Testosterone Gel: Uses, Side Effects, Dosage, and More

Testosterone gel is one of the most commonly prescribed forms of testosterone replacement therapy (TRT), a medication used to treat low testosterone (male hypogonadism).

Applied directly to the skin, testosterone gel is meant to restore testosterone levels to within the normal range and improve low T symptoms such as low sex drive, brain fog, and more.

Though popular, testosterone gel comes with several side effects and risks, including the possibility of transferring the medication to others.

Keep reading to find out more about how testosterone gel works, side effects you should know about, and how topical testosterone compares to other testosterone-boosting treatments.

Like other forms of testosterone replacement therapy, testosterone gel is used to increase testosterone levels and improve symptoms of low testosterone, such as decreased sex drive, fatigue, muscle loss, brain fog, and more.

Testosterone, the body’s primary male sex hormone (androgen), plays a key role in everything from sexual desire and sperm production to muscle mass, bone strength, energy, and mood. When levels drop, it’s no surprise you might feel off balance, but medications like testosterone gel can help you feel like yourself again.

Common brand names for testosterone gel include AndroGel^®, Vogelxo^®, Testim^®, and Fortesta^® (discontinued).

When topical testosterone is applied to the skin, the steroid is rapidly absorbed into the outermost layer of the epidermis, which forms a reservoir. From there, testosterone slowly releases into your bloodstream over several hours, achieving and maintaining steady levels compared to sudden spikes and drops. 

This steady absorption is why gels are applied once daily, usually to the shoulders, upper arms, or thighs, depending on the product. (It should never be applied to the penis or scrotum.)

Here are some basic tips on how to apply testosterone gel:

• Wash your hands. Before applying testosterone gel, wash your hands with soap and warm water.

• Prep the gel, if necessary. If you are using the pump gel for the first time, you should prime the pump before measuring out your first dose. Hold the pump over a sink and press the pump all the way down several times until the gel flows freely. Discard the initial gel. If you’re using packets or tubes, squeeze the entire packet or the prescribed amount onto your hand.

• Apply gel to the application site. Using the prescribed amount, apply a thin, even layer of testosterone gel to clean, dry skin. Rub it in until the gel is absorbed.

• Let the gel dry. Allow the gel to dry for several minutes before getting dressed or coming into contact with others.

• Wash your hands (again). To reduce the risk of transfer, wash your hands thoroughly to remove any residue.

Testosterone gel should be stored at room temperature out of the reach of children.

Testosterone gel may cause side effects in some users, including:

• Acne

• Hair loss

• Skin rash

• Headache

• Water retention (edema)

• Gynecomastia (breast growth)

• Worsened sleep apnea

• High blood pressure

• Low sperm count and infertility

• Depression

• Increased risk of enlarged prostate and elevated prostate-specific antigen (PSA)

Risk of Transfer

Testosterone gel and other forms of topical or transdermal testosterone treatments also have a risk of transfer to others, especially children or women. This can happen through skin-to-skin contact or from clothing (like if your partner or child wears a T-shirt with gel residue on it). If a pregnant or breastfeeding person comes into contact with testosterone gel, it may harm the unborn baby or cause side effects in a nursing infant.

If testosterone gel is transferred to a child, they could potentially experience virilization, such as:

• Enlargement of the penis or clitoris

• Development of pubic hair

• Aggressive behavior

• Increased erections and libido

The product can also cause virilization in women, such as changes in body hair distribution or a significant increase in acne.

Contraindications and Drug Interactions

Testosterone gel isn’t recommended for people with prostate cancer or breast cancer, or those with heart, kidney, or liver problems.

It can lower blood sugar, which may affect insulin needs in people with diabetes and change how blood thinners work. It can also increase fluid retention with adrenocorticotropic hormone (ACTH) or corticosteroids.

It can take up to 72 hours to achieve steady-state testosterone levels after the first application of testosterone gel. But it can take much longer for higher testosterone levels to translate to improved symptoms.

A review examining how quickly different effects of TRT appear found the following timelines:

• Sexual interest: 3 to 6 weeks

• Depression: 3 to 6 weeks

• Body composition and strength: 12 to 16 weeks

• Erections/ejaculations: Up to 6 months

• Bone density: After 6 months

• Quality of life: After 9 months

Testosterone gels come in a range of strengths and dosage forms.

• AndroGel is available in 1% and 1.62% formulations, with typical starting doses of 50 mg and 40.5 mg daily, respectively, and flexible adjustment ranges up to 100 mg.

