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Overview: Topical testosterone is used to treat low testosterone levels in men caused by certain conditions. Common side effects include skin reactions where the medicine is applied, changes in certain lab test results, headache, high blood pressure, and mood swings. Serious side effects may include blood clots, liver damage, and an increased risk of prostate cancer. Topical testosterone comes in several forms, including a gel or liquid that is applied to the skin. It is important to avoid exposing other people to the medicine after you apply it.

Uses

What is topical testosterone used for?

Topical testosterone is commonly used to treat low testosterone levels in men caused by certain conditions, such as hypogonadism. 

Topical testosterone may also be used for other conditions as determined by your health care provider.

How does topical testosterone work (mechanism of action)?

Testosterone is a sex hormone that is made naturally in the body. Medicines that contain testosterone (also known as testosterone replacement therapy, or TRT) work by adding more testosterone to a person’s body to help them achieve normal levels. 

How is topical testosterone supplied (dosage forms)?

Brands and other names

  • AndroGel
  • Testim
  • Vogelxo

Example dosage forms and strengths

  • 12.5 mg/pump, 20.25 mg/pump metered-dose pump transdermal gel
  • 20.25 mg/1.25 g, 40.5 mg/2.5 g, 50 mg/5 g transdermal gel
  • 1%, 1.62% transdermal gel
  • 30 mg/pump topical solution

See also: Testosterone nasal and testosterone

How should I store topical testosterone?

Topical testosterone should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.

Side Effects

What are the most common side effects of topical testosterone?

The most common side effects of topical testosterone are listed below. These side effects may vary depending on the product you are using. Tell your health care provider if you have any of these side effects that bother you.

  • Skin reactions where the product is applied
  • Increased red blood cell levels (see below)
  • Increase in prostate-specific antigen (PSA) levels
  • Headache
  • Increased blood pressure (see below)
  • Mood swings
  • Diarrhea or vomiting

There may be other side effects of topical testosterone that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of topical testosterone?

While less common, the most serious side effects of topical testosterone are described below, along with what to do if they happen. Some of these side effects may vary based on the topical testosterone product you are using.

Severe Allergic Reactions. Topical testosterone may cause allergic reactions, which can be serious. Stop using topical testosterone and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Prostate Cancer. Topical testosterone may increase your risk of prostate cancer. Keep all appointments with your health care provider so they can monitor you while you are using topical testosterone.

Increased Red Blood Cell Levels. Topical testosterone may increase levels of red blood cells, also called erythrocytosis or polycythemia. This can increase hemoglobin levels in your blood. In severe cases, it may increase your risk for blood clots. Tell your health care provider right away if you have any of the following symptoms of erythrocytosis or polycythemia.

  • Blurred vision
  • Headaches
  • Confusion 
  • Itching 
  • Weakness or tiredness

Blood Clots. Topical testosterone may increase the risk of blood clots in your arteries or veins and could cause a stroke, heart attack, or venous thromboembolism, including a blood clot in the lungs (pulmonary embolism) or deep vein thrombosis (DVT). Stop using topical testosterone and get emergency help if you have any of the following signs of blood clots. 

  • Chest pain or pressure
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, jaw, throat, or arm
  • Sweating, upset stomach, vomiting, or dizziness
  • Sudden weakness on one side of your body
  • Sudden and severe headache
  • Slurred speech or trouble understanding speech
  • Pain, swelling, or tenderness in your arm or leg
  • Vision loss
  • Bulging eyes 
  • Double vision

Risk of Misuse. Misusing topical testosterone can lead to serious side effects, such as heart problems or mental health problems. Misuse means using a medicine in a way other than how it was prescribed or using too much. Use topical testosterone exactly as prescribed. Call your health care provider right away or go to the nearest emergency room if you have any of the following serious symptoms.

  • Chest pain or pressure or trouble breathing
  • Depression
  • Extreme energy and behavior (mania)
  • Having a hard time knowing what is real and what is imagined (delusions)
  • Feeling paranoid or aggressive

Decreased Sperm Count. Topical testosterone may lower your sperm count. Talk with your health care provider if this is a concern for you.

Liver Damage. Liver damage, also called hepatotoxicity, can happen when using topical testosterone. Call your health care provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Fluid Retention (Edema). Topical testosterone can cause fluid retention, also called edema. Fluid retention can cause serious issues in people with certain conditions, such as heart failure or kidney problems. Call your health care provider right away if you have any of the following symptoms. 

  • Chest pain
  • Irregular heartbeat
  • Shortness of breath
  • Stretched or shiny skin
  • Swollen body parts, such as the belly or ankles

Enlarged Breasts. Topical testosterone may cause enlarged breasts in men (gynecomastia) that could be painful. Tell your health care provider if you have this symptom or it is a concern for you.

Changes in Lipid Levels. Topical testosterone can cause changes in your lipid (fat) levels in your blood, including cholesterol. Keep all appointments with your health care provider to check your blood. 

