From the Guidelines
The recommended starting dose for testosterone gel is typically 50 mg (5 g of gel containing 1% testosterone) applied once daily to clean, dry skin, usually on the shoulders, upper arms, or abdomen. Before starting therapy, baseline blood work should include total testosterone, free testosterone, complete blood count, liver function tests, lipid panel, prostate-specific antigen (PSA), and estradiol levels 1. After initiating therapy, follow-up blood tests should be conducted at 2-3 months to assess testosterone levels, then every 6-12 months during maintenance therapy 1. Blood draws should be done in the morning, ideally 2-4 hours after gel application for accurate measurement.
Key Considerations
- Testosterone gel works by providing steady hormone levels through transdermal absorption, bypassing first-pass liver metabolism.
- Dose adjustments may be necessary based on symptoms and blood test results, with increases typically made in 25 mg increments.
- Patients should wash hands thoroughly after application and allow the gel to dry completely before dressing to prevent transfer to others.
Monitoring and Follow-up
- Testosterone levels should be tested 2 to 3 months after treatment initiation, and/or after any dose change 1.
- Once stable levels are confirmed on a given dose, monitoring every 6 to 12 months is typically sufficient 1.
- The timing of testosterone measurements will vary depending on the preparation, with levels measured midway between injections for patients receiving testosterone injections, and at any time for patients receiving transdermal preparations 1.
Safety Considerations
- Data regarding the safety of testosterone therapy have been conflicting, with some studies suggesting a possible increased risk of heart attack and stroke with the use of testosterone preparations to treat age-related hypogonadism 1.
- However, multiple associations, societies, and agencies support the use of testosterone in hypogonadal men, citing cardiometabolic benefits and low-certainty evidence of harms 1.
From the FDA Drug Label
The recommended starting dose of testosterone gel 1.62% is 40.5 mg of testosterone (2 pump actuations or a single 40.5 mg packet) applied topically once daily in the morning to the shoulders and upper arms. Prior to initiating testosterone gel 1.62%, confirm the diagnosis of hypogonadism by ensuring that serum testosterone concentrations have been measured in the morning on at least two separate days and that these serum testosterone concentrations are below the normal range. To ensure proper dosing, the dose should be titrated based on the pre-dose morning serum testosterone concentration from a single blood draw at approximately 14 days and 28 days after starting treatment or following dose adjustment. In addition, serum testosterone concentration should be assessed periodically thereafter.
The recommended starting dose for testosterone gel is 40.5 mg of testosterone, applied topically once daily in the morning. Blood work is required to confirm the diagnosis of hypogonadism, with serum testosterone concentrations measured in the morning on at least two separate days. Additionally, periodic assessments of serum testosterone concentration are necessary to ensure proper dosing and adjust the dose as needed, with evaluations at approximately 14 days and 28 days after starting treatment or following dose adjustment 2.
From the Research
Recommended Starting Dose for Testosterone Gel
- The recommended starting dose for testosterone gel is not explicitly stated in the provided studies, but one study 3 used a dose of 50mg/day of Testogel in hypogonadal men with liver cirrhosis.
- Another study 4 used increasing dosages of testosterone gel until physiologic levels of testosterone were realized or until the study period (6 weeks) was concluded, but the exact starting dose is not specified.
Recommended Blood Work
- Baseline laboratory studies that should be obtained before starting testosterone gel treatment include:
- Total testosterone
- Free testosterone
- Dihydrotestosterone
- Estradiol
- Luteinizing hormone
- Follicle-stimulating hormone
- Complete blood counts
- Lipid panels
- Chemistry panels 4
- Testosterone and free testosterone levels should be monitored weekly, and estradiol and dihydrotestosterone levels should be monitored less frequently 4
- Liver function tests, such as γ-GT, bilirubin, and triglycerides, should also be monitored, especially in patients with liver disease 5
- Hemoglobin and hematocrit levels should be monitored, as testosterone therapy can cause increases in these parameters 6