Can Testogel cause anxiety? Whilst anxiety is not specifically listed as a recognised side effect in the official product information, some men using this testosterone replacement therapy report mood changes including nervousness and irritability. Testogel is a transdermal gel licensed in the UK for treating male hypogonadism, delivering testosterone through the skin to restore hormone levels. Understanding the relationship between testosterone therapy and mental health is important for anyone considering or currently using this treatment. This article examines the evidence, explores why mood changes may occur, and provides guidance on managing anxiety symptoms whilst using Testogel safely under medical supervision.

What Is Testogel and How Does It Work?

Testogel is a transdermal testosterone replacement therapy (TRT) licensed in the UK for treating male hypogonadism—a condition where the testes produce insufficient testosterone. It is available as a clear, colourless gel containing testosterone in concentrations of 1% (sachets) or 1.62% (metered-dose pump). The 1% formulation is applied daily to clean, dry skin on the shoulders, upper arms, or abdomen, while the 1.62% formulation should only be applied to shoulders and upper arms. The gel allows testosterone to be absorbed through the skin into the bloodstream, providing relatively stable serum testosterone levels compared with injectable forms.

Once absorbed, testosterone binds to androgen receptors throughout the body, influencing numerous physiological processes. These include the maintenance of muscle mass and bone density, regulation of fat distribution, production of red blood cells, and support of sexual function. Testosterone also plays a role in mood regulation and cognitive function, though the mechanisms are complex and not fully understood. The gel formulation offers a steady delivery of hormone, avoiding the peaks and troughs associated with some injectable forms of TRT.

Testogel is prescribed following biochemical confirmation of low testosterone levels (typically two separate morning samples) alongside clinical symptoms such as reduced libido, fatigue, erectile dysfunction, or loss of muscle mass. Levels below 8 nmol/L are generally consistent with hypogonadism, while levels between 8-12 nmol/L are considered borderline and require clinical judgement. This MHRA-licensed medicine is intended for long-term use under medical supervision, with regular monitoring of testosterone levels, full blood count (haematocrit), prostate-specific antigen (PSA), and clinical response.

Testogel is contraindicated in men with known or suspected prostate or breast cancer and should be used with caution in those with severe lower urinary tract symptoms or untreated obstructive sleep apnoea. Patients must be counselled on proper application technique, thorough handwashing after application, and the importance of avoiding skin-to-skin contact with others, particularly women and children, until the application site is dry or covered.

Why Testosterone Replacement May Affect Mental Health

The relationship between testosterone and mental health is multifaceted and bidirectional. Testosterone influences neurotransmitter systems in the brain, including serotonin, dopamine, and gamma-aminobutyric acid (GABA), all of which play crucial roles in mood regulation and anxiety. When testosterone levels are corrected through replacement therapy, these neurochemical pathways may be affected, potentially leading to mood changes in some individuals.

While anxiety per se is not specifically listed in the Testogel Summary of Product Characteristics (SmPC), mood alterations including irritability, nervousness and depression are recognised as possible adverse reactions to testosterone therapy. Some men report increased irritability, mood swings, or anxiety-like symptoms when starting TRT, which may relate to the adjustment period as hormone levels stabilise. Conversely, untreated hypogonadism itself is associated with depression, anxiety, and reduced quality of life, and many men experience mood improvements with appropriate testosterone replacement.

Several factors may contribute to anxiety during Testogel use:

• Supraphysiological levels: Excessive testosterone absorption or inappropriate dosing may lead to levels above the normal range, potentially causing agitation, irritability, or anxiety-like symptoms.

• Oestrogen conversion: Testosterone is converted to oestradiol (oestrogen) via the enzyme aromatase. There is limited evidence that elevated oestrogen levels in men may influence mood, though this relationship is not fully established.

• Individual sensitivity: Genetic variations in androgen receptor sensitivity and neurotransmitter metabolism mean individuals respond differently to the same testosterone levels.

• Pre-existing conditions: Men with underlying anxiety disorders, untreated obstructive sleep apnoea, or a history of mood disturbances may be more susceptible to psychological effects during hormonal changes.

