Is Testogel any good for treating low testosterone? Testogel is a widely prescribed transdermal testosterone replacement therapy licensed in the UK for male hypogonadism. Clinical evidence demonstrates that it effectively restores testosterone levels in men with confirmed deficiency, improving symptoms such as low libido, fatigue, and reduced muscle mass. However, treatment success depends on proper patient selection, correct application technique, regular monitoring, and realistic expectations. This article examines the clinical evidence, benefits, limitations, and patient experiences to help you understand whether Testogel represents an appropriate treatment option for testosterone deficiency.

What Is Testogel and How Does It Work?

Testogel is a transdermal testosterone replacement therapy (TRT) licensed in the UK for treating male hypogonadism—a condition characterised by abnormally low testosterone levels. It is available in two formulations: Testogel 50 mg/5 g (1%) sachets and Testogel 16.2 mg/g (1.62%) pump. The clear, colourless gel is applied once daily to clean, dry skin, with specific application sites depending on the formulation: shoulders and upper arms only for the 16.2 mg/g pump, while the 1% sachets can be applied to shoulders, upper arms or abdomen. The gel should never be applied to the genital area.

The gel is absorbed through the skin, delivering testosterone directly into the bloodstream, thereby bypassing first-pass hepatic metabolism and providing stable serum testosterone levels compared to oral preparations. Once absorbed, testosterone binds to androgen receptors in various tissues, exerting its physiological effects on muscle mass, bone density, libido, mood regulation, and overall metabolic function.

Key features of Testogel include:

• Convenient administration – once-daily application without injections

• Steady hormone delivery – maintains physiological levels over 24 hours with daily dosing

• Adjustable dosing – can be titrated based on blood testosterone levels and clinical response

• MHRA-approved – licensed for use in confirmed testosterone deficiency

To prevent testosterone transfer to others, patients must allow the gel to dry completely, wash hands thoroughly after application, and cover the application site with clothing. If close contact is expected, the application site should be washed first. Patients should wait at least 2 hours (16.2 mg/g pump) or 6 hours (1% sachets) before showering or swimming.

It is essential that Testogel is prescribed only after biochemical confirmation of hypogonadism through at least two morning testosterone measurements, alongside appropriate clinical symptoms. The Medicines and Healthcare products Regulatory Agency (MHRA) emphasises that testosterone therapy should not be used for age-related decline in testosterone without confirmed deficiency.

Clinical Evidence: Is Testogel Effective for Low Testosterone?

Clinical evidence supports the efficacy of Testogel in restoring physiological testosterone levels in men with confirmed hypogonadism. Multiple randomised controlled trials and real-world studies have demonstrated that transdermal testosterone gel consistently normalises serum testosterone concentrations in the majority of patients when dosed appropriately. A systematic review published in the Journal of Clinical Endocrinology & Metabolism confirmed that testosterone gels effectively improve hypogonadal symptoms, including sexual function, mood, and energy levels, with improvements typically observed within 3–6 months of treatment initiation.

NICE Clinical Knowledge Summary (CKS) acknowledges testosterone replacement as an appropriate treatment for men with symptomatic hypogonadism confirmed by biochemical testing. The evidence base shows that Testogel produces measurable improvements in libido and erectile function in many men with hypogonadism. Additionally, studies indicate modest but significant improvements in body composition, including increased lean muscle mass and reduced fat mass, alongside beneficial effects on bone mineral density in men with osteoporosis or osteopenia secondary to testosterone deficiency.

However, the evidence regarding certain outcomes remains more nuanced. Whilst many patients report improved mood and energy levels, the magnitude of benefit varies considerably between individuals. There is no official link established between testosterone therapy and cardiovascular protection, and recent meta-analyses have produced conflicting results regarding cardiovascular safety. The effectiveness of Testogel is highly dependent on achieving target testosterone levels in the mid-normal range according to local laboratory reference ranges, which requires regular monitoring and dose adjustment. Blood tests should be performed according to the SmPC (e.g., morning trough levels around day 14 post-initiation or dose change for the 16.2 mg/g formulation).

Some patients may not achieve adequate absorption through transdermal delivery despite correct application technique and adherence, and may require alternative formulations such as intramuscular injections or subcutaneous implants.

Benefits and Limitations of Testogel Treatment

Testogel offers several distinct advantages that make it a popular first-line option for testosterone replacement therapy. The non-invasive application eliminates needle phobia and the discomfort associated with intramuscular injections, improving treatment adherence for many patients. The daily dosing regimen allows for flexible dose titration, enabling clinicians to adjust treatment based on individual response and blood test results. Unlike long-acting injectable preparations, Testogel can be discontinued relatively quickly if adverse effects occur, providing an important safety margin. The transdermal route also avoids hepatotoxicity concerns associated with oral testosterone preparations, which are rarely used in the UK.

