What age should you stop using Testogel? There is no specific upper age limit for testosterone replacement therapy with Testogel in the UK. The decision to continue or discontinue treatment depends on individual clinical factors rather than chronological age alone. Older men can benefit from Testogel well into their 70s and 80s if hypogonadism is confirmed and no contraindications exist. However, age-related comorbidities—including cardiovascular disease, prostate health, and polycythaemia risk—require careful monitoring. This article explores when Testogel should be stopped, safety considerations for older adults, and alternative treatment options available in the UK.

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 as a clear, colourless gel containing testosterone in two formulations: 1% gel and 16.2 mg/g gel (metered-dose pump).

The active ingredient, testosterone, is absorbed through the skin into the bloodstream, where it exerts its physiological effects. Once absorbed, testosterone binds to androgen receptors in various tissues, influencing muscle mass, bone density, libido, mood, and energy levels. The gel formulation allows for steady, controlled delivery of testosterone throughout the day.

Mechanism of action: Testosterone replacement aims to restore serum testosterone to normal physiological ranges, typically within the mid-normal range of your laboratory's reference interval. By doing so, it alleviates symptoms associated with hypogonadism, such as reduced sexual function, fatigue, loss of muscle mass, and decreased bone mineral density. The transdermal route offers the advantage of avoiding first-pass hepatic metabolism, reducing the risk of liver toxicity compared to oral preparations.

Testogel is typically prescribed following biochemical confirmation of hypogonadism—usually two early-morning serum testosterone measurements below the normal range—alongside clinical symptoms. It is important to note that Testogel is not licensed for use in women or children, and is contraindicated in men with known or suspected prostate or breast cancer.

Application instructions vary by formulation: the 1% gel can be applied to clean, dry skin on the shoulders, upper arms, or abdomen, while the 16.2 mg/g gel should only be applied to the shoulders and upper arms. Always wash hands thoroughly after application, cover the application site with clothing once dry, and avoid skin-to-skin contact with others, particularly women and children, to prevent testosterone transfer.

Is There an Age Limit for Using Testogel?

There is no specific upper age limit for using Testogel stipulated by the MHRA or in the product's Summary of Product Characteristics (SmPC). Testosterone replacement therapy can be prescribed to men of any age, provided they have a confirmed diagnosis of hypogonadism and no contraindications to treatment. However, clinical decision-making becomes more nuanced in older adults due to age-related comorbidities and safety considerations.

In practice, age alone should not be a barrier to testosterone replacement if clinically indicated. Many men continue to benefit from TRT well into their 70s and 80s, particularly if hypogonadism is contributing to reduced quality of life, sarcopenia (muscle loss), osteoporosis, or metabolic dysfunction. The key principle is individualised assessment: each patient's cardiovascular risk profile, prostate health, haematological parameters, and overall frailty must be carefully evaluated.

NICE Clinical Knowledge Summary (CKS) on testosterone deficiency does not specify an age cut-off but emphasises the importance of thorough investigation before initiating TRT in any age group. In older men, particular attention should be paid to:

• Cardiovascular disease: The MHRA has noted that evidence regarding cardiovascular risks remains inconclusive, but advises monitoring in men with pre-existing cardiovascular conditions.

• Prostate cancer screening: While testosterone does not cause prostate cancer, it may stimulate existing disease.

• Polycythaemia risk: Older men are more susceptible to elevated haematocrit levels, increasing thrombotic risk.

Ultimately, the decision to continue or stop Testogel in older age should be based on ongoing clinical benefit, tolerability, and individualised risk-benefit assessment rather than chronological age alone.

When Should You Consider Stopping Testogel Treatment?

Discontinuation of Testogel should be considered in several clinical scenarios, regardless of age. The decision to stop treatment is typically guided by lack of efficacy, development of contraindications, or patient preference following informed discussion with a healthcare professional.

Key reasons to consider stopping Testogel include:

• Prostate abnormalities: Development of prostate cancer or significant prostatic symptoms (e.g., severe lower urinary tract symptoms) may necessitate cessation. Regular monitoring of prostate-specific antigen (PSA) is essential, particularly in men over 50, with digital rectal examination (DRE) performed based on clinical indication.

• Cardiovascular events: If a patient experiences a myocardial infarction, stroke, or develops unstable angina, TRT should be reviewed and may require temporary cessation pending specialist cardiovascular assessment.

• Polycythaemia: Elevated haematocrit (>0.54 or 54%) increases the risk of thromboembolism. If this occurs despite dose adjustment or venesection, stopping Testogel may be necessary.

• Lack of symptomatic improvement: If symptoms of hypogonadism do not improve after 6–12 months of adequate treatment with confirmed therapeutic testosterone levels, the diagnosis should be reconsidered and treatment may be discontinued.

