tr>
                <tr>
                  <td align="left" colspan="2" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                    <paragraph>
                      <content styleCode="bold">What are the possible side effects of XYOSTED?</content>
                    </paragraph>
                    <paragraph>
                      <content styleCode="bold">XYOSTED can cause serious side effects including:</content>
                    </paragraph>
                    <list listType="unordered">
                      <item>
                        <content styleCode="bold">Increase in red blood cell count (hematocrit) or hemoglobin. </content>
                        <list listType="unordered">
                          <item>XYOSTED increases red blood cell counts in some patients. High red blood cell counts increase the risk of clots, strokes, and heart attacks.</item>
                          <item>You may need to stop XYOSTED if your red blood cell count increases.</item>
                          <item>Your healthcare provider should check your red blood cell count and hemoglobin while you use XYOSTED.</item>
                        </list>
                      </item>
                    </list>
                    <list listType="unordered">
                      <item>
                        <content styleCode="bold">If you already have an enlarged prostate, your signs and symptoms may get worse while using XYOSTED. This can include:</content>
                        <list listType="unordered">
                          <item>increased urination at night</item>
                          <item>trouble starting your urine stream</item>
                          <item>having to pass urine many times during the day</item>
                          <item>having an urge that you have to go to the bathroom right away</item>
                          <item>having a urine accident</item>
                          <item>being unable to pass urine or weak urine flow</item>
                        </list>
                      </item>
                    </list>
                    <list listType="unordered">
                      <item>
                        <content styleCode="bold">Increased risk of prostate cancer</content>. Your healthcare provider should check you for prostate cancer or any other prostate problems before you start and while you use XYOSTED.</item>
                      <item>
                        <content styleCode="bold">Blood clots in the legs or lungs. </content>Signs and symptoms of a blood clot in your leg can include leg pain, swelling or redness. Signs and symptoms of a blood clot in your lungs can include difficulty breathing or chest pain.</item>
                      <item>
                        <content styleCode="bold">Increase in blood pressure. </content>XYOSTED can increase your blood pressure. Increases in blood pressure can increase the risk of heart attack or stroke over time. Your risk may be greater if you have already had a heart attack or stroke or if you have other risk factors for heart attack or stroke. If your blood pressure increases while on XYOSTED, blood pressure medicines may need to be started. If you are taking blood pressure medicines, new blood pressure medicines may need to be added or your current blood pressure medicines may need to be adjusted to control your blood pressure. If your blood pressure cannot be controlled, XYOSTED may need to be stopped. Your healthcare provider will monitor your blood pressure while you are being treated with XYOSTED.</item>
                      <item>
                        <content styleCode="bold">Abuse.</content> Testosterone can be abused, when taken at higher than prescribed doses and when used with other anabolic androgenic steroids. Abuse can cause serious heart and psychological side effects. Your healthcare provider should check you for signs of abuse before and during treatment with XYOSTED.</item>
                      <item>
                        <content styleCode="bold">In large doses XYOSTED may lower your sperm count.</content>
                      </item>
                      <item>
                        <content styleCode="bold">Liver problems</content>. Symptoms of liver problems may include:<list listType="unordered">
                          <item>nausea or vomiting</item>
                          <item>yellowing of your skin or whites of your eyes</item>
                          <item>dark urine</item>
                          <item>pain on the right side of your stomach area (abdominal pain)</item>
                        </list>
                      </item>
                    </list>
                    <list listType="unordered">
                      <item>
