Testosterone (Topical)

Topical testosterone is a cream, gel or other solution applied to the skin to increase a person's testosterone levels.

Overview

Testosterone is an androgenic hormone that is produced naturally in the body in both sexes, although in much higher quantities in men than in women. Testosterone contributes to the development and functioning of the male sex organs and reproductive organs and promotes typically male body characteristics such as increased muscle mass and body hair.

Topical testosterone is given to people whose bodies do not produce enough testosterone naturally. This can result in improvements in:

  • Body composition (increased muscle mass relative to body fat)
  • Bone density
  • Cognition (some age-related cognitive deficiencies may be reversed)
  • Erythropoiesis (formation of red blood cells)
  • Libido
  • Mood and feelings of well-being
  • Overall quality of life
  • Reduced risk of cardiovascular disease
  • Sexual function

Although testosterone exists in much higher quantities in males, the hormone is present in both men and women, and low testosterone can cause issues in either sex. Testosterone is occasionally prescribed to women, but it is far more commonly prescribed to men.

Topical testosterone is administered on to the body through a gel or cream, usually in the morning, and absorbs through the skin gradually into the bloodstream. This creates a slow release of the hormone throughout the day. There are several other delivery methods for testosterone, including intramuscular injections and tablets, but topical testosterone products are often preferred. This is because they allow patients to avoid the use of needles and because oral testosterone passes through the liver, which can not only cause complications to this organ, but the liver can also deactivate testosterone as it passes through, making this an inefficient delivery method.

Because topical testosterone delivers an external hormone into your body, it does not cure the condition of low testosterone levels. If you stop taking the medication, the symptoms of low testosterone will return.

Topical testosterone can be transferred to other people if they come into contact with the area of skin to which it has been applied. If you use these products, you should take care that no one else comes into contact with the product.

Some of the more common brand names of topical testosterone products are Androgel, Axiron, First-Testosterone, First-Testosterone MC, Fortesta, Testim and Vogelxo.

Conditions Treated

  • Low testosterone
  • Hypogonadism

Type of Medicine

  • Androgenic hormone

Side Effects

Topical testosterone products may cause some side effects. The more common side effects that people experience are listed below.

  • Skin Irritation
  • Skin irritation is the most common side effect of topical testosterone, affecting up to 37% of patients. You may experience the following symptoms in the location that you apply the medication:
  • Burning sensations
  • Hard skin
  • Itching
  • Redness

If this is the case, consult your doctor. Topical testosterone comes in several different formats, such as gels, creams, and patches. Your doctor may switch you to a different topical product, or a different form of delivery altogether. Alternatively, you may be prescribed another topical product to calm the irritation so that you can continue using your topical testosterone.

More Serious Side Effects

If you experience any of the side effects on the list below, stop taking your medication and contact your doctor immediately:

  • Coughing fits, wheezing, coughing blood
  • Difficulty breathing
  • Difficulty or pain when urinating
  • Liver problems, including nausea, stomach pain, lack of appetite, a dark color to the urine
  • Loss of bladder control
  • Pain in the jaw or shoulders
  • Pain or sensation of pressure in the chest
  • Pain or swelling in the breasts/pectoral area
  • Pain or swelling in one or both legs
  • Rapid increase in weight
  • Very frequent urination
  • Effect On Male Fertility

Topical testosterone products may decrease sperm count in males, particularly when higher doses are taken. If you are trying to have children when you are prescribed testosterone, discuss this with your doctor who will explain your options.

Other Side Effects

Some other less serious side effects are common. Consult your doctor if you experience any of the following symptoms:

  • Acne
  • Blurred vision
  • Changes in your mood
  • Irritation in the mouth or gums
  • Flushed skin
  • Frequent or prolonged erections
  • Headaches
  • High blood pressure
  • Minor dizziness
  • Muscle pain
  • Ringing or pounding in the ears
  • Unusual dreams
  • Allergic Reactions

Allergic reactions to topical testosterone products are very rare, given that it is a hormone that occurs naturally in the body. However, there are other ingredients in the gels, creams and other solutions that you may be allergic to. If you notice any symptoms of an allergic reaction, seek emergency medical care immediately. Such symptoms include:

  • Any problems with your breathing, including wheezing or hoarseness
  • Drowsiness, dizziness, and feeling uncoordinated
  • Skin reactions like redness, hives, or itching
  • Swelling, especially when located in the throat, face, or the tongue

Every individual's response to a drug is unique and you may experience side effects that are not listed here. Pay attention to your body and how you feel while you are taking topical testosterone. If you notice any unusual side effects, consult your doctor or pharmacist for advice. You may be able to take another drug to counter the side effects, or your dosage of the medication may be altered.

Dosage

The various topical testosterone products are all dosed differently, and you will receive a dose that based on factors such as the severity of your condition, your sex, and your age. However, the typical doses for topical testosterone products are as follows:

  • Gel: 5 grams daily, with each dose usually coming in individual packets
  • Transdermal gel: four pumps of the multi-use bottle

Each of the above would deliver a starting dose of around 40-60 mg of testosterone per day. Lower doses are prescribed to women.

