Testogel is a testosterone replacement therapy prescribed for men with confirmed hypogonadism (low testosterone). Understanding how many pumps in Testogel you need is essential for safe, effective treatment. The Testogel 16.2 mg/g pump delivers 20.25 mg of testosterone per actuation, with most men starting on two pumps daily (40.5 mg). Your dose depends on blood test results, symptom response, and ongoing monitoring. This article explains Testogel pump dosing, how to adjust your dose safely, correct application technique, and the importance of regular monitoring to achieve optimal testosterone levels whilst minimising risks.
Summary: The standard starting dose of Testogel 16.2 mg/g pump is two pump actuations once daily, delivering 40.5 mg of testosterone, with a maximum licensed dose of four pumps daily (81 mg).
- Each Testogel 16.2 mg/g pump actuation delivers 20.25 mg of testosterone in 1.25 g of gel.
- Dose adjustments are made in one-pump increments based on blood testosterone levels measured approximately 14 days after starting or changing dose.
- The gel should be applied to clean, dry skin on shoulders, upper arms, or abdomen, avoiding the genital area.
- Regular monitoring includes serum testosterone, full blood count (haematocrit), PSA, and liver function tests to detect adverse effects early.
- Testosterone therapy is contraindicated in men with prostate or breast cancer, and haematocrit above 54% requires dose reduction or temporary withholding.
- Patients must avoid skin-to-skin contact with others for several hours after application to prevent testosterone transfer, especially to women and children.
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Understanding Testogel Dosing and Pump Delivery
Testogel (testosterone gel) is a transdermal hormone replacement therapy prescribed for adult men with confirmed testosterone deficiency (hypogonadism). The medication is available in the UK in a metered-dose pump dispenser, which delivers a precise amount of testosterone with each actuation. Understanding how the pump system works is essential for achieving optimal therapeutic outcomes and maintaining stable testosterone levels.
Testogel 16.2 mg/g pump delivers 1.25 g of gel containing 20.25 mg of testosterone per actuation. This standardised delivery system ensures consistent dosing and reduces the risk of under- or over-treatment. The pump mechanism is designed to dispense the gel in a controlled manner, making it easier for patients to self-administer their prescribed dose accurately at home. It is important not to confuse this formulation with Testogel 1% sachets (which contain 50 mg testosterone per 5 g sachet) or other testosterone gels such as Testavan, as dosing differs between products.
The number of pumps required varies between individuals and depends on baseline testosterone levels, clinical response, and ongoing monitoring results. The licensed starting dose is two pump actuations once daily (40.5 mg testosterone), which may be adjusted based on blood test results and symptom improvement. The maximum licensed dose is four pump actuations daily (81 mg testosterone). It is crucial to follow your prescriber's instructions precisely, as testosterone is a controlled medication under the Misuse of Drugs Act 1971, and inappropriate use can lead to adverse effects.
Key points about Testogel pump delivery:
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Each pump actuation of Testogel 16.2 mg/g delivers 20.25 mg of testosterone
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The pump should be primed before first use according to the Patient Information Leaflet (typically three actuations discarded into a tissue)
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Consistent daily application at the same time optimises absorption
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Never share your Testogel pump with others, even if they have similar symptoms
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The gel is flammable: avoid open flames and do not smoke until the gel has dried completely
Patients should store the pump at room temperature and keep it out of reach of children and pets, as accidental exposure can cause serious harm, including virilisation (development of male characteristics) in women and children.
Standard Testogel Pump Dosage for Adults
The licensed starting dose of Testogel 16.2 mg/g pump for adult men with hypogonadism is two pump actuations once daily, delivering 40.5 mg of testosterone. This starting dose aligns with the UK Summary of Product Characteristics (SmPC) and provides a baseline from which adjustments can be made. The gel should be applied in the morning to mimic the body's natural circadian rhythm of testosterone production, which peaks in the early hours.
Dose titration is performed in increments of one pump actuation (20.25 mg) based on serum testosterone levels measured approximately 14 days after starting treatment or after any dose change. The maximum licensed dose is four pump actuations daily (81 mg testosterone). Exceeding this dose is not recommended and may increase the risk of adverse effects, including polycythaemia (elevated red blood cell count) and cardiovascular events.
Factors influencing starting dose and titration include:
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Severity of testosterone deficiency (based on two morning blood tests taken before treatment)
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Patient age and overall health status
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Presence of comorbidities (cardiovascular disease, diabetes, obesity)
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Previous response to testosterone therapy, if applicable
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Serum testosterone levels during treatment and clinical symptom response
It is important to note that the standard dose is not suitable for everyone. Older men, those with significant comorbidities, or patients with borderline testosterone levels may require careful dose titration to minimise potential adverse effects. All dose adjustments should be made following blood test results and clinical assessment by an endocrinologist, urologist, or GP with expertise in men's health.
