provider image
Welcome! You’re in GoodRx for healthcare professionals. Now, you’ll enjoy a streamlined experience created specifically for healthcare professionals.
Skip to main content

Natesto

testosterone nasal gel
Used for Testosterone Replacement
Used for Testosterone Replacement

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.

Last reviewed on July 24, 2024
Natesto is a controlled substance, which means that it's more likely to be misused or cause dependence. There are federal and state laws that limit the amount of medication that can be prescribed or dispensed within a certain period of time.
basics-icon

What is Natesto?

What is Natesto used for?

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.

Are you looking for information on testosterone gel instead?

Drug Facts

Common BrandsNatesto
Drug ClassTestosterone replacement
Controlled Substance ClassificationSchedule III
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
coupon-save-icon

Get your GoodRx coupon

Avg retail price
$1086.68(save 84.82%)
Manufacturer exclusive discount
$165.00
See prices
warings-icon

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.

risk-warning

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-warning

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.

    risk-warning

    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.

      risk-warning

      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.

        risk-warning

        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.

        risk-warning

        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.

          risk-warning

          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.

            risk-warning

            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.

              basics-icon

              What are the 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%)

              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

              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

              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 attackpain 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

              Pros and cons of Natesto

              thumbs-up

              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

              thumbs-down

              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

              Pharmacist tips for Natesto

              pharmacist
              • 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.

                    • 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

                          • 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.

                                    faqs

                                    Frequently asked questions about Natesto

                                    How long does it take Natesto to work?
                                    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.
                                    How effective is Natesto?
                                    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.
                                    How many pumps is in a Natesto bottle?
                                    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.
                                    What's the difference between Natesto and AndroGel?
                                    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.
                                    Can you take Natesto for fertility?
                                    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.
                                    Can you use Natesto with other nasal medications?
                                    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.
                                    Can you use Natesto if you have nasal problems or changes to your nose structure?
                                    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.
                                    GoodRxEducationalIcon

                                    How to save using GoodRx

                                    Compare Prices
                                    1. Compare PricesSpecify your dosage and quantity to find out exactly how much you can save.
                                    Select your free coupon
                                    2. Select your free couponYou can use the displayed coupon, or compare prices at other pharmacies near you.
                                    Show coupon to your pharmacist
                                    3. Show coupon to your pharmacistPresent your printed or electronic coupon when you pick up your prescription.
                                    Get free couponLearn more
                                    dosage

                                    Natesto dosage forms

                                    The average cost for 3 pumps of 11g of 5.5mg per actuation of Natesto is $165.00 with a free GoodRx coupon. This is 84.82% off the average retail price of $1086.68.
                                    nasal gel pump
                                    Nasal gel pump
                                    DosageQuantityPrice as low asPrice per unit
                                    11g of 5.5mg per actuation3 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.

                                    drug-cost

                                    How much does Natesto cost?

                                    To access savings, use a GoodRx coupon and pay just a fraction of the retail price.View prices & coupons
                                    contraindications-icon

                                    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

                                    alternatives

                                    What are alternatives to Natesto?

                                    There are a number of medications that your doctor can prescribe in place of Natesto. Compare a few possible alternatives below.
                                    Natesto
                                    Used for:
                                    $165.00 Lowest GoodRx priceView Prices
                                    Used for:
                                    • Low testosterone (hypogonadism)

                                    $47.35 Lowest GoodRx priceView Prices
                                    Used for:
                                    $32.44 Lowest GoodRx priceView Prices

                                    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 found

                                    Acerus 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.

                                    View All References (6)

                                    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.

                                    GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
                                    Was this page helpful?

                                    Browse medications

                                    View All

                                    Research prescriptions and over-the-counter medications from A to Z, compare drug prices, and start saving.