• Fortesta delivers 10 mg per pump actuation, usually starting at 40 mg daily with a dosing window of 10 to 70 mg.

• Testim comes in 50-mg tubes, applied once daily, with the option to increase to 100 mg if needed.

• Vogelxo is available in 1% formulations as a pump, tube, or packet. The standard starting dose is 50 mg daily, which can be increased to 100 mg based on testosterone levels.

Testosterone gel uniformly and predictably raises serum testosterone levels into the mid to high normal adult male range.

In one year-long study, daily use of 1.62% testosterone gel was found to be both safe and effective for men with low testosterone. By the end of treatment, more than three-quarters of participants maintained testosterone levels within the normal range, with nearly 78 percent of those on continuous therapy and 87 percent of those switched from placebo achieving normal T levels.

Various studies have also proven specific symptom improvements beyond higher testosterone levels.

A study that compared testosterone gel to a transdermal patch revealed that the gel was better tolerated and more effective in improving body composition. While 66 percent of patch users reported skin irritation, only 5.5 percent of gel users had the same complaint. The gel also produced greater gains in lean body mass and reductions in fat mass compared to the patch. However, both treatments were equally successful in improving sexual function and mood.

Another study that compared testosterone gel (Testim) to a testosterone patch (Andropatch^®) found that the gel raised testosterone levels more effectively over 90 days than the patch. The gel also led to bigger improvements in mood, sexual desire, erections, and body composition, especially at the highest dose. Both treatments also increased muscle mass, but the patch showed little benefit for mood or sexual function and caused more skin irritation than the gel.

And in a study of men with HIV and low testosterone, daily use of testosterone gel provided steadier testosterone levels and fewer hormone fluctuations compared to testosterone injections. The gel also led to better improvements in physical and emotional well-being, while injections caused higher peaks and dips. Both treatments were safe, but the gel was better tolerated.

When compared to other testosterone products, there are a variety of advantages to using testosterone gel.

For instance, research shows that testosterone gel has a lower incidence of skin irritation, is easier to apply than the transdermal patch, and is invisible.

Testosterone gel also provides stable testosterone levels, while injectable testosterone has been linked to “roller-coaster” highs and lows, in which testosterone levels rise into the high normal range immediately following injection, but fall into the hypogonadal range within two weeks. This rise and fall can lead to fluctuations in energy, mood, and sexual function. Injectable testosterone can also cause a higher rate of increased red blood cells compared with gels due to higher circulating testosterone levels.

Some of the pros of using testosterone gel include:

• Steady hormone levels. Testosterone gel provides a more consistent release of testosterone compared to injections, avoiding spikes and crashes.

• Easy to use. It’s a simple, once-daily application, and no needles are required.

• Flexible dosing. The gel’s available in pumps, packets, or tubes with varying strengths.

• Well-tolerated. Compared to patches, gels have a lower rate of skin irritation.

• Discreet. Testosterone gel is invisible once applied.

• Proven benefits. Testosterone gel has been shown to improve sexual desire, energy levels, mood, muscle mass, and quality of life in men with low T.

Some of the cons of using testosterone gel include:

• Risk of transfer. Testosterone gel can transfer to partners or children through skin-to-skin contact or clothing.

• Daily consistency. Gels must be applied every day, unlike injections that can last weeks.

• Side effects. Testosterone gel can cause local side effects like irritation or rashes. It can also cause systemic side effects like worsened sleep apnea, increased blood pressure, or low sperm count.

• Monitoring is required. When using testosterone gel or other forms of TRT, it’s essential to run regular blood tests to track testosterone, PSA, and other biomarkers.

• Not for everyone. Testosterone gel may not be suitable for men with prostate or breast cancer, or for those with certain heart, liver, or kidney conditions.

We asked Jillian Edmonds, PharmD, Senior Clinical Pharmacist at Hims & Hers, for her top tips for testosterone gel users. Here’s her expert advice on how to apply it safely, reduce risks, and get the most out of your treatment.

How to Apply

Topical testosterone gel is available by prescription under different brand names and generic manufacturers. Each product has its own set of instructions on how to measure and apply a dose. Before you begin using testosterone gel, read the specific instructions provided with your product for proper use. Always refer to your prescription label so you know exactly how much to use and how often to apply it. 