Regular monitoring of testosterone levels and clinical symptoms is essential to optimise dosing and minimise adverse psychological effects.

Managing Anxiety While Using Testogel

If you experience anxiety whilst using Testogel, several practical strategies can help manage symptoms whilst ensuring safe continuation of therapy. First and foremost, do not discontinue treatment abruptly without medical guidance, as sudden hormonal changes may worsen mood symptoms. Instead, schedule a review with your prescribing clinician to discuss your concerns and assess whether dose adjustment is appropriate.

Optimising your Testogel regimen may involve:

• Dose titration: Your doctor may reduce the daily dose temporarily to determine whether anxiety symptoms are dose-related. Testosterone levels should be measured according to the specific product guidance (timing varies between formulations).

• Application timing: Some men find that applying Testogel at a consistent time each day helps maintain stable hormone levels and reduces mood fluctuations.

• Monitoring biochemistry: Blood tests should include total testosterone (aiming for mid-normal range), full blood count (haematocrit), liver function tests, and PSA. Additional tests such as oestradiol or sex hormone-binding globulin (SHBG) may be performed if specifically indicated (e.g., gynaecomastia).

Lifestyle modifications can significantly support mental wellbeing during TRT:

• Regular physical activity: Exercise has proven anxiolytic effects and helps optimise body composition and testosterone utilisation.

• Sleep hygiene: Adequate sleep (7–9 hours) is crucial for hormonal balance and mood regulation.

• Stress management: Techniques such as mindfulness, cognitive behavioural strategies, or relaxation exercises can help manage anxiety symptoms.

• Limiting stimulants: Reducing caffeine and alcohol intake may decrease anxiety and improve sleep quality.

If anxiety persists, your doctor should assess for other contributing factors such as obstructive sleep apnoea (particularly if you snore heavily or experience daytime sleepiness), thyroid dysfunction, or substance use. Your GP may consider psychological support through NHS Talking Therapies or, in some cases, short-term anxiolytic medication. In cases of significant adverse effects, your clinician may temporarily pause therapy or seek endocrinology input.

When to Seek Medical Advice About Testogel Side Effects

Prompt medical review is essential if you experience significant or persistent side effects whilst using Testogel. Contact your GP or prescribing endocrinologist if anxiety symptoms are severe, worsening, or interfering with daily functioning, work, or relationships. Early intervention can prevent escalation and ensure appropriate management.

Seek emergency medical attention by calling 999 if you experience:

• Severe chest pain or pressure

• Signs of stroke (follow the FAST guidance: Face, Arms, Speech, Time to call 999)

• Severe breathlessness

Contact your GP on the same day or call NHS 111 if you experience:

• Severe mood changes: Including sudden onset of depression, suicidal thoughts, or marked personality changes.

• Panic attacks: Especially if these are new or significantly more frequent than before starting treatment.

• Physical symptoms accompanying anxiety: Such as palpitations, severe headaches, or visual disturbances, which may indicate other serious conditions requiring investigation.

• Signs of excessive testosterone: Including aggressive behaviour, severe irritability, persistent insomnia, or symptoms of polycythaemia (such as facial flushing, dizziness, or visual disturbances).

Routine monitoring appointments should occur at 3-6 months after starting Testogel or after dose changes, then at least annually thereafter, according to NICE Clinical Knowledge Summaries and specialist guidelines. However, do not wait for scheduled appointments if concerning symptoms develop. Your clinician should assess:

• Testosterone levels: To ensure you are within the mid-normal range for your local laboratory.

• Haematocrit and haemoglobin: If haematocrit exceeds 54%, dose reduction, temporary cessation, or venesection may be required.

• PSA and prostate examination: Particularly in men over 50 or those with risk factors.

• Liver function tests: To monitor for rare hepatic effects.

• Mental health screening: Using validated tools if mood symptoms are present.

Remember that Testogel is contraindicated in men with known or suspected prostate or breast cancer. Never source testosterone products from unregulated suppliers, as these may contain incorrect doses or contaminants that increase the risk of adverse effects. All testosterone therapy should be prescribed and monitored by a qualified healthcare professional. If you suspect an adverse reaction to Testogel, you can report it through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Frequently Asked Questions