How much Testogel you should take depends entirely on your individual clinical needs and must be determined by your doctor following blood tests and clinical assessment. Testogel is a prescription-only testosterone replacement therapy used to treat male hypogonadism (low testosterone levels) in the UK. It is available in two formulations—Testogel 1% sachets (50 mg per sachet) and Testogel 16.2 mg/g pump (20.25 mg per actuation)—with typical starting doses ranging from 20.25 mg to 50 mg daily. Your dose is adjusted based on follow-up blood testosterone levels, symptom improvement, and monitoring for side effects. Self-adjusting your dose or using Testogel without medical supervision can lead to serious health risks, including cardiovascular complications and hormonal imbalances.

Understanding Testogel Dosing and Prescription Guidelines

Testogel is a prescription-only medicine containing testosterone in gel form, used to treat male hypogonadism (low testosterone levels). In the UK, it is regulated by the Medicines and Healthcare products Regulatory Agency (MHRA) and can only be prescribed by a registered healthcare professional following appropriate clinical assessment and blood tests confirming testosterone deficiency.

The amount of Testogel you should take is determined individually by your doctor based on your specific clinical needs, blood testosterone levels, and response to treatment. There is no single 'correct' dose that applies to everyone. Self-adjusting your dose or using Testogel without medical supervision can lead to serious health consequences, including cardiovascular risks, prostate problems, and hormonal imbalances.

Testogel is available in the UK in two formulations: Testogel 50 mg/5 g sachets (1% gel) and Testogel 16.2 mg/g pump (1.62% gel). Each 5 g sachet of the 1% formulation contains 50 mg testosterone. Each pump actuation of the 16.2 mg/g formulation dispenses 1.25 g of gel containing 20.25 mg testosterone. Understanding these differences is essential, as switching between formulations requires dose recalculation under medical supervision.

NICE guidance (NICE Clinical Knowledge Summaries: Testosterone deficiency in adult men) emphasises that testosterone replacement therapy should only be initiated after two separate morning blood tests (taken before 11 am, ideally fasting) confirm low testosterone levels, accompanied by symptoms of hypogonadism such as reduced libido, erectile dysfunction, fatigue, or loss of muscle mass. Interpretation should use your local laboratory reference ranges and correlate with clinical symptoms. Treatment should be monitored regularly with follow-up blood tests to ensure testosterone levels remain within the normal physiological range and to monitor for potential adverse effects.

Standard Testogel Doses for Testosterone Replacement

The typical starting dose for Testogel in adult men depends on the formulation prescribed. For Testogel 1% sachets, the usual starting dose is 50 mg of testosterone once daily (one 5 g sachet), applied in the morning to clean, dry, intact skin on the shoulders, upper arms, or abdomen. For Testogel 16.2 mg/g pump, the starting dose is typically 20.25 mg once daily (one pump actuation of 1.25 g gel), applied to the shoulders or upper arms only. The gel should be applied at approximately the same time each day to maintain stable testosterone levels.

For Testogel 1% sachets, the dose may be adjusted by your doctor in 25 mg increments (half a sachet) to a maximum of 100 mg daily, based on your blood testosterone levels and clinical response. For Testogel 16.2 mg/g pump, doses are adjusted in 20.25 mg steps (one pump actuation at a time) up to a maximum of 81 mg daily (four pump actuations). Your doctor will specify which formulation and strength you should use, and it is crucial not to switch between products without medical guidance.

Application technique matters significantly for optimal absorption and efficacy. Spread the gel thinly over a large area of the approved application sites rather than concentrating it in one spot. Allow the gel to dry for 3–5 minutes before dressing. Wash your hands thoroughly with soap and water immediately after application. The minimum time before washing or showering the application site differs by product: for Testogel 1% sachets, avoid washing for at least 6 hours; for Testogel 16.2 mg/g pump, avoid washing for at least 2 hours. Always check your product's patient information leaflet for specific instructions.

Important safety precautions: Never apply Testogel to the genitals or to broken, irritated, or damaged skin. Cover the application site with clothing once the gel has dried to prevent transfer of testosterone to others through skin contact. Avoid open flames and do not smoke until the gel has completely dried, as alcohol-based gels are flammable. Testogel is not suitable for women (particularly those who are pregnant or breastfeeding), children, or men with prostate cancer, breast cancer, or certain other medical conditions. The medication carries a risk of transferring testosterone to others through close skin contact; if accidental contact occurs, the exposed person should wash the affected skin immediately with soap and water.

How Your Doctor Determines the Right Testogel Dose

Your doctor will determine your appropriate Testogel dose through a comprehensive clinical assessment that includes detailed medical history, physical examination, and laboratory investigations. The process begins with confirming genuine testosterone deficiency through two separate fasting morning blood tests (ideally taken between 8 am and 11 am) showing testosterone levels below your local laboratory's normal reference range, accompanied by symptoms of hypogonadism. Interpretation must use local laboratory reference ranges and correlate with your clinical symptoms.

Baseline investigations before starting Testogel typically include: full blood count (to check haemoglobin and haematocrit), prostate-specific antigen (PSA) and digital rectal examination (DRE) in men over 40 or those with prostate risk factors, liver function tests, lipid profile, luteinising hormone (LH), follicle-stimulating hormone (FSH), prolactin, sex hormone-binding globulin (SHBG) with calculated free testosterone, and thyroid function tests. These tests help identify any contraindications to testosterone therapy, establish baseline values for monitoring, and screen for secondary causes of hypogonadism such as pituitary disease.

