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
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.
Side effects of Natesto
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
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%)
Less Common 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
Natesto serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- 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
The following Natesto 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
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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.
Common questions about Natesto
Natesto reaches the appropriate level in your body within 40 minutes after you apply a dose, so you might quickly start to see your symptoms improve. But, it might take longer to feel the full effect. Take the medication around the same time each day to keep your testosterone levels within normal levels.
In a clinical trial, 90% of people taking Natesto had normal testosterone levels within 3 months. In another study, people who took Natesto experienced symptom improvements in mood and erectile function after one month of treatment. Discuss with your prescriber if you have questions about how well this medication might work for you.
A bottle of Natesto has enough medication for 60 pumps. If you use 2 pumps for each dose (1 pump per nostril), then one bottle should last you about 10 days. Check with your pharmacist to make sure you have enough refills of the medication.
Both Natesto and AndroGel are testosterone gels used to treat people with low testosterone levels. The biggest difference is that Natesto is a nasal gel that's applied to the inside of the nose, whereas AndroGel is a topical testosterone applied to the skin. So, Natesto has a lower risk of accidental transfer and exposure to others compared to AndroGel. Talk to your prescriber about which medication is right for you.
Testosterone replacement medications, especially in large doses, typically lower sperm count, which might affect your fertility and make it harder to have a baby. But, some studies suggest that Natesto could help keep sperm counts normal while also bringing testosterone levels up to a normal range. Right now, Natesto is not approved by the FDA to treat fertility issues. If you have questions about this medication and fertility, talk to your reproductive endocrinologist.
Generally no, it's not recommended to use Natesto with other medications that are used in the nose because it's not known whether they interact. One exception is using Natesto with over-the-counter (OTC) nasal sprays that help to relieve stuffy nose, such as oxymetazoline (Afrin). Oxymetazoline (Afrin) doesn't affect the amount of Natesto that's absorbed in your body so you can use them together. Discuss with your prescriber or pharmacist each time you start a new medication to make sure you're using them safely.
No, Natesto shouldn't be used if you have nasal or sinus conditions, such as abnormal growths inside the nose or swelling of the sinuses. It's also not recommended if you've had nasal or sinus surgery or a broken nose in the past 6 months. Talk to your prescriber if you have or have had any sort of nasal conditions. You might require treatment with a different form of testosterone.
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Natesto dosage
Nasal gel pump| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 11g of 5.5mg per actuation | 3 pumps | $25.00 | $8.33 |
Typical dosage 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?
$25.00
Natesto contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Natesto will not be safe for you to take.
- Males with breast cancer or prostate cancer
- Currently pregnant or breastfeeding
What are alternatives to Natesto?
