7 AndroGel Side Effects and How to Manage Them
Key takeaways:
AndroGel (testosterone) is a topical prescription medication. It treats low testosterone levels and is absorbed through your skin. You apply it to your arms and shoulders.
Increased prostate specific antigen (PSA) levels, emotional changes, and high blood pressure are common but relatively mild AndroGel side effects. In rare cases, more serious side effects have occurred, such as heart attack and stroke.
It’s possible to accidentally expose others to AndroGel. Be sure to take steps to prevent this, such as covering the area you applied the medication to. It’s also a good idea to wash your hands after applying it so you don’t expose others, especially women and children.
Table of contents
AndroGel (testosterone) is a prescription medication that treats low testosterone levels. It can also be used as part of gender-affirming hormone therapy. This topical medication raises testosterone levels. It can help improve mood, sexual function, and muscle strength, among other effects.
AndroGel is available as a convenient-to-use gel inside of a pump or a packet. But proper use of AndroGel is essential. There are some risks and side effects to consider.
AndroGel side effects at a glance
Most of AndroGel’s side effects aren’t too common. But when they do happen, dosage adjustments and lifestyle changes can help take care of them. Serious side effects are possible, but they’re rare.
Common or mild AndroGel side effects include:
Increased prostate specific antigen (PSA) levels
Mood swings and other emotional changes
Skin irritation
Excessive hair growth
High blood pressure
High cholesterol
High triglycerides
Increased hemoglobin
Worsening urinary symptoms due to enlarged prostate
Headache
Nausea
Vomiting
Rare but serious AndroGel risks include:
Unintentional exposure of AndroGel to other people
Blood clots
Heart attack
Stroke
Increased risk of prostate cancer
Let’s discuss seven of these AndroGel side effects and how to manage them.
1. Increased prostate specific antigen levels
AndroGel can raise levels of PSA, which is a protein produced by the prostate. PSA changes are typically reversible if you stop applying AndroGel. But high PSA levels that persist over time may indicate prostate issues, including prostate cancer.
As with other lab changes, it’s hard to detect PSA changes on your own. This is why it’s important to regularly see your prescriber while using AndroGel. They can monitor your PSA levels through blood work. They’ll likely check your PSA levels before prescribing AndroGel and routinely while you’re using it.
Low testosterone levels: Understand the possible symptoms associated with low T.
Testosterone replacement therapy: Discover the risks and benefits of taking testosterone.
Oral and injectable testosterone: AndroGel is only one option to consider. Learn about other forms of testosterone replacement therapy.
2. Emotional changes
Testosterone medications are well-known for their effects on muscle mass. But they can also affect your emotions. AndroGel can contribute to emotional changes such as mood swings, irritability, and feelings of depression.
Small-but-effective lifestyle changes can help support your emotional well-being. Routine physical activity can help stabilize mood shifts. Mindfulness techniques, such as meditation or breathing exercises, may also help.
Do your best to speak openly with your prescriber if you notice any major mood swings or feel down. They can help determine if this is due to AndroGel. They may adjust your dosage or recommend trying a different testosterone-boosting treatment to improve how you’re feeling.
3. High blood pressure
AndroGel may contribute to higher blood pressure. High blood pressure can increase the risk of heart problems if it’s left unchecked — especially if it was already high before starting AndroGel. This is why it’s important for your healthcare team to monitor your blood pressure on a regular basis.
There is good news, though. There are several ways to lower your blood pressure if it begins to go up after starting AndroGel. Lifestyle changes, such as reducing salt intake and getting regular exercise, are good starting points. Eating a balanced diet rich in fruits and vegetables may also help. Limiting alcohol and quitting smoking can have positive effects as well.
If measures like these aren’t enough, your prescriber may adjust your AndroGel dose. Alternatively, they may prescribe you a blood pressure medication. Or if you’re already taking one, they may increase your dose.
4. High cholesterol
AndroGel may raise your levels of low-density lipoprotein (LDL, often referred to as "bad" cholesterol) and triglycerides. It may also lower high-density lipoprotein (HDL, or "good" cholesterol) readings. These changes may increase your risk of heart disease if left unmanaged.
Again, regular checkups with your healthcare team can help prevent these changes from becoming a larger issue. They can order lab tests to ensure your cholesterol levels remain within their target range.
You can also play an active role in your heart health. Reducing your consumption of saturated fats and adopting a more heart-healthy diet should help. Regular physical activity can positively impact cholesterol levels too.
5. Worsening benign prostatic hyperplasia
Benign prostatic hyperplasia (BPH), or an enlarged prostate, may cause problems with urination. AndroGel can contribute to prostate growth, which can worsen urinary symptoms. These include frequent urination, weak urine flow, and difficulty urinating.
