How to Apply Testosterone Cream

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Testosterone topical cream (which is actually more gel-like) is used to treat people whose bodies don't make enough natural testosterone—a condition called hypogonadism—and as hormone replacement therapy (HRT) for transgender men and non-binary people. Testosterone is a hormone that triggers the growth and development of male sex organs and maintains masculine secondary sex characteristics, such as a deep voice, muscle mass, and a relatively hairy body. Testosterone cream/gel is available only via a doctor's prescription and precautions need to be taken while applying it.

Part 1
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Applying Testosterone Cream

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    Once your doctor has established that you’d benefit from testosterone gel, talk with them about what product (and strength) is most appropriate for you. Androgel and Fortesta are both available in individual packets and multi-dose pumps. [1] Vogelxo is available as individual packets, multi-dose pumps and tubes.
    • Prime the applicator before using it for the first time by holding it over a sink and pushing the pump until it releases full doses of gel. If you’re using an Androgel of Vogelxo, pump it three times. [2] If you’re using Fortesta, pump it 8 times. [3]
      • Wash the extra gel down the drain or prime the pump over a waste bin that pets and children can’t access.
    • Individual packets (AndroGel, Fortesta, and Vogelxo) are pre-portioned and don’t need any priming—you just tear the packet open.
    • If you’re using testosterone for gender-affirming care, talk to your doctor about what results you want from HRT. It can take longer for your secondary sex characteristics to develop with topical testosterone compared to injections.
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    Once you've primed the applicator, wash your hands and pump the prescribed amount of testosterone gel into your palm. [4] If you’re using individual foil packets or the Vogelxo single-unit tube, squeeze the entire contents into the palm of your hand or directly to the area your doctor recommended applying it. [5]
    • AndroGel is available in two dosage strengths: 1% and 1.62% concentrations. Both are applied to the skin, but in different amounts.
      • The recommended starting dose of AndroGel 1% is 50mg (4 pumps) applied once daily to your skin. [6] AndroGel 1.62% prescriptions start at 20.25 mg (1 pump) daily.
    • The strength of the gel and number of pumps you need are based on your base testosterone levels and how large a person you are.
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    Apply the testosterone cream/gel to clean, dry skin on your shoulders, upper arms, or abdomen (stomach) — unless your doctor recommends a different location. [7] In general, put the gel on areas that can be covered by clothes easily to prevent other people and animals from coming into contact with it. [8]
    • The stronger concentration of AndroGel (1.62%) is usually only applied to the shoulders and upper arms.
    • Fortesta gel/cream is typically applied to the front or inner skin of the thighs (upper legs).
    • Only apply Vogelxo gel/cream to your shoulders or upper arms—not your abdomen or stomach. [9]
    • Never apply Testosterone cream/gel to your genitals or skin that has cuts or scrapes.
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    Wash your hands with warm water and soap immediately after applying your cream. [10] Don’t touch anything or anyone else—while testosterone cream can be beneficial for people who need HRT, it can disrupt the hormone balance in people or animals who don’t.
    • If another person accidentally gets the gel on their skin, have them wash the area with soap and water as soon as possible.
    • If you have to have skin contact with someone, like during sex, thoroughly wash the area you applied the gel to beforehand.
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    After washing and drying your hands, put on clothes over the area with the gel. [11] Allow the testosterone cream/gel at least 10 minutes to absorb into your skin before putting on your clothes—this is for the protection of other people (and pets) more than anything else. [12]
    • Depending on the health and hydration of your skin, absorption can take less than 10 or up to 20 minutes.
    • Wear breathable cotton garments so your skin can keep absorbing testosterone after your clothes are on.
    • Keep dirty clothes, towels, and bed linens away from pets, children, and people who are pregnant or breastfeeding. [13]
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    After applying AndroGel 1.62%, Fortesta, or Vogelxo, wait at least two hours to shower, swim, or do any vigorous exercise. If you’re using AndroGel 1%, wait five hours. Getting your skin wet too soon can wash off the cream. [14]
    • Although the gel/cream may look like it's completely absorbed after 10 minutes, it actually takes longer for it to penetrate all the layers of your skin and reach your bloodstream.
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Part 2
Part 2 of 2:

Taking Precautions with Testosterone Cream

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    Schedule regular visits with your doctor (every few months or so) so they can check your progress, take blood samples, and see if the testosterone medication is working as expected. [15] If your serum testosterone levels are off your doctor can make changes to your dosage.
    • Signs and symptoms that your testosterone levels may be too low include low sex drive, trouble getting an erection, hair loss, lack of energy, loss of muscle mass, increase in body fat, and mood changes (depression).
    • It can take three to six months of daily application of testosterone gel to counteract hypogonadism—sometimes longer.
    • Don’t use this medicine if you’re treating the symptoms of a natural decline in testosterone due to aging. [16]
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    When not prescribed, testosterone can cause a hormonal imbalance and negative health effects. If someone is pregnant, it can cause birth defects in their fetus. It can trigger masculine secondary sex characteristics in women and over-stimulate the sexual development of children. [17]
    • Secondary sex characteristics include a deep voice and increased body hair growth.
    • Rubbing up against the skin of someone who's just applied the gel once or twice isn’t especially dangerous, but repeated exposure to testosterone can cause problems in other adults, fetuses, and children—as well as pets.
    • Have other people avoid touching anything that comes directly in contact with your skin, like clothes, towels, and sheets.
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    Applying testosterone cream to your skin for months or years increases the risk of negative side effects. You may experience bloating and swelling, acne, blurred vision, dizziness, flush, headaches, hair loss, sweating, or urinary tract problems. [18] Let your doctor know about new side effects immediately.
    • If you have a prostate you’re more likely to experience blood in your urine, difficulty urinating, or frequent urination.
    • If you have sleep apnea, testosterone cream could worsen your condition. Speak to your doctor about treatment with a CPAP machine.
    • People using testosterone cream are also at risk for deep vein thrombosis and pulmonary embolism due to the increased red blood cell count that results from testosterone therapy. Talk to your doctor if you want to be screened for this and keep an eye out for leg/calf pain or shortness of breath.
    • Taking testosterone medication typically causes your testicles to shrink due to atrophy (not working as hard producing natural testosterone). On the other hand, testosterone gel therapy can enlarge the penis or clitoris.
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Expert Q&A

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  • Question
    Where is the best place for testosterone cream?
    Scott Tobis, MD
    Board Certified Urologist
    Dr. Scott Tobis is a board certified Urologist. With more than seven years of experience, he specializes in treating patients for urologic conditions such as urologic cancers, prostate enlargement, vasectomy, kidney stones, frequent/urgent urination, erectile dysfunction, incontinence, and blood in the urine. Dr. Tobis holds a BS in Cellular and Developmental Biology from The University of California, Santa Barbara, and an MD from Dartmouth Medical School. He completed his internship in General Surgery and residency in Urologic Surgery at the University of Rochester School of Medicine and Dentistry and his fellowship in Urologic Oncology and Robotic Surgery at The City of Hope National Medical Center. Dr. Tobis is a diplomat of the American Board of Urology.
    Scott Tobis, MD
    Board Certified Urologist
    Expert Answer
    Generally, testosterone cream works best when placed on the upper arms and chest, after the skin has been cleaned and thoroughly dried first. These areas tend to have good absorption of the medication through the skin.
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      Tips

      • Store your testosterone gel in a closed container at room temperature away from any heat source, moisture, and direct light. Never freeze it.
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      • If your skin starts to get irritated and itchy from applying the testosterone gel, change locations. Make sure to clear it with your doctor first.
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      • Switch the sides you put the gel on. For example, alternate days putting the testosterone on your right and left shoulders.
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      Warnings

      • Testosterone gel is flammable until it dries on your skin, so don't apply it near heat, open flames, or while smoking.
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      References

      1. ↑ https://my.clevelandclinic.org/health/drugs/18661-testosterone-skin-gel
      2. ↑ https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=2dd150f6-cdfd-4d51-8888-12b288f26262
      3. ↑ https://www.accessdata.fda.gov/drugsatfda_docs/nda/2010/021463orig1s000lbl.pdf
      4. ↑ https://my.clevelandclinic.org/health/drugs/18661-testosterone-skin-gel
      5. ↑ https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=2dd150f6-cdfd-4d51-8888-12b288f26262
      6. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182226/
      7. ↑ Scott Tobis, MD. Board Certified Urologist. Expert Interview. 26 August 2021.
      8. ↑ Scott Tobis, MD. Board Certified Urologist. Expert Interview. 26 August 2021.
      9. ↑ https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=2dd150f6-cdfd-4d51-8888-12b288f26262
      1. ↑ Scott Tobis, MD. Board Certified Urologist. Expert Interview. 26 August 2021.
      2. ↑ https://www.nlm.nih.gov/medlineplus/druginfo/meds/a605020.html
      3. ↑ Scott Tobis, MD. Board Certified Urologist. Expert Interview. 26 August 2021.
      4. ↑ https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=2dd150f6-cdfd-4d51-8888-12b288f26262
      5. ↑ https://pubmed.ncbi.nlm.nih.gov/21361734/
      6. ↑ https://www.nih.gov/news-events/nih-research-matters/understanding-how-testosterone-affects-men
      7. ↑ https://www.nlm.nih.gov/medlineplus/druginfo/meds/a605020.html
      8. ↑ https://www.nih.gov/news-events/nih-research-matters/understanding-how-testosterone-affects-men
      9. ↑ https://my.clevelandclinic.org/health/diseases/15603-low-testosterone-male-hypogonadism

      About This Article

      Article Summary X

      If your body has stopped making enough testosterone naturally, there are creams and gels that your doctor can prescribe to quickly and easily remedy the situation. When your doctor prescribes testosterone cream, you’ll want to learn how to apply it properly to maximize the effects. If you’re using a pump for the first time, prime it by pushing the pump all the way down a few times before measuring out your dose. Then, apply the cream or gel to clean, dry skin somewhere on your shoulders, upper arms, inner thighs, or stomach. As soon as you finish applying it, wash your hands to avoid transferring the hormone to anyone else. Allow the cream or gel to absorb into your skin for at least 10 minutes before getting dressed, and try to avoid showering for 2 hours after an application. For more tips from our Medical co-author, including how to recognize negative side effects of testosterone therapy, keep reading!

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