                        <content styleCode="bold">Swelling of your ankles, feet, or body, with or without heart failure.</content>
                      </item>
                      <item>
                        <content styleCode="bold">Enlarged or painful breasts.</content>
                      </item>
                      <item>
                        <content styleCode="bold">Problems breathing while you sleep (sleep apnea).</content>
                      </item>
                      <item>
                        <content styleCode="bold">Change in mood. </content>Talk to your healthcare provide if you have changes in mood or behavior including, new or worsening depression, or suicidal thoughts.</item>
                    </list>
                    <paragraph>
                      <content styleCode="bold">Call your healthcare provider right away if you have any of the serious side effects listed above.</content>
                    </paragraph>
                    <paragraph>
                      <content styleCode="bold">The most common side effects of XYOSTED include:</content>
                    </paragraph>
                    <list listType="unordered">
                      <item>red blood cell count increase</item>
                      <item>prostatic specific antigen (PSA) increase (a test used to screen for prostate cancer)</item>
                      <item>high blood pressure</item>
                      <item>injection site reactions including:<list listType="unordered">
                          <item>bruising</item>
                          <item>bleeding</item>
                          <item>redness</item>
                          <item>hardness</item>
                        </list>
                      </item>
                    </list>
                    <paragraph>
                      <content styleCode="bold">Other side effects include </content>more erections than are normal for you or erections that last a long time.</paragraph>
                    <paragraph>Tell your healthcare provider if you have any side effect that bothers you or that does not go away.</paragraph>
                    <paragraph>These are not all the possible side effects of XYOSTED. For more information, ask your healthcare provider or pharmacist.  Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.</paragraph>
                  </td>
                </tr>
                <tr>
                  <td align="left" colspan="2" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                    <paragraph>
                      <content styleCode="bold">How should I store XYOSTED?</content>
                    </paragraph>
                    <paragraph>
                      <content styleCode="bold">Do not refrigerate or freeze. Use at room temperature.</content>
                    </paragraph>
                    <paragraph>Store at controlled room temperature, 68°F to 77°F (20°C to 25°C).  Protect from light (keep in carton until time of use). Discard unused portion.</paragraph>
                    <paragraph>
                      <content styleCode="bold">Keep XYOSTED and all medicines out of the reach of children.</content>
                    </paragraph>
                  </td>
                </tr>
                <tr>
                  <td align="left" colspan="2" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                    <paragraph>
                      <content styleCode="bold">General information about the safe and effective use of XYOSTED.</content>
                    </paragraph>
                    <paragraph>Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use XYOSTED for a condition for which it was not prescribed. Do not give XYOSTED to other people, even they have the same symptoms that you have. It may harm them.  You can ask your pharmacist or healthcare provider for information about XYOSTED that is written for health professionals.</paragraph>
                  </td>
                </tr>
                <tr>
                  <td align="left" colspan="2" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                    <paragraph>
                      <content styleCode="bold">What are the ingredients in XYOSTED?</content>
                    </paragraph>
                    <paragraph>
                      <content styleCode="bold">Active ingredient: </content>testosterone enanthate</paragraph>
                    <paragraph>
                      <content styleCode="bold">Inactive ingredients: </content>sesame oil</paragraph>
                    <br/>
                    <paragraph>Manufactured For:<br/>Antares Pharma, Inc. Ewing, NJ 08628 XYOSTED and the XYOSTED logo are trademarks of Antares Pharma, Inc. All rights reserved. ©2025 Antares Pharma, Inc. All rights reserved</paragraph>