Reach out to your prescriber if you have any difficulty or discomfort urinating. They may lower your AndroGel dose or prescribe other medications for BPH-related symptom relief. They may also suggest incorporating minor lifestyle changes into your daily routine to help manage BPH symptoms. For instance, reducing caffeine and alcohol intake and staying active can improve symptoms.
6. Secondary testosterone exposure
AndroGel is convenient and easy to use for most people. But it has a boxed warning — the FDA’s most serious medication warning. There’s a small but serious risk that other people can be accidentally exposed to the medication.
This is called secondary exposure. It happens when women and children come into contact with the area where you applied AndroGel. This can cause them to absorb your AndroGel through their skin. Secondary exposure of AndroGel may cause unintended side effects. Women and children may see changes in body hair, acne, and other symptoms of increased testosterone. Secondary exposure can be especially dangerous for a pregnant person and their baby.
Take proactive measures to avoid skin-to-skin contact with others after applying AndroGel. Or make sure you have thoroughly cleaned the area with soap and water. Only apply AndroGel to areas on your upper arms and shoulders that can be covered with clothing. Thoroughly wash your hands with soap and water after applying AndroGel to avoid transferring it to others, too.
7. Heart and blood-related risks
AndroGel is considered safe to use under the supervision of a healthcare professional. But it’s sometimes associated with rare and serious heart and blood risks. This is also true for other testosterone-containing medications.
AndroGel can increase hemoglobin, red blood cells, and blood pressure in some people. This can increase the risk of a heart attack and stroke in rare cases. Call 911 or go to the nearest ER if you think you’re having a heart attack or stroke.
Heart attack symptoms include:
Chest pain or pressure
Pain that travels to your jaw, neck, or arm
Unexplained sweating
Feeling like you can’t catch your breath
Stroke symptoms include:
One-sided facial drooping
Difficulty speaking or understanding speech
Sudden vision issues
A sudden and severe headache
Weakness on one side of the body
Sudden difficulty walking
AndroGel can cause deep vein thrombosis (DVT) or pulmonary embolism (PE) in rare cases. A DVT happens when a blood clot forms in a vein, most commonly in your legs. A PE occurs when a piece of a blood clot breaks off and travels to your lungs, causing breathing-related symptoms.
Pain, swelling, and redness in one leg are possible symptoms of DVT. PE symptoms include sudden difficulty breathing, chest pain, and coughing. Seek immediate medical attention if you think you’re experiencing DVT or PE.
Frequently asked questions
Yes, AndroGel and other testosterone products are schedule 3 controlled substances. The U.S. Drug Enforcement Administration places medications on a drug schedule, or a scale, by weighing their medical uses against their potential for misuse and dependence. Schedule 3 medications have a low-to-moderate risk of misuse and dependence. Be sure to only use AndroGel as instructed by your prescriber for this reason.
Yes, AndroGel can transfer to other people if they touch the area of your body where you applied AndroGel. You should cover your upper arms and shoulders with a shirt and avoid skin-to-skin contact with other people until your dose has dried. Thoroughly clean your arms and shoulders with soap and water if you expect to have skin-to-skin contact with other people.
AndroGel and testosterone therapies can help improve sexual function for people with low testosterone levels. It helps boost libido and improve erectile function. However, AndroGel doesn’t necessarily make you last longer in bed or directly affect your endurance. Data on the treatment of premature ejaculation is limited for testosterone therapies.
The bottom line
AndroGel (testosterone) is a topical medication used to raise testosterone levels. It’s a schedule 3 controlled substance, which means there’s a low-to-moderate risk of misuse and dependence. AndroGel also has potential side effects, including abnormal prostate specific antigen (PSA) levels and high blood pressure. Emotional changes are also possible. Serious but rare AndroGel side effects, such as stroke and heart attack, can happen as well. Your prescriber should monitor you for risks of these side effects. And they may recommend dosage adjustments and lifestyle changes to manage them.
Secondary exposure, or transferring testosterone to other people, is another risk since AndroGel is applied to your skin. Be sure to take precautions to avoid exposing others to AndroGel.
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References
ASCEND Therapeutics U.S. (2024). Androgel [package insert].
Bassil, N., et al. (2009). The benefits and risks of testosterone replacement therapy: A review. Therapeutics and Clinical Risk Management.
Coskuner, E. R., et al. (2021). Premature ejaculation and endocrine disorders: A literature review. The World Journal of Men's Health.
Drug Enforcement Administration. (2024). Drug scheduling.
Grundy, S. M., et al. (2019). AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation.
Johnson, J. M., et al. (2013). The effect of testosterone levels on mood in men: A review. Psychosomatics.
Oza, R., et al. (2015). Nonpharmacologic management of hypertension: What works? American Family Physician.
Rizk, P., et al. (2018). Testosterone therapy improves erectile function and libido in hypogonadal men. Current Opinion in Urology.
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