Can testosterone therapy cause itching?

Testosterone Therapy Can Cause Itching, Especially with Transdermal Formulations

Yes, testosterone therapy can cause itching (pruritus), particularly with transdermal delivery systems, with patches causing itching in up to 66% of users and gels in about 5% of users. 1

Skin Reactions by Testosterone Formulation Type

• Transdermal patches: Up to 66% of users experience skin reactions including erythema (redness) and pruritus (itching) 1
• Transdermal gels: Approximately 5% of users experience skin reactions, making them better tolerated than patches 1
• Intramuscular injections: Can cause local pain, soreness, bruising, erythema, swelling, nodules, or furuncles at the injection site 1

Mechanism and Management of Testosterone-Related Skin Reactions

• Skin reactions are primarily irritant contact dermatitis, though allergic contact dermatitis can also occur 2
• Reactions typically occur at the application site and may include:
  • Erythema (redness) 1
  • Pruritus (itching) 1
  • In severe cases, skin ulceration has been reported (though rare) 3

Management strategies for skin reactions:

• Pretreatment with topical corticosteroids: May reduce the incidence and severity of skin irritation with transdermal testosterone systems 4
• Switching formulations: Patients who cannot tolerate patches may have better results with gels 5
• Rotation of application sites: May help reduce local irritation 6
• Proper application technique: Following manufacturer instructions can minimize reactions 6

Other Common Side Effects of Testosterone Therapy

Beyond skin reactions, testosterone therapy can cause:

• Polycythaemia (increased red blood cell count) 1, 7
• Acne and oily skin 1
• Fluid retention (uncommon but can be concerning in patients with heart failure) 1
• Sleep apnea exacerbation or development 1
• Testicular atrophy and decreased fertility 1

Important Monitoring Considerations

• Baseline and follow-up monitoring should include:
  • PSA and digital rectal examination (for prostate health) 1
  • Hematocrit or hemoglobin levels 1
  • Assessment for sleep apnea symptoms 1
  • Evaluation of skin reactions, particularly with transdermal formulations 1

Clinical Pearls and Pitfalls

• Formulation selection is crucial: For patients prone to skin reactions, gels are preferable to patches due to lower rates of skin irritation 1
• Application technique matters: Testosterone gel should be applied to clean, dry skin of the shoulders and upper arms (areas covered by a short-sleeve t-shirt) 6
• Avoid oral testosterone preparations: These are associated with hepatotoxicity and should be avoided in the United States 1
• Consider alternative formulations: If skin reactions are severe and persistent despite management strategies, switching to intramuscular formulations may be necessary 5