When do you come off Testogel? This decision is highly individualised and must be made with your doctor, typically an endocrinologist or men's health specialist. Testogel is a transdermal testosterone replacement therapy prescribed for confirmed hypogonadism. Some men require lifelong treatment, whilst others may stop after addressing reversible causes such as obesity or medication-induced low testosterone. Discontinuation depends on factors including the type of hypogonadism, treatment response, adverse effects, and patient preference. Regular monitoring of testosterone levels, blood counts, and prostate health is essential throughout treatment and after stopping. This article explains when and how to safely discontinue Testogel under medical supervision.

What Is Testogel and How Does It Work?

Testogel is a transdermal testosterone replacement therapy (TRT) prescribed to men with confirmed hypogonadism—a condition characterised by abnormally low testosterone levels. Available as a clear or slightly opalescent gel, Testogel contains testosterone as its active ingredient, in concentrations of 1% or 1.62%. The gel is applied once daily to clean, dry, intact skin, with the 1% formulation applied to shoulders, upper arms, or abdomen, while the 1.62% formulation should only be applied to shoulders and upper arms.

The mechanism of action involves supplementing endogenous testosterone production. Once absorbed, testosterone binds to androgen receptors in various tissues, influencing protein synthesis, muscle mass, bone density, libido, mood, and energy levels. In men with hypogonadism, Testogel aims to restore testosterone to physiological levels, thereby alleviating symptoms such as fatigue, reduced sexual function, loss of muscle mass, and mood disturbances.

Testogel is licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) and is typically initiated following biochemical confirmation of low testosterone on at least two separate morning blood tests, alongside clinical symptoms. Testosterone replacement should only be prescribed when there is clear biochemical and clinical evidence of hypogonadism, and treatment should be monitored regularly to assess efficacy and safety.

It is important to note that Testogel is not suitable for everyone. Contraindications include prostate or breast cancer, and caution is advised in men with cardiovascular disease, sleep apnoea, polycythaemia, severe cardiac, hepatic or renal insufficiency, and benign prostatic hyperplasia. Common adverse effects include skin reactions at the application site, acne, mood changes, and increased haematocrit levels.

Patients should be counselled that testosterone therapy suppresses spermatogenesis and is unsuitable when trying to conceive. Strict precautions are necessary to prevent testosterone transfer to others: wash hands thoroughly after application, allow gel to dry completely, cover the application site with clothing, and avoid skin contact with others—especially pregnant women and children. Patients should observe the recommended interval before washing, swimming, or bathing.

When Do You Come Off Testogel?

The decision to discontinue Testogel is individualised and should always be made in consultation with a healthcare professional, typically an endocrinologist or specialist in men's health. There is no predetermined duration for testosterone replacement therapy; some men may require lifelong treatment, whilst others may stop after a defined period depending on the underlying cause of their hypogonadism.

Primary hypogonadism—where the testes themselves are unable to produce adequate testosterone due to congenital conditions, trauma, infection, or chemotherapy—is generally permanent, and discontinuation is rarely appropriate unless significant adverse effects occur or the patient chooses to stop treatment. In contrast, secondary hypogonadism (hypothalamic or pituitary dysfunction) may sometimes be reversible, particularly if caused by obesity, certain medications (such as opioids or corticosteroids), or lifestyle factors. In these cases, addressing the underlying cause may restore natural testosterone production, allowing for cessation of TRT.

Other reasons for stopping Testogel include:

• Development of contraindications, such as prostate cancer

• Adverse effects that outweigh benefits, including polycythaemia (haematocrit >0.54), worsening sleep apnoea, or mood disturbances

• Patient preference, after discussion of risks and benefits

• Lack of clinical response despite adequate dosing and compliance

• Restoration of natural testosterone production following treatment of reversible causes

Regular monitoring is essential throughout treatment. UK guidance recommends checking testosterone levels about 3 months after starting or changing dose and at least annually thereafter. Full blood count (including haematocrit) should be checked at baseline, 3 and 12 months, then annually. Prostate-specific antigen (PSA) and digital rectal examination (DRE) should be performed according to age and risk factors, with referral to urology if PSA is above age-specific thresholds or if DRE is abnormal, following NICE NG12 guidance.

How to Safely Stop Using Testogel

Discontinuing Testogel should be done under medical supervision. While there is no requirement to taper the dose when stopping testosterone replacement therapy, it is important to agree a plan with your prescriber to manage the potential return of hypogonadal symptoms.