How to Reduce the Risk of Transfer

Testosterone gel can spread to other people if they come into contact with the application site or use items where the medication may have transferred, like blankets or clothing. This can cause serious problems for others. In children, it could cause signs of early puberty, and in females, it may cause the development of male features like changes in voice or body hair. 

The good news is that there are a few simple steps you can take to help keep others safe. Apply the gel to a small area that can be easily covered with clothing once it dries. Always wash your hands with soap and water immediately after applying testosterone gel. If you expect skin-to-skin contact with the application site, you should wash the area thoroughly beforehand. If someone touches the skin where you applied your medicine, they should wash that area right away.

Do Not Use for Off-Label Purposes

Testosterone gel should only be used in adult males diagnosed with low testosterone levels, as prescribed by a healthcare provider. Testosterone gel should never be used for other purposes, such as bodybuilding or improving your athletic performance. Using testosterone gel for purposes other than diagnosed low hormone levels can result in serious side effects such as heart attack or heart failure, stroke, and changes in your mental health, like depression, mood swings, and delusions. Always use your medication as prescribed by your provider.

Things to Know

Testosterone gel is a great option to treat low testosterone levels, but it can also cause side effects for users. It’s important to know the risks associated with your medications and talk about them with your provider before starting new treatments. Below are some common side effects and interactions reported with testosterone gel use. 

Testosterone gel can increase your blood pressure. High blood pressure can raise your risk of heart attack or stroke. Check your blood pressure regularly as suggested by your provider. 

If you have an enlarged prostate, testosterone gel may worsen your symptoms during use. Speak with your provider if you’re experiencing new or worse symptoms. 

Testosterone gel can lower your blood sugar levels. If you have diabetes, you may need to monitor your blood sugar more often while using testosterone gel. It’s important to recognize the symptoms of low blood sugar, like confusion, a fast heartbeat, sweating, and shakiness. If you notice these symptoms, talk with your provider. You may need an adjustment to your diabetes medications. 

Large doses of testosterone gel may lower your sperm count and affect your ability to have a child. If this happens, there’s a chance it may not go back to normal after stopping use of the gel. Talk with your provider about your family planning goals before starting this medication.

Testosterone gel can cause pain, tenderness, or growth in the breast area, which may persist during treatment. Talk to your provider if you experience this, as they may need to adjust your dose.

Dispose of testosterone gel packaging in the trash where others, including pets, can’t touch it. To prevent accidental exposure and keep everyone safe, seal the packaging in an individual bag or place it in an empty container before disposing of it.

One of the many advantages of TRT is that it comes in many forms. Here’s what we know about testosterone gel:

• Testosterone gel is a popular and effective TRT option. It helps restore testosterone to healthy levels and improves symptoms like low sex drive, fatigue, brain fog, and reduced muscle mass, while providing steady hormone levels compared to injections or patches.

• Testosterone gels are easy to use and well-tolerated. Applied once daily, testosterone gels are discreet and generally cause fewer skin reactions than patches. They also avoid the hormone “roller-coaster” effect seen with injections.

• Risks and precautions are important. Testosterone gel can cause side effects, lower fertility, and transfer to others through skin contact. Regular monitoring is required.

Testosterone gel can be a safe and effective way to restore hormonal balance and improve quality of life for men with low testosterone. Just be sure to use it as directed and work closely with a healthcare professional to find the right fit for you.

If you want to learn more about how to raise your T levels, check out this guide on how to increase testosterone naturally.

Here are some frequently asked questions about testosterone gel:

How long do I need to use testosterone gel?

Most men with low testosterone require long-term treatment to maintain healthy hormone levels. Your healthcare provider will regularly monitor your hormone levels and symptoms to decide if you should continue.

What happens if I miss a dose?

If you miss a dose, apply it as soon as you remember. If it is almost time for your next application, skip the missed dose and apply at your usual time. Do not use extra medication to make up for the missed dose.

Can testosterone gel damage the liver?

Research shows that testosterone gels don’t carry a risk of liver damage that some other forms of testosterone do. This is because testosterone gels don’t undergo hepatic first-pass metabolism, which means the liver doesn’t specifically break them down. 

Will testosterone gel impact fertility?

Yes, testosterone gel and other forms of TRT can lower sperm count and cause infertility. If you plan to have children, you may want to consider other treatments like clomiphene citrate (Clomid^®) or enclomiphene citrate.

Who should not use testosterone gel?

Testosterone gel is only approved for adult men. It is not indicated for use in women, children, or teenagers.