                    <paragraph>For more information, go to <linkHtml href="http://www.xyosted.com">www.XYOSTED.com</linkHtml> or call 1-844-XYOSTED (1-844-996-7833).    </paragraph>
                  </td>
                </tr>
              </tbody>
            </table>
            <paragraph/>
          </text>
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          <title>
            <content styleCode="bold">Instructions for Use</content>
          </title>
          <text>
            <paragraph>
              <content styleCode="bold">​XYOSTED<sup>​®</sup>
              </content>
              <br/>
              <content styleCode="bold">Testosterone Enanthate Injection USP CIII</content>
            </paragraph>
            <paragraph>Single-dose auto-injector.<br/>For a single subcutaneous administration.<br/>Administer one device weekly.</paragraph>
            <paragraph>Read this Instructions for Use before you start using XYOSTED (ZYE-oh-sted) and each time you get a refill. There may be new information. This leaflet does not take the place of talking with your healthcare provider about your medical condition or treatment.</paragraph>
            <paragraph>
              <content styleCode="bold">Important Information about XYOSTED:</content>
            </paragraph>
            <list listType="unordered">
              <item>Use XYOSTED exactly as your healthcare provider tells you to take it.</item>
              <item>Inject XYOSTED only 1 time each week. Do not use XYOSTED every day.</item>
              <item>Your healthcare provider will show you or your caregiver how to inject XYOSTED. You should not inject XYOSTED until you have been trained on the proper way to use it.</item>
              <item>Check XYOSTED before you inject it. XYOSTED should be clear to light yellow in color and should be free of visible particles.</item>
              <item>
                <content styleCode="bold">Do not</content> use if the liquid is cloudy or if visible particles are present. You may see air bubble(s), this is normal.</item>
              <item>
                <content styleCode="bold">Do not</content> use XYOSTED if the safety seal is broken or if the Auto-Injector appears broken, damaged or changed in any way.</item>
              <item>XYOSTED should be injected in the stomach (abdomen) area after cleaning the skin.</item>
              <item>
                <content styleCode="bold">Do not</content> inject XYOSTED within 2 inches of the belly button (navel).</item>
              <item>
                <content styleCode="bold">Do not</content> inject XYOSTED in any other areas of the body.</item>
              <item>
                <content styleCode="bold">Do not</content> inject XYOSTED in areas where the skin is tender, bruised, red, scaly, hard, or has scars or stretch marks.</item>
              <item>Discard unused portion.</item>
            </list>
            <paragraph>If you are not sure if XYOSTED was injected, or if you have a hard time giving the injection, do not inject another dose. Call your pharmacist or healthcare provider right away.</paragraph>
            <table border="1" cellpadding="2" cellspacing="0" width="30%">
              <tbody>
                <tr>
                  <td align="center" styleCode="Botrule Lrule Rrule Toprule" valign="top">
                    <paragraph>
                      <content styleCode="bold">If you need help or instructions, call:<br/>1-844-996-7833</content>
                    </paragraph>
                  </td>
                </tr>
                <tr>
                  <td styleCode="Botrule Lrule Rrule Toprule" valign="top">
                    <list listType="unordered">
                      <item>Carefully read all steps before beginning injection.</item>
                      <item>Injection process must be completed without interruption.</item>
                    </list>
                  </td>
                </tr>
              </tbody>
            </table>
            <paragraph>
              <renderMultiMedia referencedObject="Lb1262b53-6c7b-43f0-816d-ab49a796e9ce"/>
            </paragraph>
            <paragraph>
              <content styleCode="bold">​Supplies You Will Need</content>
            </paragraph>
            <list listType="unordered">
              <item>1 XYOSTED Auto-Injector</item>
              <item>1 alcohol swab</item>
              <item>1 cotton ball or gauze</item>
            </list>
            <paragraph>
              <content styleCode="bold">​Storage Conditions</content>
            </paragraph>
            <list listType="unordered">
              <item>Do not refrigerate or freeze.</item>
              <item>Protect from light.</item>
              <item>Use at room temperature.</item>
              <item>Store at 68° - 77° F (20° - 25° C).</item>
