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Treatment with testosterone undecanoate (Nebido®) in castor oil has made the treatment of hypogonadal men more simple by increasing the injection interval to 12 weeks, while maintaining the testosterone level within the normal range. The clinical efficacy of testosterone undecanoate demonstrated improvement in sexual function in patients unresponsive to phosphodiesterase-5 inhibitors, a relief in depressive symptoms with a better performance in psychometric tests. For men with heart disease, cardiac risk factors were reduced (insulin resistance, fat mass and lipid profiles), in addition an increase in time for exercise-induced ischemia was noticed. Only small changes were found in hemoglobin and hematocrit. Liver function and blood pressure were stable. PSA showed an insignificant increase in all investigations, and no incidence of prostate cancer was detected. Only modest adverse events were noticed: acne and breast tenderness. In conclusion, treatment with testosterone undecanoate is effective and safe.