Testogel is a prescription-only testosterone replacement therapy (TRT) gel used to treat hypogonadism in adult men with confirmed testosterone deficiency. Obtaining Testogel in the UK requires a formal diagnosis through blood tests and clinical assessment by a GP or specialist. The process involves measuring testosterone levels on at least two separate mornings, excluding contraindications such as prostate cancer, and ensuring ongoing monitoring for safety. Testogel cannot be purchased over the counter or online without a valid prescription from a registered UK prescriber. This guide explains the steps to access Testogel through NHS or private routes, what to expect during assessment, and how to collect and use your prescription safely.

What Is Testogel and Who Can Use It?

Testogel is a transdermal testosterone gel authorised in the UK by the Medicines and Healthcare products Regulatory Agency (MHRA) for testosterone replacement therapy (TRT) in adult men with hypogonadism. The gel contains testosterone as the active ingredient and is applied daily to clean, dry skin. Once absorbed, it delivers a steady release of testosterone into the bloodstream, helping to restore physiological hormone levels.

Testogel is indicated specifically for men with confirmed testosterone deficiency (hypogonadism) accompanied by clinical symptoms. These symptoms may include reduced libido, erectile dysfunction, fatigue, loss of muscle mass, mood disturbances, and decreased bone density. It is not suitable for men with normal testosterone levels seeking performance enhancement, nor is it licensed for use in women or children.

Key contraindications include known or suspected androgen-dependent tumours, such as prostate or breast cancer. Men with these conditions should not use Testogel, as testosterone may stimulate the growth of hormone-sensitive tumours.

Important cautions and monitoring requirements apply to men with:

• Cardiovascular disease – evidence on cardiovascular risk is mixed and risk cannot be excluded; individualised assessment and monitoring are essential

• Elevated haematocrit or polycythaemia – TRT should be deferred if haematocrit is raised and stopped if it exceeds 54%

• Untreated obstructive sleep apnoea – TRT may worsen the condition; assessment and treatment should be considered before starting therapy

• Severe heart failure – use with caution and close monitoring

Testogel is a prescription-only medicine (POM), meaning it cannot be purchased over the counter or online without a valid prescription from a registered UK prescriber. Self-administration without proper diagnosis and monitoring carries significant health risks, including cardiovascular events, erythrocytosis, and hormonal imbalances.

Fertility warning: TRT suppresses spermatogenesis and is not appropriate for men who are trying to conceive. If fertility is desired, discuss alternative treatments with your doctor or request referral to an andrology or endocrinology specialist.

Getting a Prescription for Testogel in the UK

Obtaining a prescription for Testogel requires a formal diagnosis of hypogonadism, which must be confirmed through clinical assessment and biochemical testing. The process begins with a consultation with your GP or a specialist endocrinologist. You will be asked about symptoms such as low energy, reduced sexual function, mood changes, and any relevant medical history.

Your doctor will arrange blood tests to measure your testosterone levels. According to guidance from the Society for Endocrinology, the British Society for Sexual Medicine (BSSM), and NICE Clinical Knowledge Summaries, at least two fasting early-morning samples (taken between 8 am and 11 am on separate days) are required to confirm low testosterone, as levels fluctuate throughout the day. A diagnosis of hypogonadism is typically made when total testosterone is consistently below 8 nmol/L. Levels between 8 and 12 nmol/L are considered borderline; in this range, your doctor will assess symptoms, calculate free testosterone (using sex hormone-binding globulin [SHBG] and albumin), and use clinical judgement to decide whether treatment is appropriate.

Additional investigations may include:

• Luteinising hormone (LH) and follicle-stimulating hormone (FSH) to distinguish primary from secondary hypogonadism

• Prolactin levels to exclude pituitary disorders

• SHBG and albumin to calculate free testosterone when total testosterone is borderline

• Prostate-specific antigen (PSA) and, where appropriate, digital rectal examination (DRE) in men aged over 50, or over 45 if at higher risk (e.g., Black ethnicity or family history of prostate cancer)

• Full blood count to assess haemoglobin and haematocrit

• Liver and kidney function tests, lipid profile, and HbA1c to assess cardiovascular and metabolic risk

• Ferritin and other tests if secondary causes (e.g., haemochromatosis, pituitary disease) are suspected

Once hypogonadism is confirmed and contraindications excluded, your doctor can issue a prescription for Testogel. The prescription will specify the formulation and starting dose:

• Testogel 1% (50 mg/5 g) gel – typically started at 50 mg daily, with possible adjustment to 100 mg or reduction to 25 mg based on response

• Testogel 16.2 mg/g pump – typically started at 40.5 mg daily (two pump actuations), with adjustments in 20.25 mg increments

Your GP may refer you to an endocrinologist or urologist if the cause of hypogonadism is unclear, if specialist input is needed, or if there are complex comorbidities.

NHS vs Private Routes for Testosterone Replacement Therapy

Patients in the UK can access Testogel through NHS services or private healthcare, each with distinct advantages and considerations. Understanding these pathways helps you make an informed choice based on your circumstances.

NHS Route:

The NHS provides TRT, including Testogel, free of charge to eligible patients with confirmed hypogonadism. You will typically start by seeing your GP, who will arrange initial blood tests and assessments. If hypogonadism is confirmed, your GP may initiate treatment or refer you to an endocrinology or urology clinic for specialist review. Waiting times for specialist appointments can vary—ranging from a few weeks to several months depending on local demand and clinical urgency. Once treatment is established, ongoing prescriptions and monitoring are provided through your GP practice at no cost, aside from standard NHS prescription charges (currently £9.90 per item in England; prescriptions are free in Scotland, Wales, and Northern Ireland).