              <item>Keep XYOSTED and all medicines away from children.</item>
            </list>
            <paragraph>
              <content styleCode="bold">​Inspect Auto-Injector</content>
            </paragraph>
            <list listType="unordered">
              <item>
                <content styleCode="bold">Do not</content> remove Cap until ready to inject.</item>
              <item>Inspect Auto-Injector for any visible damage. <content styleCode="bold">Do not</content> use if it appears damaged or broken.</item>
              <item>Check the expiration date. <content styleCode="bold">Do not</content> use if the expiration date has passed.</item>
              <item>Inspect the medicine through the Viewing Window; it should be clear to light yellow and free of visible particles (<content styleCode="bold">see Figure 2</content>).</item>
            </list>
            <paragraph>
              <renderMultiMedia referencedObject="Laeeba5a7-d31a-4d2b-ab26-d0465dcb1c48"/>
            </paragraph>
            <paragraph>
              <content styleCode="bold">Do not</content> use if the medicine is cloudy or if visible particles are present. You may notice an air bubble, this is normal.</paragraph>
            <paragraph>
              <content styleCode="bold">​Select &amp; Prep Injection Site</content>
            </paragraph>
            <paragraph>Wash your hands with soap and water.<br/>Wipe the abdomen injection site with an alcohol swab.</paragraph>
            <paragraph>
              <br/>Allow the site to dry on its own.<br/>
              <content styleCode="bold">Do not</content> fan or blow on the injection site.<br/>
              <content styleCode="bold">Do not</content> touch the site again before injecting.</paragraph>
            <paragraph>
              <br/>Only use the left or right side of the abdomen (belly) for injection sites.<br/>
              <content styleCode="bold">Do not</content> use the area within 2 inches around your navel (belly button). <br/>
              <content styleCode="bold">See Figure 3.</content>
            </paragraph>
            <paragraph>
              <renderMultiMedia referencedObject="L61cea53f-cbc1-4049-ada7-a953f718203b"/>
            </paragraph>
            <paragraph>
              <content styleCode="bold">Do not</content> use in areas where the skin is tender, bruised, red, scaly, or hard. Avoid areas with scars, tattoos, or stretch marks.</paragraph>
            <paragraph>
              <content styleCode="bold">​Administering Injection</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">1. Remove Cap</content>
            </paragraph>
            <paragraph>Twist the Cap to remove (this will also break the red safety seal). <content styleCode="bold">See Figure 4.</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">
                <renderMultiMedia referencedObject="L7b311590-3c6d-4ae2-a186-3c5524497137"/>
              </content>
            </paragraph>
            <paragraph>After the Cap is removed, a few drops of liquid may appear, this is normal.<br/>The Auto-Injector should be used or discarded after the Cap is removed.<br/>
              <content styleCode="bold">Do not</content> re-Cap for later use.</paragraph>
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                    <paragraph>
                      <content styleCode="bold">Do not</content> touch the Needle End of the Auto-Injector with your hand or fingers after the Cap is removed, doing so can cause injection and injury to your hands.</paragraph>
                  </td>
                </tr>
              </tbody>
            </table>
            <paragraph>
              <content styleCode="bold">​2. Position Auto-Injector</content>
            </paragraph>
            <paragraph>Gently squeeze the abdomen injection site to create a raised area and hold that area firmly until after the injection is complete (<content styleCode="bold">see Figure 5</content>).</paragraph>
            <paragraph>
              <renderMultiMedia referencedObject="Leb0afe06-2bb8-4785-bd13-b401ecbbe899"/>
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            <paragraph>Place the Needle End of the Auto-Injector on the abdomen injection site.</paragraph>
            <paragraph>Keep the Auto-Injector straight at a 90 degree angle to the abdomen injection site. (<content styleCode="bold">see Figure 6</content>).</paragraph>
            <paragraph>
              <renderMultiMedia referencedObject="Ld959ea11-8a3c-4cc5-bb60-40c8cb67d14e"/>
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            <paragraph>
              <content styleCode="bold">3. Inject &amp; Hold Down</content>
            </paragraph>
            <paragraph>Firmly push the Auto-Injector down on the abdomen site and continue to hold down after you hear the “CLICK” (<content styleCode="bold">see Figure 7</content>).</paragraph>