Your doctor may want to conduct blood tests fairly regularly after you start taking topical testosterone to see how the medication is affecting your blood testosterone levels. Ensure you keep these appointments -- depending on your response to the medication as indicated by these tests, your doctor may want to adjust your dose of testosterone. The maximum dose that is usually prescribed is 100 mg per day.

Because the dose of testosterone you take needs to be precise, topical testosterone products usually come in single-use packets containing a given dose of testosterone. Some may come with a multiple-use pump like a hand wash bottle, where each full pump delivers a set amount of testosterone. Your doctor will advise you on how many packets or pumps you need to use in order to receive your prescribed dose.

Different testosterone products are designed to be applied to different areas of the body, and there are some that should not be applied to the back, chest or stomach. Ask your doctor where you should apply your medication.

You will usually be advised to apply your topical testosterone in the morning, so that you will see increased testosterone levels throughout the day. Be sure to apply the product after you have showered or bathed, and that you are completely dry. Otherwise, you may not receive the dose you were intending to take.

If you miss a dose, apply the next one as soon as you can. However, if it will soon be time to take your next dose, just skip the missed dose and continue your schedule as normal. Do not double your next dose, as this can raise your testosterone levels to levels that may cause undesired side effects.

Interactions

Topical testosterone products may react with other medications that you are taking, causing undesired or dangerous side effects. You should always discuss any other medication, herbal supplements or vitamin products that you are taking with your doctor before you proceed to use topical testosterone. The drugs listed below are of particular concern:

Corticosteroids -- Corticosteroids, when taken alongside topical testosterone, can cause you to retain more fluid than you normally would. This may lead you to feel bloated, and in some people fluid retention can be dangerous. Note that if you experience skin irritation through the use of topical testosterone, you should consult your doctor for advice rather than purchase an over the counter product, as many such products contain corticosteroids.

Cyclosporine -- Cyclosporine can increase your risk of liver damage, and this risk may be increased when cyclosporine is taken at the same time as testosterone. Testosterone may also enhance the effect of cyclosporine in your body. You should not take these two drugs together unless advised to do so by your doctor, who will likely want to monitor you more closely to make sure that side effects can be managed.

Insulin -- Topical testosterone may reduce your blood sugar levels, meaning that you dose of insulin may need to be adjusted to compensate for this. If you are diabetic and taking insulin, you should monitor your blood sugar levels closely while taking topical testosterone.

Licorice -- Although licorice is known to many people as a candy product or an ingredient in processed foods, it is also commonly consumed as a herbal supplement. There is some evidence to suggest that licorice lowers testosterone levels in healthy adults, therefore your doctor may advise you to avoid licorice while you are taking topical testosterone.

Warfarin -- this is a drug that prevents clotting in the blood. Testosterone can drastically enhance the effects of warfarin in the body, such that your dose of warfarin may need to be reduced while you are taking testosterone -- in some cases by as much as 80%. Otherwise, you are at risk of dangerous bleeding if you receive a cut because the blood will not be able to clot over the wound. The same applies to any other anticoagulant medication.

Warnings

Contraindicated Conditions

Topical testosterone can be harmful if taken by people with certain existing medical conditions. The main conditions of concern are listed below, however, you should discuss with your doctor any other conditions that you may have before you take topical testosterone products.

Breast cancer: Some studies have shown that higher blood levels of testosterone can increase the risk of breast cancer in both premenopausal and postmenopausal women. If you have or are at risk of developing breast cancer (for example if you have a family history of the disease), you may be advised not to take testosterone.

Enlarged prostate: topical testosterone products may cause growth in the prostate, and this is a concern if you already have an enlarged prostate, also referred to as benign prostate enlargement (BPE) or benign prostate hyperplasia (BPH).

Prostate cancer: The research looking at the effects of testosterone supplementation on the risk of prostate cancer is somewhat controversial and the evidence is not completely clear. However, to avoid unnecessary risk, you may be advised not to take testosterone if you have or are at risk of prostate cancer.

There are other conditions for which you may still be able to use topical testosterone products, but your doctor may wish to adjust the dose or see you for more frequent checkups. These include:

  • Blood clots
  • Diabetes
  • Heart problems
  • High levels of calcium in the blood
  • Kidney problems
  • Liver problems
  • Lung disease
  • Sleep apnea

Avoid Transferring the Medication to Others

Topical testosterone products can transfer to other people if they touch your skin in the areas in which you have applied the products. Testosterone is not safe to be used by everyone, and can potentially be harmful to some individuals.