Key benefits include:

• Stable testosterone levels with minimal fluctuation

• Improved sexual function and libido in responsive patients

• Enhanced mood, energy, and quality of life

• Positive effects on body composition and bone density

• Convenient home administration without clinic visits

However, Testogel has notable limitations that patients and clinicians must consider. Skin-to-skin transfer represents a significant safety concern—testosterone can be transferred to partners or children through close physical contact, potentially causing virilisation in women and children. Patients must allow the gel to dry completely, cover the application site with clothing, and wash hands thoroughly after application. Before close contact, the application site should be washed. Some individuals experience local skin reactions, including irritation, redness, or allergic contact dermatitis at application sites.

Other limitations include variable absorption rates between individuals, which may necessitate higher doses or alternative delivery methods in some patients. The daily application requirement demands consistent adherence, and missed doses can result in symptom recurrence. Cost considerations may also be relevant, as costs vary by formulation, dose, and local formulary—patients should check local guidance. Additionally, there is no official link between testosterone therapy and improved cardiovascular outcomes, and long-term safety data beyond 5–10 years remain limited.

Importantly, testosterone replacement therapy suppresses spermatogenesis and may impair fertility. Men who wish to father children should discuss alternatives or specialist referral before starting treatment.

Potential Side Effects and Safety Considerations

Whilst Testogel is generally well-tolerated, patients should be aware of potential adverse effects and important safety considerations. Common side effects (affecting 1–10% of users) include skin reactions at application sites (erythema, pruritus, dry skin), acne or oily skin, headache, and mood changes. These effects are typically mild and often resolve with continued use or dose adjustment. Less commonly, patients may experience gynaecomastia (breast tissue enlargement), peripheral oedema, or changes in libido.

Serious adverse effects requiring medical attention include:

• Polycythaemia (elevated red blood cell count) – occurs in transdermal users but less frequently than with injectable formulations; treatment should be withheld or reduced if haematocrit exceeds 0.54

• Prostate effects – benign prostatic hyperplasia symptoms or elevated PSA levels

• Sleep apnoea – worsening of existing condition or new-onset symptoms

• Venous thromboembolism – the MHRA has highlighted a risk of venous thromboembolism with testosterone products

• Cardiovascular events – whilst evidence remains inconclusive, some studies suggest potential increased risk in certain populations

The MHRA emphasises that testosterone therapy is contraindicated in men with prostate or breast cancer, and should be used cautiously in those with cardiovascular disease, severe heart failure, or untreated sleep apnoea. Regular monitoring is essential and should include full blood count (to detect polycythaemia), PSA measurements, blood pressure, and serum testosterone at baseline, 3–6 months, and annually thereafter. Liver function tests and lipid profiles should be checked if clinically indicated.

Important drug interactions include potentiation of coumarin anticoagulants (requiring INR monitoring) and altered requirements for insulin or oral hypoglycaemic medications (requiring blood glucose monitoring).

Patient safety advice:

Patients should seek urgent medical attention (call 999 or go to A&E) for chest pain, sudden shortness of breath, or one-sided leg swelling. They should contact their GP for persistent headaches, visual disturbances, or urinary symptoms. Suspected side effects should be reported via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

To prevent testosterone transfer, application sites must be covered with clothing, hands washed thoroughly after application, and patients should shower before intimate contact. Women and children should avoid contact with application sites. Patients should inform all healthcare providers about testosterone use, particularly if taking interacting medications.

Patient Experiences and Treatment Outcomes with Testogel

Patient experiences with Testogel vary considerably, reflecting the heterogeneous nature of hypogonadism and individual treatment responses. Clinical audits and patient-reported outcome studies indicate that many men report overall satisfaction with Testogel treatment, citing improvements in energy levels, sexual function, and general wellbeing as primary benefits. Many patients appreciate the convenience of home administration and the absence of injection-related discomfort, which contributes to better long-term adherence compared to injectable alternatives.

Patients typically report that symptom improvement begins within 4–12 weeks, with maximal benefits observed after 6–12 months of consistent treatment. Sexual function improvements, including libido and erectile quality, are often among the first noticeable changes. Enhanced mood, reduced fatigue, and improved motivation generally follow within 2–3 months. Physical changes such as increased muscle mass and strength develop more gradually over 6–12 months, whilst bone density improvements require at least 12–24 months of therapy.

However, not all experiences are uniformly positive. Some patients discontinue Testogel within the first year, citing reasons including inadequate symptom relief, skin irritation, inconvenience of daily application, concerns about transfer to family members, or adverse effects such as mood changes or acne. Some men find the requirement to avoid swimming or showering for several hours after application (at least 2 hours for 16.2 mg/g pump; 6 hours for 1% sachets) restrictive to their lifestyle. Real-world data suggest that achieving optimal testosterone levels may require dose adjustments in many patients, necessitating patience during the titration phase.

Factors associated with better outcomes include:

• Confirmed biochemical hypogonadism (rather than borderline levels)

• Younger age and absence of significant comorbidities

• Good treatment adherence and proper application technique

• Regular monitoring and dose optimisation

• Management of comorbidities (e.g., obesity, sleep apnoea)

• Realistic expectations about treatment benefits

Patients considering Testogel should discuss their individual circumstances, lifestyle factors, and treatment goals with their healthcare provider to determine whether it represents the most appropriate testosterone replacement option for their specific situation.

Frequently Asked Questions