Patients should never adjust their dose without medical supervision. Self-titration can lead to supraphysiological testosterone levels, increasing the risk of polycythaemia, cardiovascular events, and other serious complications. If you are prescribed Testogel 1% sachets (50 mg per sachet), the starting dose is typically one sachet daily, with titration up to a maximum of two sachets (100 mg) daily if needed. Always verify the exact formulation and dosing instructions with your prescribing clinician or pharmacist.
How to Adjust Your Testogel Dose Safely
Dose adjustment of Testogel should only occur under medical supervision, following blood tests that measure serum testosterone levels. According to the UK SmPC for Testogel 16.2 mg/g, testosterone levels should be checked approximately 14 days after starting treatment or after any dose change. The timing of the blood sample is important and should follow the product-specific guidance (typically 2–4 hours after gel application for Testogel 16.2 mg/g). Once stable therapeutic levels are achieved, monitoring is usually performed every 3–6 months, then 6–12 monthly.
If testosterone levels remain below the normal reference range (typically 10–30 nmol/L, though this varies by laboratory), your clinician may increase the dose by one pump actuation (20.25 mg) daily, up to the maximum of four actuations (81 mg). Conversely, if levels are supraphysiological (above normal range) or if adverse effects develop, the dose may be reduced. Adjustments are made incrementally to avoid sudden fluctuations in hormone levels, which can cause mood changes, fatigue, or other symptoms.
Signs that may indicate dose adjustment is needed:
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Persistent symptoms of low testosterone despite treatment (fatigue, low libido, erectile dysfunction, reduced muscle mass)
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Development of adverse effects (acne, mood changes, fluid retention, gynaecomastia)
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Abnormal blood test results (elevated haematocrit >54%, abnormal liver function, rising PSA)
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Changes in body weight or clinical status
Patients should maintain regular contact with their prescribing clinician and report any new or worsening symptoms promptly. It typically takes several weeks for testosterone levels to stabilise after any dose change, so patience is essential during the titration process.
Important safety thresholds:
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If haematocrit rises above 54%, testosterone therapy should be reduced or temporarily withheld, and the cause investigated; venesection may be required
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Rising PSA or abnormal digital rectal examination findings require urological assessment before continuing therapy
Never attempt to 'catch up' missed doses by applying extra pumps the following day, as this can cause dangerous spikes in testosterone levels. If you miss a dose, simply apply your normal amount the next day and inform your clinician at your next appointment.
Applying Testogel: Technique and Best Practices
Correct application technique is crucial for optimal testosterone absorption and to minimise the risk of transfer to others. Testogel should be applied to clean, dry, intact skin on the shoulders, upper arms, or abdomen. The MHRA advises against applying the gel to the genital area, as this can cause local irritation and is not the intended site of administration. Rotate application sites daily to prevent skin irritation and ensure consistent absorption.
Step-by-step application process:
- Wash and dry your hands thoroughly before handling the pump
- Prime the pump if using for the first time (follow the Patient Information Leaflet; typically three actuations discarded into a tissue)
- Dispense the prescribed number of pumps into the palm of your hand
- Apply immediately to the chosen area, spreading thinly over a large surface area
- Allow to dry for 3–5 minutes before dressing; avoid open flames and do not smoke until the gel is completely dry (the gel is flammable)
- Wash your hands thoroughly with soap and water after application
The gel should be applied at approximately the same time each morning to maintain stable testosterone levels throughout the day. For Testogel 16.2 mg/g pump, avoid showering, bathing, or swimming for at least 2 hours after application to ensure adequate absorption. For Testogel 1% sachets, the recommended interval is typically 6 hours. Always follow the specific instructions in your Patient Information Leaflet, as wash-off times vary between formulations.
Important safety considerations to prevent transfer to others:
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Cover the application site with clothing once the gel is dry
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Avoid skin-to-skin contact with partners, children, or pets for several hours after application
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If close skin contact is anticipated within the recommended wash-off period, wash the application site with soap and water beforehand or cover it with clothing
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If someone else comes into contact with the application site, they should wash the affected area immediately with soap and water
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Women and children are particularly vulnerable to testosterone exposure, which can cause virilisation (development of male characteristics such as increased body hair, deepening of the voice, and menstrual irregularities)
Patients should inspect the application site regularly for signs of irritation, rash, or allergic reaction. If persistent skin problems develop, contact your GP or prescribing clinician, as an alternative formulation or application site may be needed. The MHRA has issued guidance on the risk of testosterone transfer; follow all precautions carefully to protect those around you.
Monitoring Testosterone Levels and Safety on Testogel
Regular monitoring is essential for all patients receiving testosterone replacement therapy to ensure efficacy, detect adverse effects early, and adjust dosing appropriately. The British Society for Sexual Medicine (BSSM) and NICE Clinical Knowledge Summaries recommend comprehensive monitoring that includes both biochemical parameters and clinical assessment of symptoms and quality of life.
