OBJECTIVES:  Very limited data exist on patient persistence with testosterone replacement therapy (TRT). Furthermore, no persistence data are available for the long-acting injection (LAI) formulation.  Therefore, the objective of this analysis was to compare medication persistence and first switching patterns among patients initiating LAI with those using other testosterone formulations. METHODS:  This was a retrospective database analysis of 17,385 patients receiving TRT in Germany between 2008 and 2012 based on the IMS^®Health German Longitudinal Prescriptions (LRx) database.  The main outcome measure was the percentage of patients who were persistent with their index TRT at 24 months from initiation. RESULTS:  During the study period, patients receiving the LAI remained on their initial therapy significantly longer than patients using capsules, gels or short-acting injections (SAIs) (p<0.001). At three months, 70.1% of patients with the LAI were persistent with their initial TRT compared with 39.1% of patients receiving the gels and 14.7% of patients treated with the SAI. At 24 months, 20.2% of those receiving the LAI remained on their initial therapy vs. 9.7%, 5.7% and 0.5% for capsule, gels and SAIs, respectively. Sensitivity analyses showed consistent results. A total of 3,115 (17.9%) patients switched to a different product, with those starting on a LAI having the lowest switching rate (6.2%) and those starting with SAIs having the highest rate (24.2%). CONCLUSIONS:  While persistence with TRT decreased substantially over time, treatment with the long-acting injection demonstrated higher persistence compared with the gels, capsule, and short-acting injections. Persistence with treatment for low testosterone may be enhanced by the administration of testosterone utilizing a technology that prolongs the availability of drug and reduces dosing frequency.