Testosterone gel is used to treat low testosterone in adult males. It's convenient to use because you only have to apply it to your skin once a day. But compared to other forms of testosterone, there's a higher risk of exposing others to the medication through skin-to-skin contact.
Low testosterone (hypogonadism)
Testosterone gel is a testosterone replacement that acts like the natural sex hormone. Testosterone is responsible for the development and maintenance of many male features. Testosterone gel works by adding or replacing testosterone in the body to normal and healthy levels.
Testosterone gel 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 factors: Unwashed or unclothed application sites
Testosterone gel can be transferred to other people through skin-to-skin contact with the site where the medication was applied. The risk of transfer is higher when the application site is unwashed or unclothed. Females and children should avoid contact with unwashed or unclothed application sites of those using testosterone gel because exposure can cause early symptoms of puberty in children and development of male features in females.
Children can experience enlargement of the penis or clitoris, development of pubic hair, more erections, higher sex drive, aggressive behavior, or faster bone aging. Females can experience deepening of the voice, acne, absence of menstrual periods, or more facial and body hair. If you're pregnant and expecting a baby girl, coming in contact with testosterone gel can cause your baby to develop male features. If you notice any of these symptoms, talk to your provider immediately as you might need to stop the medication temporarily until the cause is known.
Follow all application instructions carefully to prevent any accidental exposure from happening. After applying testosterone gel, wash your hands with soap and water right away. If skin-to-skin contact is expected, be sure to wash the application area thoroughly with soap and water to remove any medication. If another person accidentally touches the unwashed or unclothed area of your skin where the medication was applied, they should wash the area of contact with soap and water as soon as possible.
Testosterone gel can raise your red blood cell count, which can cause blood clots. Your provider might have you perform regular blood tests to check that your red blood cell count is in the normal range.
Testosterone gel itself can cause life-threatening blood clots in your legs or lungs. Symptoms of a blood clot in the legs include leg pain, swelling, or redness. Symptoms of a blood clot in the lungs include difficulty breathing or chest pain. Let your provider know if you have any of these symptoms and seek medical help right away as you might have to stop the medication.
Testosterone gel itself might cause heart attack, stroke, or sudden cardiac (heart-related) death. 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 factors: Taking more testosterone gel than prescribed | Taking testosterone gel with other medications containing testosterone
Testosterone gel is a controlled substance because it has a risk of misuse, dependency, and addiction. Misuse is when it's taken for medical reasons other than prescribed. Misusing testosterone gel can cause serious problems involving the heart and mental health, such as heart attack, heart failure, stroke, liver problems, depression, delusions, hallucinations, and aggression.
Continued misuse of testosterone gel can lead to addiction. Addiction can cause behaviors, such as taking a higher dose than prescribed, spending a lot of time trying to get the medication when there are problems with availability, having trouble stopping the medication even if you want to stop, prioritizing medication use over other responsibilities, and experiencing withdrawal symptoms if you stop taking the medication suddenly.
And finally, testosterone gel can cause dependency. Dependency is when you rely on the medication to function normally and have withdrawal symptoms (e.g., depression, trouble sleeping, lowered sex drive) when you lower the dose or stop the medication suddenly. Remember to take testosterone gel as prescribed to lower the risk of misuse, addiction, and dependency.
Risk factors: History of enlarged prostate
Taking testosterone gel can worsen certain symptoms in people with an enlarged prostate, or benign prostatic hyperplasia (BPH). Let your provider 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.
Testosterone gel may raise your risk of prostate cancer. Your provider might have you perform occasional blood tests and physical check-ups before and during treatment with testosterone gel. Testosterone gel isn't recommended if you have prostate cancer because it can worsen your cancer.
Using 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 testosterone gel 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 factors: History of heart, liver, or kidney conditions | Taking other medications that cause swelling like corticosteroids
Testosterone gel can cause your body to hold onto more salt and water, which can lead to swelling in your arms and legs 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 provider if you have any of these symptoms because you might need to stop the medication.
*Risk factors: History of sleep apnea | Obesity | History of lung disease *
Testosterone gel can worsen symptoms in people who have breathing problems in their sleep. This is more likely to happen to people who also have a history of obesity or lung disease. If you experience more daytime sleepiness or if your partner notices that you stop breathing in your sleep more often, talk to your provider.
Risk factors: History of cancer | Taking other medications that cause high calcium in the blood
Testosterone gel can cause high calcium in the blood, especially in people with cancer. High calcium levels can lead to symptoms such as muscle weakness, frequent urination, thirst, stomach pain, and blood in the urine. During treatment with testosterone gel, your provider might have you perform regular blood tests to make sure your calcium levels are within the normal range.