• Patient choice: Some men may choose to stop due to side effects (skin irritation, acne, mood changes) or lifestyle factors (inconvenience of daily application, concerns about transfer to partners or children).

Gradual withdrawal is not typically required as testosterone levels will naturally decline over several days following cessation. However, patients should be counselled that symptoms of hypogonadism may return. Regular follow-up is advisable to reassess symptoms and consider alternative management strategies if needed.

If you experience side effects from Testogel, report them to your healthcare professional and consider reporting via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Monitoring and Safety Considerations for Older Adults

Older adults using Testogel require more frequent and comprehensive monitoring than younger patients due to increased susceptibility to adverse effects and age-related comorbidities. NICE CKS and the British Society for Sexual Medicine (BSSM) recommend a structured monitoring protocol to ensure safe, effective treatment.

Baseline assessments before initiating TRT should include:

• Full blood count (FBC) to assess haematocrit and haemoglobin

• Serum testosterone (two early-morning samples)

• PSA in men over 50 or those with prostate symptoms

• Lipid profile and HbA1c (particularly in those with metabolic syndrome)

• Liver function tests

• Bone density scan (DEXA) if clinically indicated based on fracture risk assessment

Ongoing monitoring during treatment typically involves:

• 3-month review: Assess symptom response, measure serum testosterone (for gel formulations, ideally 2–6 hours post-application as per BSSM guidance), check FBC for polycythaemia, and review PSA.

• 6–12 monthly reviews thereafter: Continue monitoring testosterone levels, FBC, PSA, and lipid profile. Adjust dose if testosterone levels are suboptimal or supraphysiological.

Specific safety considerations in older adults:

• Cardiovascular risk: Older men with pre-existing heart disease should be counselled about potential risks. Any chest pain, breathlessness, or leg swelling warrants urgent medical review.

• Prostate monitoring: Regular PSA monitoring is recommended. A PSA rise >1.4 ng/mL in one year or PSA >4.0 ng/mL (lower in high-risk men) should prompt urology referral. DRE should be performed based on clinical indication.

• Polycythaemia management: If haematocrit exceeds 0.54, consider dose reduction or temporary cessation. Venesection may be required in persistent cases.

• Sleep apnoea: Testosterone can worsen obstructive sleep apnoea; symptoms such as excessive daytime sleepiness or witnessed apnoeas should be investigated.

Patients should be advised to report any concerning symptoms promptly and attend all scheduled monitoring appointments to ensure treatment remains safe and beneficial. Any suspected side effects can be reported through the MHRA Yellow Card scheme.

Alternatives to Testogel for Testosterone Replacement

For men who cannot tolerate Testogel, prefer a different administration route, or require discontinuation, several alternative testosterone replacement options are available in the UK, each with distinct advantages and limitations.

Intramuscular testosterone injections are widely used alternatives. Sustanon 250 mg is administered every 2–3 weeks (though frequency may be individualised), providing a more affordable option but with fluctuating testosterone levels that may cause mood swings or energy dips between doses. Nebido (testosterone undecanoate 1000 mg) is a long-acting injection given every 10–14 weeks after initial loading doses, offering stable testosterone levels and improved convenience for patients who dislike daily gel application. However, injections require healthcare professional administration and carry risks of injection site reactions.

Alternative testosterone gels include Tostran 2% gel, Testim 50 mg/5 g gel, and Testavan 20 mg/g transdermal gel. These have similar efficacy to Testogel but with different application methods and concentrations that some patients may prefer.

Testosterone patches provide another transdermal option, applied nightly to the skin. They offer steady hormone delivery but may cause more skin irritation than gels. Availability in the UK may be limited and might require specialist prescribing.

Oral testosterone preparations are not routinely available in the UK and are not generally recommended due to potential liver toxicity and variable absorption.

Non-hormonal alternatives may be appropriate for some men:

• Lifestyle modifications: Weight loss, resistance exercise, and improved sleep can naturally boost testosterone levels in men with obesity or metabolic syndrome.

• Treatment of underlying conditions: Addressing hypothyroidism, hyperprolactinaemia, or discontinuing medications that suppress testosterone (e.g., opioids, corticosteroids) may restore normal levels without TRT.

• Selective symptom management: For isolated symptoms such as erectile dysfunction, phosphodiesterase-5 inhibitors (e.g., sildenafil) may be effective without requiring full testosterone replacement.

The choice of alternative should be individualised based on patient preference, comorbidities, cost considerations, and treatment goals. Specialist endocrinology or urology input may be valuable in complex cases or when standard treatments have failed.

Frequently Asked Questions