Testogel is a testosterone replacement therapy prescribed for male hypogonadism, a condition where the body produces insufficient testosterone. Some patients wonder whether being on Testogel can increase gay thoughts or alter sexual orientation. This concern reflects understandable questions about how hormones influence sexuality and identity. However, scientific evidence consistently demonstrates that testosterone therapy does not change, create, or influence sexual orientation. Sexual orientation develops through complex biological and psychological factors early in life and remains stable in adulthood. Whilst Testogel can restore libido and sexual function in men with low testosterone, it does not alter the fundamental nature of sexual attraction.

Understanding Testogel and How Testosterone Therapy Works

Testogel is a transdermal testosterone replacement therapy (TRT) licensed in the UK for treating male hypogonadism—a condition where the testes produce insufficient testosterone. The gel contains testosterone as the active pharmaceutical ingredient and is applied daily to clean, dry skin. Application sites vary by product formulation—typically shoulders and upper arms for all preparations, with abdomen suitable for some formulations but not others (check your specific product leaflet for guidance). After application, testosterone is absorbed through the skin into the bloodstream, where it supplements the body's natural hormone levels.

The mechanism of action involves testosterone binding to androgen receptors throughout the body, influencing numerous physiological processes. These include maintaining muscle mass and bone density, regulating fat distribution, supporting red blood cell production, and contributing to libido and sexual function. In men with clinically low testosterone, TRT aims to restore levels to the normal physiological range, thereby alleviating symptoms such as fatigue, reduced libido, erectile dysfunction, and mood disturbances.

Diagnosis and initiation of Testogel therapy typically requires at least two separate early-morning (ideally fasting) blood tests confirming low testosterone levels, alongside relevant clinical symptoms. Levels below 8 nmol/L are generally consistent with deficiency, while 8-12 nmol/L may be considered borderline when accompanied by symptoms. Treatment is typically initiated and monitored by endocrinologists or specialist GPs, with regular follow-up to assess symptom improvement and monitor for potential adverse effects.

Important safety considerations include preventing gel transfer to others (particularly women and children) by washing hands after application, allowing the gel to dry completely, and covering application sites with clothing. Never apply the gel to genital areas. TRT can significantly suppress sperm production and fertility, which should be discussed before starting treatment. Contraindications include known or suspected prostate or breast cancer, and caution is needed with certain cardiac, hepatic, or renal conditions. Regular monitoring of testosterone levels, full blood count (particularly haematocrit), and prostate-specific antigen (PSA) is essential for safe treatment.

Does Testosterone Treatment Affect Sexual Orientation?

There is no scientific evidence that testosterone replacement therapy, including Testogel, can change, influence, or create sexual orientation. Sexual orientation—whether heterosexual, homosexual, bisexual, or otherwise—is a complex aspect of human identity that develops through a combination of biological, psychological, and social factors during early development. Current scientific consensus, supported by research from major medical and psychological organisations including the Royal College of Psychiatrists and the British Psychological Society, indicates that sexual orientation is established early in life and remains largely stable throughout adulthood.

Testosterone and sexual function are related but distinct from sexual orientation. Whilst testosterone plays a role in libido (sexual desire) and sexual function in both men and women, it does not determine the gender(s) to which an individual is attracted. Men with low testosterone may experience reduced sexual desire overall, and TRT may restore this drive to normal levels. However, restoring testosterone does not alter the fundamental nature of sexual attraction or orientation.

Some patients beginning TRT may experience increased awareness of their sexuality as libido improves. This heightened sexual interest reflects the restoration of normal physiological function rather than a change in orientation. If someone notices thoughts or feelings about their sexuality whilst on treatment, this typically represents either pre-existing aspects of their identity becoming more apparent, or increased general sexual awareness due to improved hormonal balance.

Clinical studies examining testosterone therapy have never demonstrated changes in sexual orientation as an outcome. The MHRA, which regulates medicines in the UK, does not list changes in sexual orientation among the known effects of testosterone products in their Summary of Product Characteristics. Any concerns about sexuality or identity warrant supportive discussion with healthcare professionals, but these should not be attributed to the medication itself.

Common Psychological Effects of Testosterone Replacement

Testosterone replacement therapy can produce genuine psychological effects that patients should understand as part of informed treatment. Many men with hypogonadism report improvements in mood, energy levels, and overall sense of wellbeing once testosterone levels are normalised. Research indicates that low testosterone is associated with increased rates of depression, irritability, and reduced cognitive function, and TRT may help alleviate these symptoms in appropriately selected patients.

Mood and emotional regulation often improve during the first 3–6 months of treatment. Patients frequently report feeling more motivated, experiencing better concentration, and having improved emotional stability. However, these effects vary considerably between individuals. Some men may experience mood swings, particularly during the initial adjustment period as the body adapts to changing hormone levels. In rare cases, excessive testosterone levels (if dosing is too high) can contribute to irritability or aggressive feelings, which is why monitoring is essential.

Libido and sexual confidence typically increase with TRT, which can affect how patients perceive themselves and their relationships. This renewed sexual interest is a restoration of normal function rather than an abnormal effect. Some patients report increased self-confidence and assertiveness, which may influence social interactions and self-perception more broadly. These changes reflect the wide-ranging effects of testosterone on brain function and should be understood as part of the treatment's intended therapeutic action.