Sleep Apnea. Topical testosterone may increase your risk of sleep apnea, which is a condition where breathing stops and starts again while sleeping. You may be at higher risk of sleep apnea if you have obesity or lung problems, such as asthma or chronic obstructive pulmonary disease (COPD). Tell your health care provider if you or your bed partner notices that you have symptoms such as snoring, sleepiness during the day, restless sleeping, or waking up suddenly after gasping or choking.

Increased Blood Pressure (Hypertension). Topical testosterone may increase your blood pressure or make it worse if you have a history of high blood pressure. This may increase your risk of a heart attack or stroke over time. Call your health care provider if your blood pressure increases while using this medicine.

If you measure your blood pressure and the top number (systolic) is 180 or higher or the bottom number (diastolic) is 120 or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for and tell your health care provider right away if you have any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea or vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heartbeats

Warnings & Precautions

Who should not use topical testosterone?

Allergies to Ingredients. People who are allergic to any of the following should not use topical testosterone.

  • AndroGel
  • Testim
  • Testosterone
  • Vogelxo
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific topical testosterone products they stock.

Certain Types of Cancer. Topical testosterone should not be used if you have or might have breast or prostate cancer.

Pregnancy. Do not use topical testosterone if you are pregnant or may become pregnant. If you become pregnant, contact your health care provider right away. See the Pregnancy section for more details.

Breastfeeding. Do not use topical testosterone if you are breastfeeding. You must either stop breastfeeding or stop topical testosterone. See the Breastfeeding section for more details.

What should I know about topical testosterone before using it?

Do not use topical testosterone unless it has been prescribed to you by a health care provider. Use it as prescribed.

Do not share topical testosterone with other people, even if they have the same condition as you. It may harm them.

Keep topical testosterone out of the reach of children. Topical testosterone is a controlled substance because it can be misused or lead to dependence. Store topical testosterone in a safe place to protect it from theft. It is illegal to sell or give away this medicine.

There are multiple forms of topical testosterone available. Read and closely follow the instructions for the product you have and make sure you understand how to prepare, use, and throw it away properly. If you have any questions, talk to your health care provider.

Depending on the topical testosterone product you are using, it should be applied to your shoulders, armpits, or parts of your upper arms that will be covered by a short-sleeved T-shirt. Do not apply topical testosterone to other areas not recommended in the product instructions, such as your stomach, penis, or scrotum. 

After applying topical testosterone, wash your hands well with soap and water right away. Allow the product to dry, then cover the area with clothing. Keep the area covered until you are ready to wash the medicine off.

Topical testosterone can be transferred to other people after you apply it. Women and children should avoid coming in contact with the area where you applied the medicine because of the risk of side effects. If a woman or child accidentally touches the area where you applied the medicine, they should wash their skin well with soap and water right away. If you expect to have any skin-to-skin contact with another person, wash the area where you applied topical testosterone well with soap and water to remove any medicine that may be left on your skin.

Topical testosterone products may be flammable until they dry. After applying topical testosterone, do not go near an open flame or smoke until the product dries. 

Keep all appointments with your health care provider, including for blood tests, blood pressure checks, and other tests, before starting and while you are using topical testosterone. This will help your health care provider make sure it is safe for you to use topical testosterone.

What should I tell my health care provider before using topical testosterone?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if topical testosterone is right for you.

In particular, make sure that you discuss any of the following.

Benign Prostatic Hyperplasia (BPH). Tell your health care provider if you have an enlarged prostate, or BPH. Topical testosterone can worsen symptoms of BPH or may increase the risk of prostate cancer. Tell your health care provider if you have any worsening prostate symptoms, such as having a hard time peeing or a weak flow, more frequent peeing, or having an urgent need to pee.

Other Current and Past Health Conditions. Tell your health care provider if you have any of the following.

Pregnancy. People who can become pregnant are not usually prescribed topical testosterone. Topical testosterone may cause harm to a fetus. If you are pregnant or may become pregnant, you should avoid contact with the area where topical testosterone has been applied.

Breastfeeding. People who can breastfeed are not usually prescribed topical testosterone. Topical testosterone may cause harm to a breastfed baby.

Other Medicines and Supplements. Topical testosterone may interact with other medicines and supplements. Before using topical testosterone, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Interactions

Does topical testosterone interact with foods or drinks?

There are no known interactions between topical testosterone and foods or drinks.

It is unknown if drinking alcohol will affect topical testosterone.

Does topical testosterone interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using topical testosterone.

  • Insulin, which is a medicine used for diabetes
  • A blood thinner, such as warfarin, which is a medicine used to treat or prevent blood clots
  • A corticosteroid, such as dexamethasone, methylprednisolone, or prednisone, which is a medicine for certain inflammatory conditions

This may not be a complete list of medicines that can interact with topical testosterone. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much topical testosterone?

If you or someone else has used too much topical testosterone, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of topical testosterone?

If you miss your dose of topical testosterone, apply it as soon as you remember. If it is almost time for your next dose, skip the missed dose and follow the original schedule.