Testosterone replacement: how gels are used and monitored

Testosterone replacement treats male hypogonadism, in which the testes do not make enough testosterone. The emc entry for Testogel says treatment is for when the deficiency is confirmed by both clinical features and biochemistry, which means symptoms alone are not sufficient: blood tests are required. Causes and other treatable contributors are considered first. This page does not recommend treatment for anyone, and a dedicated NHS patient page was not available when checked.

The emc entry describes a standard daily application of two pump actuations to clean, dry skin on the shoulders or upper arms, with possible adjustment by the prescriber up to a stated maximum based on blood testosterone levels. The gel is spread gently as a thin layer and left to dry for several minutes before dressing. Hands are washed afterwards and bathing is delayed for at least an hour.

A key warning is that testosterone gel can transfer to other people through close skin contact, causing unwanted masculinising effects in children or women. Wash hands after use, wash the application site before close contact, and keep treated skin covered when others might touch it. Keep gel away from children and pets, and tell the prescriber if a partner or child has unexpected hair growth or acne.

• Cover the application area with clothing after the gel dries.

• Wash hands thoroughly after each application.

The emc entry states clinicians should regularly check testosterone levels, haemoglobin or haematocrit because of a risk of too many red blood cells (polycythaemia), PSA and liver function, and recommends annual prostate examination. Treatment is adjusted according to the results, and your clinician explains what the readings mean for you.

Expect questions about how you feel, how and where you apply the gel, and whether anyone at home might have been exposed. Blood tests are interpreted alongside symptoms rather than on their own. Keep a note of the days you apply the gel and bring your results to appointments. If you plan to change the dose, skip applications or stop, discuss it first, because the clinician is working from monitored blood levels.

Testogel is contraindicated in known prostate cancer, breast cancer or hypersensitivity to testosterone.

The SmPC makes monitoring a standing part of treatment because testosterone can affect the blood count and the prostate. That is why a prescriber, rather than the person alone, decides continuation. Lifestyle and other contributing conditions are usually reviewed too, so treatment is only one part of the plan. Ask your clinician which results they are watching and how often they will be repeated, and make sure the practice has an up-to-date list of everything else you take, including supplements and anything bought from a pharmacy.

Tell your prescriber and pharmacist about every other medicine you take so that interactions can be checked. Do not use testosterone products obtained outside a regulated pharmacy; counterfeit and unlicensed supplies carry unknown contents and risks. Testosterone is prescription only. Suspected side effects can be reported through the Yellow Card scheme.