A typical approach involves:

• Discussing with your doctor whether to stop treatment immediately or gradually reduce the dose based on your individual circumstances

• Monitoring symptoms closely after stopping, including energy levels, mood, libido, and physical well-being

• Conducting repeat blood tests to assess endogenous testosterone recovery, with testing typically performed several weeks after cessation

For men with secondary hypogonadism, particularly those whose condition was induced by reversible factors, the hypothalamic-pituitary-gonadal (HPG) axis may recover spontaneously after stopping exogenous testosterone. However, this recovery can take several months, and some men may experience a prolonged period of low testosterone before natural production resumes. In such cases, specialist-led treatments to stimulate endogenous production might be considered, though these are often off-label in the UK.

Patients should be advised to:

• Maintain regular contact with their GP or specialist after stopping treatment

• Report any concerning symptoms promptly, including severe fatigue, depression, or loss of libido

• Follow the agreed cessation plan with their healthcare provider

• Continue healthy lifestyle measures, including regular exercise, balanced nutrition, adequate sleep, and stress management, which support natural testosterone production

It is important to note that testosterone therapy suppresses spermatogenesis, and recovery of fertility may take months after stopping treatment. If fertility is a goal, discuss this with your healthcare provider, as additional monitoring or referral may be appropriate.

What Happens When You Stop Testogel Treatment?

When Testogel is discontinued, the body's response depends largely on the underlying cause of hypogonadism and the duration of treatment. In men with permanent primary hypogonadism, testosterone levels will fall back to pre-treatment levels within days to weeks, as the half-life of transdermal testosterone is relatively short. This typically results in the return of hypogonadal symptoms, including fatigue, reduced libido, erectile dysfunction, mood changes, decreased muscle mass, and increased body fat.

In cases of secondary hypogonadism, the outcome is more variable. If the underlying cause has been addressed—such as weight loss in obesity-related hypogonadism or cessation of offending medications—natural testosterone production may gradually resume. However, prolonged use of exogenous testosterone can suppress the HPG axis, and recovery may take several months. During this recovery period, men may experience:

• Return of hypogonadal symptoms, including low mood, irritability, fatigue, and reduced motivation

• Physical changes, such as decreased muscle strength, increased fat deposition, and reduced bone density over time

• Sexual dysfunction, including reduced libido and erectile difficulties

• Hot flushes and sweating, similar to those experienced with low testosterone

The psychological and physical impact of returning to low testosterone levels can significantly affect quality of life. Some men may experience depressive symptoms, which should be monitored carefully. If you experience severe low mood or thoughts of self-harm, seek urgent medical attention through your GP, NHS 111, or emergency services (999) as appropriate.

Haematological changes also occur after stopping Testogel. Elevated haematocrit levels, a common side effect during treatment, typically normalise within weeks to months. Conversely, men may notice changes in lipid profiles and body composition over a longer period.

Patients should be counselled that symptom recurrence does not necessarily indicate treatment failure but reflects the underlying hormonal deficiency. If symptoms become intolerable and natural testosterone production does not recover, reinitiation of TRT may be considered after thorough reassessment.

Monitoring and Follow-Up After Stopping Testogel

Structured follow-up is essential after discontinuing Testogel to assess endogenous testosterone recovery, monitor for symptom recurrence, and identify any complications. The frequency and nature of monitoring should be tailored to individual circumstances, but general principles include:

Biochemical monitoring should commence approximately four to six weeks after complete cessation, allowing sufficient time for exogenous testosterone to clear and for any endogenous production to become apparent. Key investigations include:

• Early morning total testosterone (ideally between 8–10 am), measured on at least two separate occasions to confirm levels

• Luteinising hormone (LH) and follicle-stimulating hormone (FSH) to assess HPG axis function and differentiate between primary and secondary hypogonadism

• Full blood count to monitor haematocrit normalisation

• Consider lipid profile and HbA1c if clinically indicated, particularly in men with pre-existing metabolic risk factors

Clinical assessment should focus on:

• Symptom evaluation, using validated questionnaires or structured clinical interviews to assess energy, mood, sexual function, and quality of life

• Physical examination, including assessment of muscle mass, body composition, and secondary sexual characteristics

• Cardiovascular and metabolic health, particularly in men with pre-existing risk factors

Patients should be advised to contact their GP if they experience:

• Severe or persistent low mood or depression

• Significant deterioration in quality of life

• New or worsening erectile dysfunction

• Unexplained weight gain or loss

• Symptoms suggestive of cardiovascular disease

Long-term follow-up may be necessary, particularly if testosterone levels remain low or symptoms persist. Consider endocrinology referral for persistent low testosterone with inappropriately low/normal LH/FSH, pituitary symptoms, or other red flags. If fertility is a goal and recovery is delayed, referral for semen analysis may be appropriate.

If you experience any suspected side effects from Testogel, even after stopping treatment, report them through the MHRA Yellow Card Scheme. Shared decision-making, incorporating patient preferences and clinical evidence, should guide all management decisions following Testogel discontinuation.

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