Natesto
Natesto is a prescription testosterone nasal gel that's applied to the inside of the nose. It's a testosterone replacement therapy that's FDA approved to treat adult males with low testosterone levels. You'll have to apply it to each nostril 3 times a day. Common side effects include headache, runny nose, and nosebleeds. The medication only comes as a brand-name medication since no generic version is available.
What is Natesto?
What is Natesto used for?
Low testosterone (also called hypogonadism)
How Natesto works
Natesto is a testosterone replacement therapy that acts like the natural sex hormone, testosterone. Testosterone is responsible for the development and maintenance of many male features and functions, such as muscle and bone strength and growth and regulating sex drive and sperm production. Natesto works by raising testosterone to normal and healthy levels in males with low testosterone.
Drug Facts
Get your GoodRx coupon
What are the risks and warnings for Natesto?
Natesto can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Nasal side effects
Natesto can cause nasal side effects such as common cold symptoms, runny nose, nosebleeds, nasal discomfort, and nasal scabbing. Most of these side effects are either mild or moderate in severity. Let your prescriber know if you have any of these side effects because you might need to stop the medication if symptoms continue.
Risk of blood clots, including heart attack or stroke
Risk factors: History of heart conditions
Taking testosterone replacement therapy, like Natesto, can raise your risk of blood clots. This can lead to problems such as strokes and heart attacks. Your healthcare team will have you perform regular blood tests, called the complete blood count (CBC), to check that your blood cell counts are in the safe range. Get emergency help right away if you have chest pain, cold sweats, left arm pain, difficulty breathing, trouble walking, trouble speaking, or weakness on one side of the body, since you might have to stop taking the medication.
Prostate problems
Risk factors: History of enlarged prostate
Taking Natesto can worsen certain symptoms in people with an enlarged prostate, or benign prostatic hyperplasia (BPH). Let your prescriber know if you experience any changes in your urinary routine, such as more urination at night, feeling like you need to urinate more often or immediately, trouble urinating, accidentally urinating, or urinating slowly.
Natesto can also raise your risk of prostate cancer. Your prescriber might have you perform occasional blood tests and physical check-ups before and during treatment with this medication.
Potential for misuse, dependency, and addiction
Risk factors: Taking more Natesto than prescribed | Taking Natesto with other testosterones
Natesto is a controlled substance because it has a risk of misuse and dependency, especially if you use higher doses than prescribed or use it with other testosterones.
Continued misuse of Natesto can lead to addiction. The FDA has only approved this medication for the treatment of low testosterone in males. Taking Natesto for other reasons can lead to serious side effects, such as heart attack, heart failure, stroke, depression, hallucinations, and delusions. Only take this medication as prescribed by your healthcare professional.
Liver problems
Taking certain forms of testosterone, such as methyltestosterone and testosterone enanthate intramuscular injection, for long periods of time can cause life-threatening liver problems. This isn't a known risk of Natesto but it's important to look out for signs and symptoms of liver damage. Let your provider know if you're experiencing stomach pain, light-colored stools, dark urine, or if your skin or the whites of your eyes turn yellow because you might need to stop the medication.
Swelling in the legs or arms (edema)
Risk factors: History of heart, liver, or kidney conditions | Taking other medications that cause swelling like corticosteroids
Natesto can cause your body to hold onto more salt and water, which can lead to swelling in your legs or arms and sudden weight gain. This is more likely to happen if you're taking other medications that cause swelling, such as corticosteroids (e.g., prednisone, methylprednisolone (Medrol)). It can be more serious in people with heart, liver, or kidney conditions. Talk to your prescriber if you have any of these symptoms because you might need to stop the medication.
Sleep apnea
*Risk factors: History of sleep apnea | Obesity | History of lung disease *
Natesto can cause sleep apnea, a condition in which you stop breathing for short periods of time while sleeping. This is more likely to happen to people who also identify as obese or have lung problems. If you experience more daytime sleepiness or if your partner notices that you stop breathing in your sleep more often, talk to your prescriber.
High calcium levels in the blood
Risk factors: History of cancer | Taking other medications that cause high calcium in the blood
Natesto can cause high calcium in the blood (hypercalcemia), especially in people with cancer. For people with cancer, high calcium levels might be a sign that the cancer has spread to the bones. During treatment with Natesto, your prescriber might have you perform regular blood tests to make sure your calcium levels are within a safe range.
What are the side effects of Natesto?