            <paragraph>
              <renderMultiMedia referencedObject="Le529f873-bf28-4f17-9bc4-58d592f8810a"/>
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            <paragraph>While holding the XYOSTED Auto-Injector down, slowly count from 1 to 10 to allow all of the medicine to be delivered (<content styleCode="bold">see Figure 8</content>).</paragraph>
            <paragraph>
              <renderMultiMedia referencedObject="Ld44655bf-d24d-47ef-aba6-82bdc51d4755"/>
            </paragraph>
            <paragraph>Keep holding the XYOSTED Auto-Injector down for a total of 10 seconds even if your injection is complete and the viewing window turns orange sooner.</paragraph>
            <paragraph>It is normal if there is slight bleeding from the site after injection. If this occurs, hold a cotton ball or gauze on the area for a few seconds. <content styleCode="bold">Do not</content> rub the area.</paragraph>
            <paragraph>
              <content styleCode="bold">​4. Inspect Viewing Window</content>
            </paragraph>
            <paragraph>After injecting, inspect the Viewing Window. It should be orange, confirming the dose was administered (<content styleCode="bold">see Figure 9</content>).</paragraph>
            <paragraph>
              <renderMultiMedia referencedObject="L56948d1d-e0c0-4b27-a9f0-72164c95913f"/>
            </paragraph>
            <paragraph>If the Viewing Window is not orange:</paragraph>
            <list listType="unordered">
              <item>
                <content styleCode="bold">Do not</content> use another Auto-Injector.</item>
              <item>
                <content styleCode="bold">Do not</content> attempt another injection.</item>
              <item>
                <content styleCode="bold">Call</content> your healthcare provider or <content styleCode="bold">1-844-996-7833</content> for assistance.</item>
            </list>
            <paragraph>
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            </paragraph>
            <paragraph>
              <content styleCode="bold">​Disposal After Injection</content>
            </paragraph>
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              <tbody>
                <tr styleCode="First Last">
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                    <paragraph>
                      <content styleCode="bold">After completing your injection, dispose of the XYOSTED Auto-Injector and Cap in an FDA-cleared sharps disposal container immediately after use.</content>
                    </paragraph>
                  </td>
                </tr>
              </tbody>
            </table>
            <paragraph>
              <content styleCode="bold">Do not</content> dispose of the XYOSTED Auto-Injector in your household trash.</paragraph>
            <paragraph>If you do not have an FDA-cleared sharps disposal container, you may use a household container that is:</paragraph>
            <list listType="unordered">
              <item>made of a heavy-duty plastic</item>
              <item>can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out</item>
              <item>upright and stable during use</item>
              <item>leak-resistant</item>
              <item>properly labeled to warn of hazardous waste inside the container</item>
            </list>
            <paragraph>When your sharps disposal container is almost full, you will need to follow your community guidelines for the proper way to dispose of your sharps disposal container. There may be state or local laws about how you should throw away used needles and syringes. For more information about safe sharps disposal in the state that you live in, go to the FDA’s website at: <linkHtml href="http://www.fda.gov/safesharpsdisposal">http://www.fda.gov/safesharpsdisposal</linkHtml>.</paragraph>
            <paragraph>
              <content styleCode="bold">Do not</content> dispose of your used sharps disposal container in your household trash unless your community guidelines permit this. Do not recycle your used sharps disposal container.</paragraph>
            <paragraph>This Instructions for Use has been approved by the U.S. Food and Drug Administration</paragraph>
            <paragraph>LB-0118 V09</paragraph>
            <paragraph>Manufactured for:<br/>Antares Pharma, Inc.<br/>Ewing, NJ 08628<br/>07/2025</paragraph>
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          <text>
            <paragraph>
              <content styleCode="bold">XYOSTED<sup>® </sup>
              </content>(testosterone enathate injection, USP) <content styleCode="bold">CIII</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">50 mg/0.5 mL</content>
