Testogel pump is a transdermal testosterone replacement therapy prescribed for male hypogonadism in the UK. Correct application technique is essential for effective treatment and preventing inadvertent hormone transfer to others. This guide explains how to use Testogel pump safely, including step-by-step instructions, approved application sites, common mistakes to avoid, and post-application precautions. Understanding proper usage ensures optimal testosterone absorption, minimises side effects, and protects household members from unintended exposure. Always use Testogel under medical supervision with regular monitoring of hormone levels and prostate health.

What Is Testogel Pump and How Does It Work?

Testogel pump is a transdermal testosterone replacement therapy (TRT) licensed in the UK for treating male hypogonadism—a condition characterised by abnormally low testosterone levels. The pump delivers a measured dose of testosterone gel (16.2 mg/g testosterone) through the skin, providing a convenient alternative to intramuscular injections. Each full actuation of the pump dispenses 1.25 g of gel containing 20.25 mg of testosterone, allowing for precise dosing tailored to individual patient needs.

The active ingredient, testosterone, is absorbed through the skin into the bloodstream, where it mimics the body's natural hormone. Once absorbed, testosterone undergoes conversion to dihydrotestosterone (DHT) and oestradiol, both of which contribute to its physiological effects. The transdermal route provides steady hormone delivery, which may help maintain more consistent serum testosterone levels throughout the day compared with some other formulations.

Mechanism of action:

• Testosterone binds to androgen receptors in target tissues

• Promotes protein synthesis and muscle development

• Maintains bone density and red blood cell production

• Supports libido and mood

Testogel pump is typically prescribed when blood tests confirm low testosterone levels accompanied by symptoms such as reduced libido, fatigue, erectile dysfunction, or loss of muscle mass. Diagnosis requires symptoms consistent with hypogonadism plus low morning total testosterone confirmed on at least two separate occasions. Your clinician will also assess luteinising hormone (LH), follicle-stimulating hormone (FSH), and sex hormone-binding globulin (SHBG) as appropriate, and identify any underlying cause.

Contraindications and cautions: Testogel must not be used in men with known or suspected prostate cancer or breast cancer. It should be used with caution in men with severe cardiac, hepatic, or renal disease, uncontrolled heart failure, obstructive sleep apnoea, or polycythaemia. Your doctor will assess your suitability before prescribing.

The MHRA-approved product requires a prescription and should only be used under medical supervision. Regular monitoring of testosterone levels, prostate health (including prostate-specific antigen [PSA] and digital rectal examination as clinically indicated), haematocrit, and blood pressure is essential to ensure safe and effective treatment. Patients should be aware that testosterone replacement is a long-term commitment requiring ongoing clinical review. For further information, consult the MHRA Summary of Product Characteristics (SmPC) and Patient Information Leaflet (PIL) for Testogel 16.2 mg/g gel (pump dispenser), available via the electronic Medicines Compendium (EMC), and NHS resources on male hypogonadism.

Step-by-Step Guide: How to Use Testogel Pump Correctly

Proper application technique is crucial for ensuring optimal testosterone absorption and minimising the risk of transfer to others. The following step-by-step guide reflects best practice recommendations for using Testogel pump safely and effectively, in line with the MHRA-approved Patient Information Leaflet.

Before application:

• Apply Testogel at approximately the same time each morning, ideally after showering

• Ensure the application site (shoulders and/or upper arms) is clean, dry, and free from cuts, irritation, or broken skin

• Wash and dry your hands thoroughly before handling the pump

• Prime the pump before first use by pressing the actuator three times fully (discard this gel)

1. Application process:
2. Dispense the gel: Press the pump fully down once for each prescribed dose (your doctor will specify how many actuations you need—typically 2 actuations to start, with an allowable range of 1–4 actuations once daily)
3. Apply to the skin: Spread the gel thinly and evenly over clean, dry, intact skin of the shoulders and/or upper arms—do not rub vigorously
4. Allow to dry: Let the gel dry for 3–5 minutes before dressing; the area should feel dry to the touch
5. Wash hands immediately: Use soap and water to remove any residual gel from your hands

Important safety note: Testogel is alcohol-based and flammable until dry. Avoid open flames, smoking, or sources of ignition until the gel has fully dried on your skin.

