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Introduction: Severe burn injuries trigger a hypermetabolic state characterized by profound catabolism, muscle wasting, and impaired wound healing. Following the 2023 market withdrawal of oxandrolone, our burn center implemented intramuscular (IM) testosterone cypionate as an alternative anabolic agent. We aimed to evaluate its safety in male burn patients by assessing metabolic, hepatic, hematologic, and cardiovascular outcomes. Methods: This single-center, retrospective review included adult male burn patients who received at least two doses of IM testosterone cypionate 200 mg and had a documented baseline (pre-treatment) and at least one follow-up total testosterone level. Outcomes included changes in testosterone levels, liver enzymes, hemoglobin, blood pressure, and the incidence of adverse events such as thrombotic complications, injection site reactions, or glycemic disturbances. Results: Five patients met inclusion criteria. Median age was 40 years and median total body surface area burn was 30%. All patients were hypogonadal at baseline, with improvement in testosterone levels to within the normal range after at least two doses. No patients developed polycythemia or experienced thrombotic events. Mild transaminitis occurred in all patients, possibly due to concurrent hepatotoxic medications. No significant hematologic, lipid, or cardiovascular complications were identified. None of the patients experienced an injection site reaction or developed hyperglycemia. Limitations included small sample size, inconsistent lipid monitoring, and delays in follow-up testosterone levels due to send-out testing. Conclusions: IM testosterone cypionate appears to be a safe and feasible anabolic strategy for male burn patients when appropriately monitored. The observed rise in testosterone was consistent with the intended dosing effect, and no major safety concerns emerged. Mild liver enzyme elevations were common but not clearly attributable to testosterone. Larger studies are needed to confirm safety, refine dosing and monitoring strategies, and compare with alternative anabolic agents.