Private Route:

Private clinics and online TRT services offer faster access, often with appointments available within days. Consultations are conducted by private GPs or endocrinologists, and blood tests can be arranged quickly. However, private care involves out-of-pocket costs: initial consultations typically range from approximately £100–£300, blood tests £50–£150, and ongoing prescriptions and monitoring incur recurring fees. Some private providers offer subscription models.

Important considerations:

• Ensure any private provider is registered with the Care Quality Commission (CQC) and employs General Medical Council (GMC)-registered prescribers

• Private prescriptions can be dispensed at any UK pharmacy, but you will pay the full cost of medication

• If you wish to transfer from private to NHS care, your GP practice is not obliged to continue privately initiated TRT; acceptance depends on local shared-care agreements and clinical appropriateness. Discuss this with your GP early to ensure continuity of care

What to Expect During Your Testogel Assessment

Your initial assessment for Testogel is comprehensive and designed to confirm the diagnosis, exclude contraindications, and establish a safe treatment plan. Whether conducted via the NHS or privately, the process follows similar clinical principles aligned with UK guidelines.

During your consultation, the doctor will take a detailed medical history, including:

• Specific symptoms and their duration (fatigue, low libido, erectile dysfunction, mood changes)

• Previous medical conditions, particularly cardiovascular disease, diabetes, or prostate issues

• Current medications and any history of hormone therapy

• Family history of prostate or breast cancer

• Lifestyle factors such as alcohol use, smoking, and exercise habits

• Fertility plans – TRT suppresses sperm production and is not suitable if you are trying to conceive

A physical examination may include measurement of blood pressure, body mass index (BMI), and assessment of secondary sexual characteristics. In men aged over 50, or over 45 if at higher risk, a digital rectal examination to assess prostate size may be performed as part of shared decision-making.

Baseline investigations are essential before starting Testogel and are detailed in the previous section.

Your doctor will discuss the benefits and risks of TRT, including potential adverse effects such as skin irritation, acne, mood changes, erythrocytosis (elevated red blood cell count), and the possibility of cardiovascular events. You will receive detailed instructions on how to apply Testogel correctly:

• Application sites depend on the formulation. Testogel 1% (50 mg/5 g) may be applied to the shoulders, upper arms, or abdomen. Testogel 16.2 mg/g pump should be applied to the shoulders and upper arms only (not the abdomen).

• Do not apply to the genitals, broken or irritated skin, or areas that will be covered by tight clothing immediately.

• Wash your hands thoroughly with soap and water immediately after application.

• Allow the gel to dry fully (3–5 minutes) before dressing.

• Cover the application site with clothing to minimise the risk of transferring testosterone to others through skin-to-skin contact.

• Avoid showering, bathing, or swimming for at least 6 hours after application (follow the specific product instructions).

• If another person (especially women or children) comes into contact with the application site, they should wash the area with soap and water as soon as possible.

Follow-up monitoring is essential to ensure safe and effective treatment:

• Testosterone levels: Check serum testosterone approximately 2–4 hours after application, around 14 days after starting or adjusting the dose. The aim is to achieve levels in the mid-normal range (typically 12–20 nmol/L).

• Full blood count: Check at baseline, 3 months, 6 months, 12 months, and then annually. If haematocrit rises above 54%, TRT should be stopped and the cause investigated.

• PSA and prostate assessment: Baseline PSA (and DRE where appropriate) in men aged over 50 or over 45 if at higher risk. Monitor PSA at 3, 6, and 12 months, then annually. Refer urgently under NICE guideline NG12 if PSA is above age-specific thresholds, PSA velocity is rapid, or there is an abnormal DRE or new lower urinary tract symptoms.

• Liver function, lipids, HbA1c, and bone density as clinically indicated.

If you experience any suspected side effects, report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

Collecting Your Testogel Prescription from a Pharmacy

Once your prescription is issued, you can collect Testogel from any registered community pharmacy in the UK. If prescribed via the NHS, you can use your local pharmacy or a pharmacy of your choice. Private prescriptions are also accepted at all UK pharmacies, though you will pay the full cost of the medication.

Testogel is available in two main formulations:

• Testogel 1% (50 mg/5 g) gel – available as sachets or a metered-dose pump. The usual starting dose is 50 mg daily, which may be adjusted to 100 mg or reduced to 25 mg based on follow-up blood tests.

• Testogel 16.2 mg/g pump – allows for dose adjustment in 20.25 mg increments. The usual starting dose is 40.5 mg daily (two pump actuations).

Your prescription will specify the formulation and quantity. The pharmacist will dispense the medication and may provide additional counselling on correct application technique, storage, and safety precautions.

Important points when collecting your prescription:

• Store Testogel as directed on the product label and in the patient information leaflet. Follow the specific storage instructions for your formulation.

• Keep the medication out of reach and sight of children.

• Check the expiry date and do not use if the packaging is damaged.

• If you have any questions about application, side effects, or the risk of transferring testosterone to others, ask the pharmacist before leaving.

• Remember to cover the application site with clothing after the gel has dried, and wash the site with soap and water before any anticipated close skin contact with others.

If your prescription cannot be fulfilled immediately (due to stock issues), the pharmacy can usually order Testogel for next-day collection. For ongoing treatment, consider setting up a repeat prescription arrangement with your GP practice, which can be sent electronically to your nominated pharmacy. This streamlines the process and ensures continuity of treatment.

If you experience any adverse effects such as severe skin reactions, mood disturbances, chest pain, shortness of breath, or signs of erythrocytosis (headache, dizziness, visual disturbances), contact your GP promptly. Never share your Testogel with others, and attend all scheduled follow-up appointments to ensure safe and effective treatment.

Frequently Asked Questions