Testosterone Nasal Spray: The Newest Thing in Testosterone Replacement

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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There is a new option for treating testosterone deficiency in adult men. I know, there are already gels, patches, injections and adhesive patches you stick on your gums (Striant) but apparently, we need one more and . . . wait for it . . . it’s a nasal gel. Natesto is the first nasal testosterone gel approved in the United States for the treatment of male hypogonadism and testosterone deficiency. Natesto is a metered-dose pump applicator that places the gel into the nostrils.

Advantages? Because this gel is applied inside of the nostril, there is little chance of transferring testosterone to women or children who come into close physical contact with the person using the intranasal gel. That can occur with the gels and patches used on the skin.

Disadvantages? Some men won’t like that it needs to be used three times daily. People with allergies or underlying nasal or sinus problems also may not like Natesto as a runny nose, sore throat and sinusitis are among the most common side effects.

What’s the dosage? One pump delivers 5.5 mg of testosterone so the recommended dose is 11 mg (two pumps, one in each nostril), three times a day.

Should you try Natesto now? Most physicians think until further data are available, that using the older tried and true methods are still the way to go. A worrisome point is that data in mice show brain levels of testosterone that are twice as high with the nasal gel as with intravenous testosterone. We don’t know if this occurs in men treated with the nasal gel, but maybe stick to the available testosterone gels, patch, or injections.

Dr O.

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