Children (of either sex) are at particular risk of harmful or undesired effects if their testosterone levels become too high. Testosterone levels increase naturally during adolescence and are one of the signals that causes the bones to mature. If testosterone levels are raised prematurely in children, the bones may stop growing and the child may not grow to the height they otherwise would. If the bones mature early, this may be irreversible, even if their testosterone levels fall back to a normal range. Consult your doctor if you notice any of the following symptoms in your child, as they may indicate that they have come into contact with testosterone products:

  • Aggressive behavior
  • Enlarged genitals
  • Increased frequency of erections
  • Increased sexual desire
  • Pubic hair growth

Raised testosterone levels can also be harmful to women. Symptoms of increased testosterone in women include hair growth in unusual locations, or an outbreak of acne. High testosterone levels in pregnant or breastfeeding women are of particular concern because this can pass to the baby, which is potentially harmful to the baby and its development.

You should therefore ensure that other people do not touch your skin in the locations to which you have applied the testosterone. Apply the gel or solution in an area of your body that will be completely covered by clothing, but wait for the solution to dry completely before you put your clothing on, otherwise the testosterone may absorb into your clothing. After you have finished applying the testosterone, wash your hands carefully using soap and water, to ensure that no solution remains on your hands. This will help prevent you from passing the medication on to other people.

Application

Your doctor will advise you on the best locations to apply your topical testosterone. Do not apply any topical testosterone products to genitals, or to any area of skin that has any cuts, bruises or other sores as the product may cause pain or irritation to these areas.

You should also avoid getting the product in your eyes as this can cause discomfort and irritation. If you do get the product into your eyes, wash them with warm clean water. If the irritation continues, contact your doctor.

Some topical testosterone products are flammable. Do not smoke while you are applying the product, and stay well clear of open flames until the product has completely dried.

Continued Usage is Advised

You must continue to take this medication even if your condition improves. As an external hormone administered to your body, topical testosterone will relieve your symptoms but will not cure the underlying condition, which is to say, it will not cause your body to produce more testosterone naturally.

Use Only the Prescribed Dose

You should only use testosterone as prescribed to do so by your doctor. Some serious side effects can occur in some individuals when they take higher doses of testosterone, including:

There are also risks if you take higher doses of testosterone and then abruptly stop taking it, because when you take external testosterone your body reduces or stops its natural production of the hormone. It can take some time before your body returns to its previous level of testosterone production. This can cause problems such as:

If you are asked to stop taking testosterone, you may be asked to reduce the dose gradually over a period of time, or you may be given other drugs to take afterward.

Storage

In order to ensure the potency and safety of your medication, observe the following guidelines for storage:

Avoid heat: Store the medication well away from sources of heat. Do not store the medication near to heaters, radiators, or the stove. Although the bathroom is a common place used to store medicines, this is usually not suitable as the heat from the shower may damage your medication. Your vehicle's glove compartment may also be too hot to safely store medication.

Avoid sunlight: Do not store your medication in a place where it will be exposed to direct sunlight.

Avoid moisture: You should store your topical testosterone in a dry location. Your bathroom is normally too humid to serve as a suitable place to store medication.

Store in a safe location: Topical testosterone can be dangerous when used by children. Ensure that your medication is stored in a high place that children cannot access, and out of their line of sight. You should also ideally store the medication in child-safe containers.

Check the medication before use: If the medication has become damaged, it may not provide the correct dose, or it may produce other unwanted side effects. Do not use your medication if you notice a change in its color, odor, or if it is passed its expiration date.

Safe disposal: If your medication has become damaged or spoiled, or if you have finished your course of treatment and have medication left over, dispose of it safely. Do not flush it down the toilet. Instead, ask your doctor or pharmacist how to safely dispose of topical testosterone products. There may be a "take-back"program through which you can return the medication.

Summary

Testosterone is an androgenic hormone that occurs naturally in both sexes, although it is present is much higher quantities in males. The hormone contributes to the proper functioning of many physical and mental functions, and low levels of testosterone can lead to a range of medical conditions, such as low libido, low energy levels, and depression.

People who don't produce enough testosterone naturally are often prescribed testosterone products. There are several different delivery methods for testosterone, but topical products are easier to administer than injection, and more efficient than tablets, so they are usually the preferred choice -- although skin irritation problems are common around the area that the products are applied. It's also important to ensure the hormone doesn't pass to other people through skin-to-skin contact.

There is some evidence that testosterone is dangerous when taken by people with breast cancer, prostate cancer, or benign prostate hypertrophy. Although the research is not conclusive, people with these conditions are usually advised not to take testosterone, or they may be closely monitored during the course of the treatment. Testosterone products may also cause complications when taken by people with certain other conditions -- it's important to discuss any conditions you have with your doctor before taking testosterone.

There are some other medications that may cause complications if taken at the same time as topical testosterone. These include corticosteroids such as hydrocortisone, anticoagulants such as warfarin, and insulin. Always discuss any other medication that you are taking with your doctor before you use topical testosterone.

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Last Reviewed:
December 25, 2017
Last Updated:
April 03, 2018
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