Your prescriber will adjust the dose based on blood test results, typically taken approximately 2–4 hours after application once treatment has reached steady state (e.g., after about 14 days of treatment, and after any dose changes). Never alter your dose without medical advice. If you miss a dose, apply it as soon as you remember on the same day; if it is nearly time for the next dose, skip the missed one—do not double up. Consistency in application timing helps maintain stable hormone levels and improves treatment outcomes.

If someone else must apply the gel for you (e.g., a carer), they should wear disposable gloves and wash their hands thoroughly with soap and water immediately afterwards.

Where to Apply Testogel and Areas to Avoid

Selecting the correct application site is essential for maximising testosterone absorption whilst minimising the risk of inadvertent transfer to others, particularly women and children. Testogel pump (16.2 mg/g) must be applied exclusively to specific areas of intact, healthy skin as specified in the MHRA-approved product information.

Approved application sites for Testogel pump:

• Shoulders and/or upper arms only: These are the only permitted sites for the Testogel 16.2 mg/g pump formulation

Apply the prescribed dose thinly and evenly over clean, dry skin of the shoulders and/or upper arms. Rotate between left and right sides daily to help prevent skin irritation. The gel should be spread thinly—thick application does not improve absorption and may increase the risk of transfer.

Areas to strictly avoid:

• Genitals: Risk of severe irritation and unpredictable absorption

• Abdomen, chest, back, or any other body area: Not approved for the pump formulation

• Broken, irritated, or diseased skin: May cause discomfort and alter absorption

• Areas with cuts or abrasions: Avoid application until the skin has healed

The shoulders and upper arms are specified because they are easily covered by clothing (e.g., a short-sleeved shirt), reducing the likelihood of skin-to-skin contact with others. These areas also provide consistent absorption. Patients should inspect application sites regularly for signs of skin irritation, redness, or allergic reaction. If persistent skin problems develop, contact your GP or prescribing clinician—alternative formulations may be considered.

After application: Once the gel has dried, cover the application area with clothing. Avoid showering, bathing, swimming, or activities causing heavy sweating for at least 2 hours after application to ensure adequate absorption. If close skin-to-skin contact with another person is likely within 2 hours of application, wash the application site with soap and water beforehand. Never apply Testogel to someone else's skin unless you are a carer wearing disposable gloves, and ensure the application area remains covered until the patient has washed.

Common Mistakes When Using Testogel Pump

Despite its straightforward application, several common errors can compromise treatment effectiveness or pose safety risks. Understanding these pitfalls helps ensure optimal therapeutic outcomes.

Timing and consistency errors:

• Applying at inconsistent times: Variable application times can cause fluctuating testosterone levels, potentially worsening symptoms

• Applying immediately before showering: Washing within 2 hours of application reduces absorption—always apply after bathing and allow at least 2 hours before washing the site

• Forgetting to allow drying time: Dressing immediately after application can transfer gel to clothing, reducing the dose absorbed and increasing transfer risk

Application technique mistakes:

• Rubbing the gel vigorously: This does not enhance absorption and may cause skin irritation; gentle spreading is sufficient

• Applying too thick a layer: Excess gel increases transfer risk without improving absorption—spread thinly over the approved area (shoulders and/or upper arms only)

• Not washing hands afterwards: Residual gel on hands can easily transfer to others or contaminate surfaces

• Applying to incorrect sites: The pump formulation is approved only for shoulders and/or upper arms—do not apply to the abdomen, chest, back, or genitals

Dose-related errors:

• Self-adjusting the dose: Changing your dose without medical guidance can lead to suboptimal testosterone levels or adverse effects

• Sharing medication: Testogel is prescribed specifically for you based on your blood results—never share with others

