Many men using Testogel (testosterone gel) for clinically confirmed testosterone deficiency notice changes in their sexual desire and function. Experiencing increased libido whilst on testosterone replacement therapy is typically a normal and expected response, reflecting the medication's intended effect of restoring hormone levels that regulate sexual health. This article explores why Testogel affects sex drive, what changes are considered normal, when to seek medical advice, and how to manage any concerns during treatment. Understanding these effects helps ensure testosterone replacement remains both safe and beneficial.

How Testogel Affects Libido and Sexual Function

Testogel (testosterone gel) is a hormone replacement therapy prescribed for men with clinically confirmed testosterone deficiency, also known as hypogonadism. Testosterone plays a central role in regulating sexual desire, erectile function, and overall sexual health in men. When testosterone levels are low, many men experience reduced libido, difficulty achieving or maintaining erections, and diminished sexual satisfaction.

When Testogel is applied to the skin, testosterone is absorbed transdermally into the bloodstream, gradually restoring hormone levels towards the normal physiological range. This exogenous testosterone produces effects in peripheral tissues, including those involved in sexual function, while also suppressing the body's natural testosterone production through negative feedback on pituitary gonadotrophins (LH/FSH). This suppression can reduce sperm production and potentially affect fertility.

The restoration of testosterone can lead to noticeable improvements in libido, typically within 3-6 weeks of treatment, though individual responses vary considerably. Some men report a marked increase in sexual thoughts, desire, and spontaneous erections. This effect is generally considered a therapeutic benefit rather than an adverse reaction, particularly when previous low testosterone had caused distressing sexual symptoms.

It is important to understand that Testogel aims to restore normal physiological function rather than create supraphysiological (abnormally high) testosterone levels. When used as prescribed and monitored appropriately, the medication should bring testosterone into the normal reference range for adult men, which naturally supports healthy sexual function. However, the subjective experience of increased libido can feel pronounced, especially if testosterone deficiency has been longstanding.

Is Increased Sex Drive Normal on Testosterone Replacement?

Yes, experiencing an increased sex drive whilst using Testogel is a normal and expected response for many men undergoing testosterone replacement therapy (TRT). This change reflects the medication working as intended—correcting the hormonal deficiency that likely contributed to reduced libido in the first place. Research shows that testosterone replacement typically produces modest to moderate improvements in sexual desire, frequency of sexual thoughts, and overall sexual satisfaction in hypogonadal men.

The degree of change varies between individuals and depends on several factors, including:

• Baseline testosterone levels – men with more severe deficiency may notice more dramatic improvements

• Duration of deficiency – longstanding low testosterone may mean a more noticeable change when corrected

• Age and overall health – younger men and those without significant comorbidities often respond more robustly

• Dosing and absorption – individual variation in how Testogel is absorbed affects circulating testosterone levels

Most men find that their libido stabilises after the initial months of treatment as their body adjusts to restored hormone levels. The early phase of TRT can sometimes feel like a particularly strong increase in sexual interest, but this typically moderates over time to a sustainable level that feels more natural and manageable.

It is worth noting that increased libido is generally viewed as a positive treatment outcome rather than a side effect, provided it does not cause distress or relationship difficulties. The NICE Clinical Knowledge Summary (CKS) on testosterone deficiency recognises improved sexual function as one of the key benefits of appropriate testosterone replacement. However, if the increase in sex drive feels excessive, uncontrollable, or is causing problems in your daily life or relationships, this warrants discussion with your prescribing clinician.

If your libido does not improve despite achieving normal testosterone levels, other factors such as relationship issues, depression, certain medications, or sleep apnoea may be contributing.

When to Speak to Your GP About Libido Changes

Whilst increased libido is typically a normal response to Testogel, certain situations require medical review. Regular monitoring is an essential component of safe testosterone replacement therapy, and your GP or endocrinologist should be informed about how treatment is affecting you, including changes to sexual function.

You should contact your GP or prescribing clinician if you experience:

• Excessive or distressing increases in sexual thoughts that feel uncontrollable or interfere with daily activities, work, or relationships

• Behavioural changes such as increased risk-taking, aggression, or mood instability alongside heightened libido

• Persistent erections lasting longer than four hours (priapism)—this is a medical emergency requiring immediate attention; call 999 or attend A&E immediately

• Relationship difficulties arising from mismatched libido levels with your partner

• No improvement in sexual symptoms despite several months of treatment, which may indicate inadequate dosing or absorption

• New or worsening sleep apnoea symptoms such as loud snoring, witnessed breathing pauses during sleep, or excessive daytime sleepiness

• Swelling in your ankles or legs, or increasing breathlessness, which could indicate fluid retention

Your healthcare provider will typically arrange regular blood tests to monitor testosterone levels, with timing of blood samples following the specific guidance for your Testogel formulation. Standard monitoring includes baseline tests, review at 3-6 months after starting treatment or changing dose, then at least annually. Tests usually include testosterone levels, full blood count (to check haematocrit), PSA (prostate-specific antigen), and sometimes a digital rectal examination depending on age and risk factors.

It is also important to discuss any other side effects you may be experiencing, such as skin reactions at the application site, mood changes, sleep disturbances, or changes in urinary symptoms. Your clinician can assess whether these are related to testosterone levels and adjust your treatment accordingly. Open communication ensures that testosterone replacement remains both safe and effective, optimising benefits whilst minimising potential risks.

If you experience any suspected side effects, you can report them via the MHRA Yellow Card Scheme.

Managing Sexual Side Effects During Testogel Treatment

For most men, the increase in libido during Testogel treatment is manageable and welcome, but there are practical strategies to help if you find the changes challenging. Effective management involves both medical optimisation and lifestyle considerations.

Medical management approaches include:

• Dose adjustment – if testosterone levels are at the higher end of normal or slightly elevated, your clinician may reduce the Testogel dose to achieve more moderate levels whilst still treating deficiency

• Regular monitoring – ensuring testosterone levels remain in the appropriate therapeutic range prevents excessive hormonal stimulation

• Review of application technique – correct application ensures consistent absorption and appropriate testosterone levels

Lifestyle and relationship strategies can also be valuable. Open communication with your partner about the changes you are experiencing helps manage expectations and maintain relationship harmony. Some couples find that counselling or sex therapy provides useful support during the adjustment period. Stress management techniques, including regular exercise, adequate sleep, and mindfulness practices, can help you feel more in control of heightened sexual feelings.

It is crucial to apply Testogel correctly to ensure consistent absorption and avoid transferring testosterone to others. Apply to clean, dry, intact skin according to your specific product instructions: Testogel 50 mg/5 g (1%) can be applied to shoulders, upper arms, or abdomen, while Testogel 16.2 mg/g should only be applied to shoulders or upper arms. Never apply to the genitals or to broken or irritated skin. Allow the gel to dry completely before dressing, and wash your hands thoroughly with soap and water afterwards. Cover the application site with clothing before close physical contact with others, particularly women and children, as testosterone transfer can cause unwanted effects. Wait at least 2 hours before washing, showering or swimming. Be aware that the gel is flammable until dry—avoid naked flames and smoking during application and drying.

Never adjust your Testogel dose without medical supervision. Stopping treatment abruptly or using more than prescribed can cause hormonal fluctuations and potentially serious side effects. If you are concerned about any aspect of your treatment, including sexual side effects, your healthcare team can work with you to find the most appropriate management approach whilst maintaining the therapeutic benefits of testosterone replacement.

Frequently Asked Questions