Topical testosterone most commonly causes skin problems like itching or rash. In those with female anatomy, specifically, it can cause unwanted hair growth, acne, or birth defects in pregnant people.
In this article, we use “male and female” to refer to someone’s sex as determined by their chromosomes, and “men and women” when referring to their gender (unless quoting from sources using nonspecific language).
Sex is determined by chromosomes, and gender is a social construct that can vary between time periods and cultures. Both of these aspects are acknowledged to exist on a spectrum both historically and by modern scientific consensus.
Testosterone is a typically male hormone that’s mainly produced in the testicles. It helps the male body develop sex organs, sperm, and sex drive.
The hormone also helps maintain male features such as muscle strength and mass, facial and body hair, and a deepened voice. Your testosterone levels typically peak in early adulthood and slowly decrease with age.
Topical testosterone is a prescription drug that’s applied to your skin. It’s used to treat hypogonadism, a condition of having low testosterone that can be caused by Klinefelter’s syndrome, primary testicular failure, or undescended testicles among other conditions.
There are several different types of topical testosterone that are available. Here are some of the most common types:
Testosterone gels are applied directly to your skin, usually in the armpit, upper arm, shoulder, or inner-thigh areas. AndroGel is a common brand name for this medication.
While not as common as gel versions, testosterone creams may also be sold in specialty pharmacies. The application instructions are the same for both testosterone gels and creams. No matter which version you use, make sure it’s completely absorbed into your skin to reduce transfer to others.
Testosterone replacement therapy may also be applied to the skin via patch form. A new patch is applied daily to your arm, abdomen, back, or thigh. It’s recommended that you rotate the site of application to reduce possible skin irritation.
Topical testosterone is a treatment for hypogonadism that may occur with age. However, such products aren’t intended as a treatment for lower testosterone levels as a result of aging. The
While the data on the relationship between heart disease and testosterone replacement therapy is conflicting, prescription testosterone products
Additionally, topical testosterone may not be recommended for males with a history of urinary issues, or for those at high risk for prostate cancer. While testosterone is not known to cause prostate cancer, it may fuel its growth if already present.
You also shouldn’t use topical testosterone if you have:
While topical testosterone can be helpful to males with hypogonadism, it can also cause unexpected topical and hormonal side effects.
The most common side effects of topical testosterone are skin reactions. Because you apply topical testosterone directly to your skin, you may develop a reaction at the application site. Symptoms can include:
- dry skin
Make sure you always apply the medication on clean, unbroken skin. Follow the application directions on the package carefully and report any skin reactions to your doctor.
Topical testosterone can also affect your urinary tract and may worsen symptoms of benign prostatic hyperplasia (BPH). Some people may need to urinate more than usual, including during the night. You may feel an urgent need to urinate, even when your bladder isn’t full.
Other symptoms include trouble urinating and blood in the urine. If you’re using topical testosterone and have urinary trouble, talk with your doctor.
Hypogonadism can cause gynecomastia (enlarged breasts) in males. It’s rare, but the use of topical testosterone can bring on unwanted changes to the breasts. This is because your body changes some testosterone into a form of the hormone estrogen, which can result in your body forming more breast tissue. Changes to the breasts can include:
If you’re concerned about changes to your breasts while using topical testosterone, see your doctor right away.
Feeling out of sorts
Topical testosterone can leave you feeling a bit out of sorts. Symptoms aren’t common, but they can include feeling dizzy, lightheaded, or faint. Sometimes topical testosterone use can cause hot flashes or pounding sounds in the ears.
These symptoms may be fleeting and can disappear on their own. If they continue to be a problem, talk with your doctor.
Most males can tolerate testosterone treatment quite well, but a small number develop emotional side effects from the hormonal changes. These can include:
Although emotional side effects are rare, they can be serious. Be sure to discuss any symptoms with your doctor.
Testosterone plays a big role in a male’s sex drive. But in rare cases, topical testosterone can negatively affect your sex life. It may cause problems such as:
- loss of desire
- inability to get or maintain an erection
- erections that happen too often and last too long
Call your doctor if you have any of these symptoms and they bother you.
Transfer through touch
Topical testosterone can cause side effects in females and children who come in contact with it by touching your skin or clothing, so it’s best to let the applied medication try completely before coming in contact with others.
Children may develop aggressive behavior, enlarged genitals, and pubic hair. Females may develop unwanted hair growth or acne. Testosterone transfer is especially dangerous for pregnant people because it can cause birth defects.
To prevent these problems, don’t allow skin-to-skin contact of the treated area with other people. Keep the treated area covered or wash it well before letting others touch you. Also, don’t allow others to touch any bedding and clothing that may have absorbed testosterone from your skin.
Beyond these side effects, there may be additional, more serious risks from using topical testosterone.
Increased cardiovascular risk
The FDA has
Increased risk of prostate cancer
Risk of venous thromboembolism
Some people who take topical testosterone may also be at an increased risk of developing deep vein thrombosis (DVT) or pulmonary embolism (PE). See a doctor if you experience pain and warmth in your legs, or if you have unusual shortness of breath.
These medications are injected into your skin by a doctor about every 1 to 2 weeks, although long-acting treatments may be available that only require injections every 10 weeks.
Testosterone is also available via a nasal gel that’s pumped into each nostril 3 times daily. Aside from the most common side effects of testosterone therapy, some nasal gels may also cause nasal congestion or irritation.
Testosterone buccal tablets work via absorption in the gums. These are applied to your gums twice daily.
Another option involves the surgical placement of testosterone pellets under your skin. This procedure is repeated every 3 to 6 months.
If you’re experiencing possible symptoms of hypogonadism, it’s important to see a doctor for an exact diagnosis. Testosterone levels may decrease with age, but some of the associated symptoms, such as fatigue and weight gain, may also be related to other underlying health conditions.
Once a doctor prescribes topical testosterone, they will discuss the potential side effects of the medication with you before use. However, you should seek emergency medical help right away if you experience any of
- shortness of breath
- chest pain
- slurred speech
- pain or weakness on one side of your body
Are there long-term effects of topical testosterone?
Yes. Some of the long-term concerns associated with topical testosterone include an increased risk for cardiovascular disease and related events, such as heart attack and stroke. However, the evidence is mixed. A doctor can help you determine whether the potential benefits of topical testosterone outweigh the possible risks.
What drugs react with topical testosterone?
Topical testosterone may interact with corticosteroids, insulin, and oral anticoagulants. Tell your doctor if you take any of these types of medications before starting testosterone replacement therapy.
Can you get topical testosterone over the counter?
Topical testosterone is available by prescription only. While some over-the-counter (OTC) products may claim to increase testosterone levels, these don’t contain the same active ingredients. They may
Tell your doctor about any testosterone-promoting herbs or supplements you’re currently taking.
Topical testosterone is a powerful prescription drug that you should only use under your doctor’s supervision.
It may cause side effects other than the ones we’ve mentioned, so talk with your doctor if you have questions. Some side effects may clear up on their own, but some may require medical attention. Be sure to report any side effects to your doctor.
Also be sure to tell your doctor if you have any other health conditions, including:
- prostate cancer
- heart disease
Tell them about other OTC and prescription medications and supplements you’re taking and ask about any possible drug interactions.