Common Side Effects
- Rise in prostate-specific antigen (PSA, 5%)
- Headache (4%)
- Runny nose (4%)
- Nosebleed (4%)
- Nasal discomfort (4%)
- Common cold symptoms (4%)
- Bronchitis (4%)
- Upper respiratory tract infection (4%)
- Swelling of the nasal passages (4%)
- Nasal scab (4%)
Other Side Effects
- High blood pressure
- High red blood cell count
- Changes in taste
- Changes to the sense of smell
- Loss of smell
- Poor appetite
- Nasal dryness
- Nasal congestion
- Pain in the arms and legs
- Muscle pain
- Joint pain
- Nausea
- Cough
Serious Side Effects
- Heart attack: chest pain, cold sweats, left arm pain, difficulty breathing
- Stroke: Face drooping, trouble seeing, walking, or speaking, weakness on one side of the body
- Blood clot in the legs: pain, swelling, warm to touch, redness in the leg
- Blood clot in the lungs: trouble breathing, chest pain, cough
- Liver damage: stomach pain, nausea, vomiting, yellowing of the skin, yellowing of the whites of the eyes, light-colored stools, dark urine, weight loss
- Withdrawal: depression, fatigue, craving, restlessness, irritability, lack of appetite, trouble sleeping (insomnia), lower sex drive, and low testosterone
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Blood clot—pain, swelling, warmth in the leg, shortness of breath, chest pain
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Increase in blood pressure
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing of the skin or eyes, unusual weakness or fatigue
- Mood swings, irritability, or hostility
- Prolonged or painful erection
- Sleep apnea—loud snoring, gasping during sleep, daytime sleepiness
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Swelling of the ankles, hands, or feet
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Acne
- Change in sex drive or performance
- Dryness or irritation in the nose
- Nosebleeds
- Runny or stuffy nose
- Unexpected breast tissue growth
Pros and cons of Natesto
Pros
Absorbed quickly within in your body
Compared to testosterone gel, there’s a lower risk of accidentally exposing others to testosterone
Doesn't drip out because it's a gel
Can be applied within seconds
Cons
Causes nasal side effects like runny nose and nosebleeds
Needs to be used 3 times a day
Can't be used if you have nasal or sinus problems
Only available as a brand-name medication
Pharmacist tips for Natesto
Apply Natesto into the nose 3 times a day, once in the morning, once in the afternoon, and once in the evening (6 to 8 hours apart). One full dose consists of 1 pump in each nostril. Don't apply the medication to other parts of your body.
Let your prescriber know if you have a severe runny nose after using Natesto. You might need to stop using it temporarily until the cause is known. If it doesn't go away, you might need to stop the medication and switch to another form of testosterone.
Natesto can cause growth, pain, or tenderness in the breast area. This might continue throughout treatment with this medication. Let your provider know if this becomes bothersome.
Natesto can lower your blood sugar. If you have diabetes, you might need to check your blood sugar levels more frequently. Know how to identify and manage low blood sugar.
Taking Natesto together with blood thinners like warfarin (Coumadin) might cause you to bleed more easily, so you might need to get your blood clotting time (INR) checked more often. Let your prescriber know if you experience bleeding that takes longer to stop, bruising, blood in your urine, or dark stools as your dose might need to be adjusted.
Don't blow your nose or sniff for 1 hour after using Natesto to make sure the medication stays in the nose and is fully absorbed into your body.
Store Natesto at room temperature. Throw away the used pump in the trash safely in a way that avoids accidental contact with children and pets.
How to use Natesto
Read the instructions for use before using Natesto to make sure you administer the dose correctly.
When using a new Natesto, you need to get it ready by priming it. Hold the pump upside down over the sink and press it down 10 times. Wash any gel that comes out down the sink with warm water so others don’t touch it. After this, the pump is ready to use and you won't need to prime it again.
Before you take a dose, first blow your nose.
Remove the cap, place your right index finger on the pump, and insert the tip into your left nostril until your finger touches the bottom of your nose.
Tilt the tip toward the sidewall of your nostril and press down on the pump until it stops. Slide the tip along the inside of the nostril wall to spread the dose, then remove the device from your nostril.
Repeat with the right nostril using your left index finger on the pump. Then, pinch your nostrils together and gently massage them to distribute the medication evenly.
Frequently asked questions about Natesto
How to save using GoodRx
Natesto dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 11g of 5.5mg per actuation | 3 pumps | $165.00 | $55.00 |
Typical dosing for Natesto
The typical dose is 11 mg (2 pumps, 1 per nostril) applied into your nose 3 times a day.
How much does Natesto cost?
Natesto contraindications
Males with breast cancer or prostate cancer
Currently pregnant or breastfeeding
What are alternatives to Natesto?
Low testosterone (hypogonadism) in males
Delayed puberty in males
Metastatic breast cancer that have spread to the bones in females who've started menopause in the past 1 to 5 years
What is the latest news about Natesto?
Get savings updates for Natesto
Receive price alerts, news, and other messages from GoodRx about Natesto and other healthcare topics and relevant savings offers.By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx.
References
Best studies we foundAcerus Pharmaceuticals Corporation. (2022). Natesto nasal gel- testosterone gel, metered [package insert]. DailyMed.
Crosnoe, L. E., et al. (2013). Exogenous testosterone: A preventable cause of male infertility. Translational Andrology and Urology.
Gronski, M. A., et al. (2019). Efficacy of nasal testosterone gel (Natesto®) stratified by baseline endogenous testosterone levels. Journal of the Endocrine Society.
Lipshultz, L., et al. (n.d.). Clinical improvements in erectile function and mood in hypogonadal men treated with 4.5% nasal testosterone gel. American Urological Association.
Ramasamy, R., et al. (2020). Effect of Natesto on reproductive hormones, semen parameters and hypogonadal symptoms: A single center, open label, single arm trial. The Journal of Urology.
Rogol, A. D., et al. (2015). Natesto™, a novel testosterone nasal gel, normalizes androgen levels in hypogonadal men. Andrology.
Sizar, O., et al. (2024). Male hypogonadism. StatPearls.
Yamaguchi, A. V., et al. (2019). Testosterone replacement therapy and the risk of hypoglycemia. Case Reports in Endocrinology.
You and Your Hormones. (2020). Testosterone.
Browse medications
View AllResearch prescriptions and over-the-counter medications from A to Z, compare drug prices, and start saving.