• Applying missed doses incorrectly: Doubling up on doses can cause excessively high testosterone levels

Safety oversights:

• Allowing skin-to-skin contact before washing: This is the most significant risk for testosterone transfer to partners or children—cover the site with clothing once dry and avoid close contact for at least 2 hours, or wash the site before contact

• Not covering the application site: Exposed gel can transfer through direct contact or contaminate surfaces

• Swimming or vigorous exercise shortly after application: Wait at least 2 hours to ensure adequate absorption

• Ignoring flammability: The gel is alcohol-based and flammable until dry—avoid flames and smoking during application and drying

If you are uncertain about any aspect of your technique, request a demonstration from your GP practice nurse or pharmacist. Many patients benefit from a review appointment after starting treatment to address practical questions and optimise their application method.

What to Do After Applying Testogel: Safety Precautions

Post-application precautions are critical for preventing testosterone transfer to others and ensuring your own safety. Testosterone exposure in women and children can cause virilisation effects, including unwanted hair growth, voice deepening, and menstrual irregularities in females, or premature sexual development in children.

Immediate post-application steps:

• Wash hands thoroughly with soap and water immediately after application—this is essential

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

• Cover the application site with clothing (e.g., a t-shirt) once dry to prevent direct skin contact with others

• Avoid open flames and smoking until the gel is fully dry (the gel is alcohol-based and flammable)

• Avoid showering, bathing, swimming, or heavy sweating for at least 2 hours after application to ensure adequate absorption

Preventing transfer to others:

• Avoid close skin-to-skin contact with partners, children, or other household members for at least 2 hours after application, or until you have washed the application site

• Wash the application site with soap and water before any close skin contact if this will occur within 2 hours of application

• Cover the site with clothing once the gel has dried

• Wash clothing and bed linens regularly to remove any residual testosterone

• If accidental contact occurs, the affected person should wash the area immediately and thoroughly with soap and water

• If a carer applies the gel for you, they must wear disposable gloves and wash their hands thoroughly afterwards

Monitoring and follow-up: Regular blood tests and clinical assessments are essential to monitor treatment response and safety. Your GP or specialist will typically arrange:

• Baseline assessments: Before starting treatment, your doctor will check testosterone levels (on two separate mornings), prostate health (PSA and digital rectal examination as clinically indicated), full blood count (including haematocrit), and blood pressure

• Testosterone levels: Measured approximately 2–4 hours after application, usually after about 14 days of treatment and following any dose adjustments, to guide dose titration

• Full blood count: To monitor haematocrit, as testosterone can increase red blood cell production

• Prostate monitoring: PSA and prostate examination as clinically indicated, in line with UK guidance

• Blood pressure and cardiovascular assessment: Particularly if you have risk factors

Your prescriber will adjust your dose based on symptom response and blood results, aiming for testosterone levels in the normal physiological range for adult men.

When to seek medical advice: Contact your GP or prescribing clinician if you experience:

• Persistent skin irritation or allergic reactions at application sites

• Signs of excessive testosterone effects (severe acne, aggression, mood swings, sleep disturbance)

• Symptoms suggesting polycythaemia (persistent headaches, dizziness, visual disturbances, flushing)

• Urinary symptoms or concerns about prostate health (difficulty passing urine, increased frequency, blood in urine)

• Mood changes, including depression, anxiety, or irritability

• Swelling of the ankles or legs, or breathing difficulties

• Prolonged or painful erections (priapism)

Reporting side effects: If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in the Patient Information Leaflet. 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. By reporting side effects, you can help provide more information on the safety of this medicine.

Never discontinue treatment abruptly without medical advice, as this may cause symptom recurrence. If you have concerns about your treatment or experience adverse effects, arrange a review with your prescribing clinician promptly. For further information, consult the NHS website on testosterone replacement therapy, the British Society for Sexual Medicine (BSSM) guidelines on adult testosterone deficiency, and the MHRA/EMC resources for Testogel 16.2 mg/g gel (pump dispenser).

Frequently Asked Questions