            </paragraph>
            <paragraph>NDC 54436-250-02</paragraph>
            <paragraph>For subcutaneous injections only.<br/>Single-dose autoinjector.<br/> Discard after use. ​<content styleCode="bold">DO NOT</content>​ reuse. Rx ONLY</paragraph>
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          <text>
            <paragraph>
              <content styleCode="bold">XYOSTED<sup>® </sup>
              </content>(testosterone enathate injection, USP) <content styleCode="bold">CIII</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">75 mg/0.5 mL</content>
            </paragraph>
            <paragraph>NDC 54436-275-02</paragraph>
            <paragraph>For subcutaneous injections only.<br/>Single-dose autoinjector.<br/>Discard after use. <content styleCode="bold">DO NOT</content> reuse. Rx ONLY</paragraph>
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          <text>
            <paragraph>
              <content styleCode="bold">XYOSTED<sup>®</sup>
              </content> (testosterone enathate injection, USP) <content styleCode="bold">CIII</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">100 mg/0.5 mL</content>
            </paragraph>
            <paragraph>NDC 54436-200-02</paragraph>
            <paragraph>For subcutaneous injections only.<br/>Single-dose autoinjector.<br/> Discard after use. ​<content styleCode="bold">DO NOT</content>​ reuse. Rx ONLY</paragraph>
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          <title>PRINCIPAL DISPLAY PANEL - 50 mg Kit Carton</title>
          <text>
            <paragraph>XYOSTED<sup>®</sup> (testosterone enanthate injection, USP) <br/> NDC 54436-250-04</paragraph>
            <paragraph>50 mg/0.5 mL CIII</paragraph>
            <paragraph>For subcutaneous <br/> injection only.</paragraph>
            <paragraph>Four Single-dose autoinjectors. <br/> Discard after use. <br/> DO NOT reuse.</paragraph>
            <paragraph>Dispense the enclosed <br/> Medication Guide to each <br/>patient.</paragraph>
            <paragraph>Rx ONLY</paragraph>
            <paragraph>50 mg</paragraph>
            <paragraph>Usual Dosage: Administer one device <br/> weekly. Discard unused portion. See Full <br/>Prescribing Information.</paragraph>
            <paragraph>Store and use at room temperature, <br/>20°C to 25°C (68°F - 77°F); excursions <br/>permitted to 15°C to 30°C (59°F to  <br/>86°F). Do Not refrigerate or freeze. <br/> Protect from light (keep autoinjectors in <br/> carton until ready to use).</paragraph>
            <paragraph>Keep away from children.</paragraph>
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          <text>
            <paragraph>
              <content styleCode="bold">XYOSTED<sup>®</sup>
              </content>
              <content> (testosterone enathate injection, USP)</content>
            </paragraph>
            <paragraph>
              <content>NDC 54436-275-04</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">75 mg/0.5 mL</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">CIII</content>
            </paragraph>
            <paragraph>For subcutaneous injections only</paragraph>
            <paragraph>Four Single-dose autoinjectors</paragraph>
            <paragraph>
              <content styleCode="bold">Discard after use. DO NOT</content> reuse.</paragraph>
            <paragraph>
              <content styleCode="bold">Dispense the enclosed Medication Guide to each patient.</content>
            </paragraph>
            <paragraph>Rx ONLY</paragraph>
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          <title>PRINCIPAL DISPLAY PANEL - 100 mg Kit Carton</title>
          <text>
            <paragraph>XYOSTED<sup>®</sup> (testosterone enanthate injection, USP) <br/> NDC 54436-200-04</paragraph>
            <paragraph>100 mg/0.5 mL CIII</paragraph>
            <paragraph>For subcutaneous injections only</paragraph>
            <paragraph>Four Single-dose autoinjectors <br/> Discard after use. DO NOT reuse.</paragraph>
            <paragraph>Dispense the enclosed <br/> Medication Guide to each patient.</paragraph>
            <paragraph>Rx ONLY</paragraph>
            <paragraph>100 mg</paragraph>
            <paragraph>Dosage: Administer one device weekly. <br/>See Full Prescribing Information.</paragraph>
            <paragraph>Store and use at room temperature, <br/>20°C to 25°C (68°F - 77°F); excursions permitted<br/> to 15°C to 30°C (59°F to 86°F). Do Not refrigerate <br/> or freeze. Protect from light (keep autoinjec- <br/>tors in carton until ready to use)</paragraph>
            <paragraph>Keep away from children.</paragraph>
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              <text>PRINCIPAL DISPLAY PANEL - 100 mg Kit Carton</text>
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