Baseline assessments before starting treatment typically include:
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Two early-morning serum testosterone measurements (taken before 11 am on separate occasions) to confirm hypogonadism
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Full blood count (to check haemoglobin and haematocrit)
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Prostate-specific antigen (PSA) and consideration of digital rectal examination in men over 40 or those at increased risk of prostate disease
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Liver function tests
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Lipid profile and HbA1c (especially in men with metabolic syndrome or diabetes)
Follow-up monitoring schedule:
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Serum testosterone approximately 14 days after starting treatment or after any dose change (timing of blood sample should follow product-specific guidance, typically 2–4 hours post-application for Testogel 16.2 mg/g)
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Once stable therapeutic levels are achieved, testosterone monitoring every 3–6 months initially, then 6–12 monthly
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Full blood count (haematocrit and haemoglobin) at 3–6 months, then annually or more frequently if haematocrit is elevated
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PSA monitoring periodically (typically annually in men over 40 or at risk); digital rectal examination if clinically indicated or per local protocol
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Liver function tests periodically, especially in patients with pre-existing liver disease
Patients should be aware that testosterone levels can be affected by various factors, including the timing of blood tests, recent illness, and stress. For this reason, single abnormal results should be interpreted cautiously and usually repeated before making significant treatment changes. Your clinician will consider trends over time rather than isolated values.
Important safety thresholds and actions:
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Haematocrit >54%: reduce or withhold testosterone therapy; investigate the cause and consider venesection if clinically indicated
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Rising PSA or abnormal prostate examination: refer for urological assessment before continuing therapy
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Testosterone therapy is contraindicated in men with prostate cancer or breast cancer
Warning signs requiring urgent medical attention:
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Symptoms of polycythaemia (severe headaches, dizziness, visual disturbances, chest pain, shortness of breath)
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Signs of liver dysfunction (jaundice, dark urine, persistent nausea, abdominal pain)
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Urinary symptoms (difficulty passing urine, blood in urine, increased frequency)
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Chest pain, shortness of breath, or leg swelling (possible cardiovascular or thromboembolic events)
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Significant mood changes, aggression, or depression
Additional important counselling points:
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Fertility suppression: Exogenous testosterone suppresses the body's natural production of testosterone and spermatogenesis (sperm production). Testosterone therapy is not a contraceptive, but it may reduce fertility. Discuss your fertility plans with your clinician before starting treatment.
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Cardiovascular risk: Evidence regarding cardiovascular risk with testosterone therapy remains mixed and inconclusive. Your clinician will assess your individual cardiovascular risk and discuss the balance of benefits and risks with you.
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Reporting side effects: If you experience any side effects, talk to your doctor or pharmacist. You can also report side effects directly via the MHRA Yellow Card scheme at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
Men on long-term testosterone therapy should maintain regular contact with their GP or endocrinologist and attend all scheduled monitoring appointments. The benefits of treatment—improved energy, mood, sexual function, muscle mass, and bone density—must be balanced against potential risks through careful, individualised monitoring and shared decision-making.
Frequently Asked Questions
How many pumps of Testogel should I use each day?
The standard starting dose is two pump actuations once daily (40.5 mg testosterone), applied in the morning. Your clinician may adjust this between one and four pumps daily based on your blood test results and symptom response.
Can I increase my Testogel dose if I still feel tired?
No, you must never adjust your Testogel dose without medical supervision. Dose changes should only occur following blood tests that measure your testosterone levels, typically 14 days after starting or changing your dose, and under guidance from your prescribing clinician.
What happens if I accidentally use too many pumps of Testogel?
Using too many pumps can cause supraphysiological testosterone levels, increasing the risk of polycythaemia, cardiovascular events, mood changes, and other serious complications. If you accidentally overdose, contact your GP or NHS 111 for advice and do not apply extra gel to compensate for missed doses.
How long after applying Testogel can I shower or swim?
For Testogel 16.2 mg/g pump, avoid showering, bathing, or swimming for at least 2 hours after application to ensure adequate absorption. Always follow the specific instructions in your Patient Information Leaflet, as wash-off times vary between different testosterone gel formulations.
Is Testogel the same as other testosterone gels like Testavan?
No, Testogel and Testavan are different formulations with different dosing systems and strengths. Testogel 16.2 mg/g delivers 20.25 mg per pump, whilst Testavan delivers 23 mg per pump, and they have different application sites and wash-off times, so you must not switch between products without medical guidance.
How do I get a prescription for Testogel in the UK?
You need two early-morning blood tests (before 11 am on separate occasions) confirming low testosterone levels, followed by assessment by a GP, endocrinologist, or urologist. Testogel is a prescription-only medicine and a controlled drug under the Misuse of Drugs Act 1971, so it cannot be obtained without proper medical diagnosis and ongoing monitoring.
The health-related content published on this site is based on credible scientific sources and is periodically reviewed to ensure accuracy and relevance. Although we aim to reflect the most current medical knowledge, the material is meant for general education and awareness only.
The information on this site is not a substitute for professional medical advice. For any health concerns, please speak with a qualified medical professional. By using this information, you acknowledge responsibility for any decisions made and understand we are not liable for any consequences that may result.
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