How can transfer of Androgel (testosterone) be prevented?

From the Guidelines

To prevent transfer of AndroGel, it is crucial to follow strict precautions, including washing hands thoroughly after application, covering the application site with clothing, and avoiding skin-to-skin contact with others, especially women and children, as highlighted in the AUA guideline on testosterone deficiency 1. When using AndroGel, it is essential to apply the gel to clean, dry skin of shoulders, upper arms, or abdomen as directed and allow the application site to dry completely before covering with clothing.

• Key precautions to prevent transfer include:
  • Washing hands thoroughly with soap and water after application
  • Covering the application site with clothing before any skin-to-skin contact with others
  • Avoiding direct contact with the application area, especially for women and children
  • Washing the application area thoroughly with soap and water before direct contact
  • Never allowing others to touch the application sites or unwashed clothing that has contacted these areas
  • Showering before swimming or bathing with others to remove residual gel These precautions are necessary because testosterone gel can be absorbed through skin contact, potentially causing unwanted masculinizing effects in women and children, including enlarged genitalia, premature puberty, increased body hair, and aggressive behavior, as noted in the guideline 1. The FDA includes medication guides with topical testosterone preparations and recommends observing for signs and symptoms of early puberty in children as well as avoiding contact with the unwashed or uncovered areas where the drug has been applied, emphasizing the importance of these precautions 1.

From the FDA Drug Label

Patients should wash their hands with soap and water immediately after applying testosterone gel 1.62%. Patients should cover the application site(s) with clothing (e.g., a t-shirt) after the gel has dried. Prior to situations in which direct skin-to-skin contact is anticipated, patients should wash the application site(s) thoroughly with soap and water to remove any testosterone residue. In the event that unwashed or unclothed skin to which testosterone gel 1.62% has been applied comes in direct contact with the skin of another person, the general area of contact on the other person should be washed with soap and water as soon as possible. Apply testosterone gel 1.62% only to your shoulders and upper arms that will be covered by a short sleeve t-shirt. Wash your hands right away with soap and water after applying testosterone gel 1.62%. After the gel has dried, cover the application area with clothing. Keep the area covered until you have washed the application area well or have showered. If you expect to have skin-to-skin contact with another person, first wash the application area well with soap and water. If a child or woman touches the area where you have applied testosterone gel 1.62%, that area on the child or woman should be washed well with soap and water right away.

To prevent transfer of Androgel (testosterone), follow these steps:

• Wash hands with soap and water immediately after application
• Cover the application site with clothing after the gel has dried
• Wash the application site thoroughly with soap and water before skin-to-skin contact
• Apply only to the upper arms and shoulders, and cover with a short sleeve t-shirt
• Wash the area if it comes into contact with another person's skin 2 2

From the Research

Preventing Transfer of Androgel

To prevent the transfer of Androgel (testosterone) to others, several strategies can be considered:

• Covering the application site with clothing, such as a t-shirt, can prevent transfer, as shown in a study where transfer from the abdomen was prevented when a t-shirt was worn 3.
• Washing the application site before contact with others can also reduce the risk of transfer, as mean C(av) was comparable to baseline and C(max) was slightly higher when the application site was washed before contact 3.
• Applying the gel to areas that are less likely to come into contact with others, such as the upper arms or shoulders, may also reduce the risk of transfer, as transfer was higher after direct skin-to-skin contact when the application and contact sites were upper arms/shoulders versus the abdomen 3.
• Avoiding skin contact with others for a certain period after applying the gel, such as 2 hours, can also reduce the risk of transfer, as testosterone concentrations returned to baseline within 48 hours after last skin contact 3.

Application Site and Transfer

The application site of Androgel can affect the risk of transfer:

• Applying the gel to the abdomen may result in higher transfer rates compared to applying it to the upper arms or shoulders 3.
• Washing the application site before contact can reduce the risk of transfer, regardless of the application site 3.

Studies on Transfer of Androgel

Several studies have investigated the transfer of Androgel:

• A study found that showering within 30 minutes after application of testosterone gel reduces absorption of testosterone and results in unacceptably low plasma testosterone levels in most users, and therefore, this strategy cannot be recommended to prevent involuntary transfer of testosterone 4.
• Another study found that there is a risk of testosterone transfer from males using 1.62% testosterone gel to others who come into direct skin contact with the application site, and this can be prevented by covering the application site with a t-shirt or washing the application site before contact 3.
• A study also found that considerable amounts of testosterone remain on the intact skin for several hours after evaporation of the alcohol vehicle, but contamination of a second subject causing side-effects seems very unlikely 5.