Source: DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Bloating or swelling of the face, arms, hands, lower legs, or feet
blurred vision
feeling faint, dizzy, or lightheaded
feeling of warmth or heat
flushing or redness of the skin, especially on the face and neck
frequent strong or increased urge to urinate
headache
nervousness
pain, redness, or swelling in the arm or leg
pounding in the ears
slow or fast heartbeat
sweating
swelling of the breasts or breast soreness in both females and males
tingling of the hands or feet
unusual weight gain or loss
waking to urinate at night
Incidence not known
Aggressive behavior
bluish lips or skin
decrease in testicle size
development of pubic hair
difficult or labored breathing
dizziness or lightheadedness
enlargement of the clitoris or penis
fainting
fast heartbeat
not breathing
pain, redness, or swelling in the arm or leg
painful or prolonged erection of the penis
tightness in the chest
troubled breathing
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Blemishes on the skin
burning, itching, redness, skin rash, swelling, or soreness at the application site
Less common
Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
crying
decreased interest in sexual intercourse
discoloration of the hair
false or unusual sense of well-being
inability to have or keep an erection
lack or loss of strength
loss in sexual ability, desire, drive, or performance
loss of memory
paranoia
problems with memory
quick to react or overreact emotionally
rapidly changing moods
thinning of the hair
Incidence not known
Increased in sexual ability, desire, drive, or performance
trouble sleeping
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Works well to replace testosterone in your body
Applied once a day to your skin, so it's easy to use
Available in tubes, packets, or as a pump
Some brand names are available as lower-cost generics
Can cause skin irritation
Need to avoid skin-to-skin transfer to other people
Need to wait hours before you can shower, swim, or bathe
Have to follow specific instructions on where and how it can be applied
Testosterone gel is available as different brand-name and generic medications, each with their own instructions. Before you start to use it, make sure you review the product's specific instructions.
Testosterone gel can spread to other people if they contact the area where the medication is applied (skin-to-skin contact). This can cause early symptoms of puberty in children (e.g., enlarged genitals, pubic hair) and development of male features in females (e.g., changes in body hair, acne). To prevent transfer to another person, wear clothes over the application site as soon as it's dry and wash your hands with soap and water right away after you apply the medication.
Testosterone gel shouldn't be used for bodybuilding or improving your athletic ability. Using testosterone gel for these purposes is considered misuse and can cause serious side effects such as heart attack, heart failure, stroke, depression, hallucinations, and delusions. This medication is FDA approved for the treatment of low testosterone in males only so take it exactly as prescribed by your provider.
Testosterone gel can cause growth, pain, or tenderness in the breast area. This might continue throughout treatment with testosterone gel. Let your provider know if this becomes bothersome.
Testosterone gel can lower your blood sugar. People with diabetes might need to monitor their blood sugar more often while taking this medication. Make sure you know how to recognize and treat low blood sugar. Talk to your provider if you have diabetes and are experiencing any symptoms of low blood sugar, including shakiness, sweating, fast heartbeat, and confusion because your provider might need to adjust your medications.
Testosterone gel can lower your sperm count, which might affect your ability to have a baby. This is more likely to happen if you're using higher doses of testosterone gel and there's a chance these effects can be permanent. Let your provider know if you're thinking of having a baby before you start testosterone gel.
Taking testosterone gel together with blood thinners like warfarin (Coumadin) might cause you to bleed more easily. Your provider might monitor your blood clotting time (INR) more often while taking this medication. Let your provider know if you experience bleeding that takes longer to stop, bruising, blood in your urine, or dark stools because your dose might need to be adjusted.
Testosterone gel is flammable, meaning it can easily catch on fire. Avoid fire, flames, or smoking until the application site has dried to protect yourself and others around you.
Throw away used testosterone gel tubes, packets, or pumps in the trash safely in a way that avoids accidental contact with other people, children, or pets.
The typical dose depends on the testosterone levels in your blood.
Testim, AndroGel 1%, AndroGel 1.62%, Fortesta, and Vogelxo contain different amounts of testosterone and have different administration instructions, so they are not interchangeable.
Testim: The typical starting dose is 50 mg applied once a day to the shoulders and/or upper arms. If needed, your provider might raise your dose up to the maximum dose of 100 mg once a day.
AndroGel 1%: The typical starting dose is 50 mg applied once a day in the morning to the shoulders, upper arms, and/or stomach area. If needed, your provider might raise your dose up to 100 mg once a day.
AndroGel 1.62%: The typical starting dose is 40.5 mg applied once a day in the morning to the shoulders and upper arms. If needed, your provider might adjust your dose depending on your testosterone levels. The maximum total dose is 81 mg once a day.
Fortesta: The typical starting dose is 40 mg applied once a day to the thighs in the morning. If needed, your provider might adjust your dose depending on your testosterone levels. The maximum total dose is 70 mg once a day.
Vogelxo: The typical starting dose is 50 mg applied once a day to the shoulders and/or upper arms. If needed, your provider might raise your dose up to the maximum dose of 100 mg once a day.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Males with breast cancer or prostate cancer
Women who are pregnant or breastfeeding
Low testosterone (hypogonadism)
Low testosterone levels in adult males (hypogonadism)
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