Recommended Dosage and Usage of Androgel for Hypogonadism in Adult Males
The recommended starting dose of Androgel 1.62% for treating hypogonadism in adult males 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. 1
Diagnosis Confirmation Before Initiating Therapy
Before starting Androgel 1.62%, it's essential to:
- Confirm hypogonadism diagnosis with morning serum testosterone measurements below normal range on at least two separate days 1
- Ensure proper diagnostic workup to rule out secondary causes of hypogonadism 2
Dosing and Titration Protocol
Initial Dosing
- Start with 40.5 mg of testosterone (2 pump actuations or a single 40.5 mg packet) applied once daily in the morning 1
Dose Adjustment
Dose should be titrated based on pre-dose morning serum testosterone concentration at approximately:
- 14 days after starting treatment
- 28 days after starting treatment
- Periodically thereafter 1
Titration Guidelines
| Pre-Dose Morning Total Serum Testosterone | Dose Adjustment |
|---|---|
| >750 ng/dL | Decrease daily dose by 20.25 mg (1 pump actuation or one 20.25 mg packet) |
| 350-750 ng/dL | No change: continue on current dose |
| <350 ng/dL | Increase daily dose by 20.25 mg (1 pump actuation or one 20.25 mg packet) |
Dose Range
- Minimum: 20.25 mg of testosterone (1 pump actuation or a single 20.25 mg packet)
- Maximum: 81 mg of testosterone (4 pump actuations or two 40.5 mg packets) 1
Administration Instructions
Application Site
- Apply to clean, dry, intact skin of the upper arms and shoulders only
- Do not apply to abdomen, genitals, chest, armpits, or knees 1
- Arms/shoulders application provides optimal absorption compared to other sites 3
Application Method
- Use palm of hand to apply gel
- Spread across maximum surface area as directed in product labeling
- Allow application site to dry completely
- Cover application site with clothing after drying
- Wash hands thoroughly with soap and water
- Avoid swimming, showering, or washing the application site for at least 2 hours after application 1
Safety Precautions
- Avoid fire, flames, or smoking until gel has dried (product is flammable)
- Prevent secondary exposure to women and children by covering application sites with clothing and washing hands after application 1
Monitoring Protocol
Timing of Monitoring
- Initial follow-up at 14 days and 28 days after starting treatment
- Then periodically thereafter 1
Target Testosterone Levels
- Aim for serum testosterone levels between 350-750 ng/dL 1
- Optimal target is middle tertile of normal reference range (450-600 ng/dL) 2
Safety Monitoring
- Monitor hematocrit/hemoglobin levels regularly
- Assess cardiovascular risk factors
- Monitor for prostate-related events in older men 2
Clinical Considerations and Cautions
Contraindications
- Prostate cancer
- Male breast cancer
- Desire for fertility in near future
- Severe obstructive sleep apnea
- Uncontrolled congestive heart failure
- Hematocrit >54% 2
Common Pitfalls to Avoid
- Diagnosing hypogonadism based on a single testosterone measurement
- Failing to measure free testosterone in obese patients
- Overlooking secondary causes of hypogonadism
- Initiating therapy without proper baseline evaluation
- Not monitoring for adverse effects, particularly hematocrit elevation
- Using testosterone for "age-related hypogonadism" without structural or genetic etiology 2
Important Note
Androgel 1.62% is not interchangeable with other topical testosterone products, including Androgel 1%, as they have different dosing requirements 1