Red-flag features requiring specialist referral include: very low testosterone with low or normal gonadotrophins (suggesting pituitary or hypothalamic disease), raised prolactin, pituitary symptoms (persistent headache, visual disturbances), testicular mass or abnormality, or infertility concerns. If you are trying to conceive or wish to preserve fertility, discuss this with your doctor before starting Testogel, as exogenous testosterone suppresses sperm production. Referral to andrology or endocrinology may be appropriate.

Several patient-specific factors influence dose selection, including age, body weight, severity of testosterone deficiency, presence of other medical conditions (particularly cardiovascular disease, sleep apnoea, or polycythaemia), and concurrent medications. Older men or those with cardiovascular risk factors may be started on lower doses with more cautious titration. Your doctor will also consider your treatment goals and lifestyle factors when selecting the most appropriate formulation and application sites. Regular follow-up appointments are scheduled to assess treatment response, tolerability, and the need for dose adjustment.

Adjusting Your Testogel Dose Based on Blood Tests

Dose adjustments are made gradually based on follow-up blood testosterone measurements and clinical response. After starting Testogel, your doctor will typically arrange a blood test after 3 to 6 months of treatment to measure your testosterone levels. The timing of this blood test relative to gel application is product-specific: for Testogel 16.2 mg/g pump, blood should be taken 2–4 hours after application; for Testogel 1% sachets, follow your doctor's or laboratory's protocol (often a morning pre-dose sample). The target is to achieve testosterone levels within the normal physiological range for your laboratory, often aiming for mid-normal values.

If your testosterone levels are below the target range despite treatment, your doctor may increase your dose incrementally: for Testogel 1% sachets, by 25 mg (half a sachet) up to a maximum of 100 mg daily; for Testogel 16.2 mg/g pump, by 20.25 mg (one pump actuation) up to a maximum of 81 mg daily (four actuations). Conversely, if levels are above the normal range or you experience dose-related side effects such as mood changes, acne, or excessive erythrocytosis (raised red blood cell count), your dose may be reduced. These adjustments are made cautiously, with repeat blood tests after each change to assess the effect.

Clinical response is equally important as blood test results when adjusting doses. Your doctor will assess whether your symptoms of hypogonadism are improving, including energy levels, sexual function, mood, and physical changes. Some men achieve testosterone levels within the normal range but continue to experience symptoms, which may prompt further investigation of other contributing factors such as sleep disorders, depression, thyroid problems, or other endocrine conditions.

Monitoring for adverse effects is integral to dose management. Regular blood tests will check haemoglobin and haematocrit at baseline, 3 to 6 months, 12 months, and then annually. Testosterone can stimulate red blood cell production; if haematocrit rises above 54%, your dose may need to be reduced or treatment temporarily stopped. PSA levels (and digital rectal examination where indicated) are monitored at baseline and periodically in men over 40; any abnormal or rising PSA or suspicious findings on examination require referral to urology. Liver function tests and lipid profiles are performed periodically. Never adjust your Testogel dose without consulting your doctor, as inappropriate dosing can lead to serious health complications. If you experience side effects, report them via the MHRA Yellow Card scheme (search 'Yellow Card' online or ask your pharmacist).

What to Do If You Miss or Take Too Much Testogel

If you miss a dose of Testogel, apply it as soon as you remember on the same day. However, if it is almost time for your next scheduled dose (for example, late evening when you normally apply it in the morning), skip the missed dose and resume your regular schedule the following morning. Do not apply a double dose to make up for a forgotten application, as this can cause testosterone levels to spike above the therapeutic range, potentially increasing the risk of side effects.

Missing occasional doses is unlikely to cause significant problems, as testosterone levels decline gradually rather than immediately. However, frequently missing doses can lead to fluctuating testosterone levels, which may result in return of hypogonadism symptoms such as fatigue, low mood, and reduced libido. If you regularly forget doses, consider setting a daily reminder on your phone or incorporating application into your morning routine. Discuss any adherence difficulties with your doctor or pharmacist, who can suggest strategies to help.

If you accidentally apply more than your prescribed dose, do not panic. If the gel has not yet dried, wash it off immediately with soap and water. Do not apply additional doses or alter your dosing schedule without medical advice. Contact your doctor or pharmacist for guidance on how to proceed. Applying too much Testogel on one occasion can lead to temporarily elevated testosterone levels, which may cause symptoms including mood swings, irritability, acne, oily skin, or sleep disturbances. Prolonged excessive dosing can lead to more serious complications including erythrocytosis (thickening of the blood due to increased red blood cells), worsening of sleep apnoea, and cardiovascular risks.

Seek medical attention promptly if you experience symptoms suggesting serious adverse effects, such as chest pain, severe headache, visual disturbances, difficulty breathing, or signs of a blood clot (leg pain, swelling, warmth, or redness). Contact your GP during working hours or NHS 111 for urgent advice outside normal hours. If another person is accidentally exposed to Testogel through skin contact (particularly women or children), they should wash the affected area immediately with soap and water and seek medical advice if symptoms of virilisation (such as unexpected hair growth or voice changes) occur. If you have concerns about your Testogel dosing, application technique, or treatment response, discuss these with your prescribing doctor at your next review appointment. Maintaining open communication with your healthcare team ensures safe, effective testosterone replacement therapy tailored to your individual needs. Remember to report any suspected side effects via the MHRA Yellow Card scheme.

Frequently Asked Questions