Anxiety about treatment effects is not uncommon, and patients may attribute various thoughts or feelings to their medication. It is important to distinguish between actual pharmacological effects and coincidental psychological experiences. If you experience concerning mood changes, increased aggression, significant anxiety, or thoughts that distress you, these warrant discussion with your prescribing clinician. Measuring your testosterone levels and haematocrit is advisable if significant mood changes occur, as adjusting the dose to ensure levels remain within the physiological range may help. Those with pre-existing mental health conditions should be monitored particularly carefully, with coordination between endocrine and mental health teams where appropriate.

If you experience thoughts of self-harm or suicide, seek urgent help by calling 999 in an emergency, contacting NHS 111, your local urgent mental health helpline, or the Samaritans (116 123) for 24/7 support.

When to Speak with Your GP About Treatment Concerns

Open communication with your healthcare provider is essential for safe and effective testosterone replacement therapy. You should contact your GP or prescribing specialist if you experience any unexpected psychological or emotional changes during treatment, including persistent mood disturbances, anxiety, depression, or any thoughts that cause you distress or concern. These conversations are confidential, and healthcare professionals are trained to discuss sensitive topics without judgement.

Specific reasons to seek medical advice include:

• Significant mood swings, irritability, or aggressive feelings that affect daily life or relationships

• Symptoms of depression, including persistent low mood, loss of interest in activities, or thoughts of self-harm

• Anxiety or intrusive thoughts that are new or worsening since starting treatment

• Any concerns about your sexual health, function, or feelings about your sexuality

• Physical side effects such as skin reactions, breast tenderness, difficulty urinating, or unexplained swelling

• Symptoms suggesting excessive testosterone levels, including acne, oily skin, or increased body hair growth

Regular monitoring is a standard part of TRT management. Your clinician will typically check testosterone levels, full blood count (particularly haematocrit, with consideration of dose reduction if above 0.54), liver function, and prostate-specific antigen (PSA) at intervals determined by your individual circumstances. Abnormal findings may require specialist referral—for example, to urology if there are concerning PSA changes or abnormal prostate examination findings.

If you experience accidental gel transfer to another person, advise them to wash the affected area with soap and water as soon as possible. Always follow the precautions to prevent transfer: wash hands thoroughly after application, allow gel to dry completely, and cover application sites with clothing.

If you are experiencing questions about your sexual identity or orientation, these are valid concerns that deserve supportive exploration, but they should be understood as separate from your testosterone therapy. Your GP can refer you to appropriate counselling or psychological support services if needed. Many people explore aspects of their identity at various life stages, and this process is unrelated to hormone treatment. The NHS provides access to psychosexual counselling and LGBTQ+-affirming mental health services that can offer specialist support.

For urgent mental health concerns, including thoughts of self-harm or suicide, call 999 in an emergency, contact NHS 111, or your local urgent mental health helpline. The Samaritans (116 123) also provide confidential support 24/7.

If you suspect side effects from your medication, you can report these through the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Evidence-Based Information on Hormones and Sexual Identity

Scientific research into the relationship between hormones and sexual orientation has been extensive, and the evidence consistently shows that adult hormone levels do not determine or change sexual orientation. Studies examining testosterone levels in gay, bisexual, and heterosexual men have found no consistent differences that would explain sexual orientation. Similarly, research on individuals receiving hormone therapy for various medical conditions has never demonstrated that altering adult hormone levels changes sexual orientation.

Prenatal hormone exposure has been investigated as one of many factors potentially contributing to sexual orientation development. Some research suggests that hormone levels during critical periods of foetal brain development might influence later sexual orientation, alongside genetic, epigenetic, and environmental factors. However, this relates to development before birth, not to adult hormone levels or hormone therapy. Once sexual orientation is established, it remains stable regardless of subsequent hormone changes.

Gender identity and sexual orientation are distinct concepts that are sometimes confused. Gender identity refers to one's internal sense of being male, female, or another gender, whilst sexual orientation refers to the gender(s) to which one is attracted. Testosterone therapy is used in gender-affirming care for transgender men under specialist supervision (often as an off-label use in the UK), but in this context, it does not create or change sexual orientation—it aligns physical characteristics with gender identity. Transgender individuals may identify as gay, straight, bisexual, or any other orientation, independent of hormone therapy.

Psychological research from organisations including the British Psychological Society and the Royal College of Psychiatrists affirms that sexual orientation is not a choice and cannot be changed through medical or psychological interventions. Attempts to change sexual orientation (sometimes called 'conversion therapy') are considered unethical and harmful. If you are questioning your sexuality whilst on testosterone therapy, this likely represents a personal journey of self-discovery rather than a medication effect. Professional support from LGBTQ+-affirming therapists or organisations such as Stonewall or LGBT Foundation can provide valuable guidance during this process, entirely separate from your endocrine treatment.

The NHS provides resources on sexual health and identity, and your GP can refer you to appropriate services if you wish to discuss these matters further.

Frequently Asked Questions