Testosterone Patch Dosing and Administration
For testosterone replacement therapy using patches, start with a 2-4 mg/24-hour patch applied once daily to clean, dry, intact skin of the back, abdomen, upper arms, or upper thighs, rotating sites with each application. 1
Patient Selection Criteria
Before initiating testosterone patch therapy, confirm hypogonadism with:
- Morning total testosterone drawn between 8-10 AM on at least 2 separate occasions showing frankly low levels 1
- Free testosterone by equilibrium dialysis 1
- Sex hormone-binding globulin level in patients with obesity 1
- LH and FSH levels to distinguish primary from secondary hypogonadism 1
If secondary hypogonadism is confirmed, complete workup with serum prolactin, iron saturation, pituitary function testing, and MRI of the sella turcica to identify underlying causes before starting therapy. 1
Specific Patch Dosing Protocol
The standard testosterone 24-hour patch (Androderm) delivers 2 mg per 24 hours, with dosing range of 2-6 mg daily depending on response. 2
Application Instructions:
- Apply to dry, intact skin of back, abdomen, upper thighs, or upper arms 2
- Change patch daily, preferably at the same time 3
- Rotate application sites to minimize skin irritation 2
- Peak testosterone levels occur 6-8 hours after patch application 2, 1
Position in Treatment Algorithm
Transdermal testosterone gels are recommended as first-line therapy over patches due to better tolerability, with patches reserved for patients who cannot use gels. 1 The Endocrine Society prioritizes gels because patches frequently cause moderate to severe skin reactions and adherence problems. 4, 2
However, patches offer advantages over gels:
- No risk of transference to partners or children through skin-to-skin contact 2, 1
- Predictable absorption patterns compared to variable gel absorption 2
- Reproduce physiological diurnal testosterone rhythm 3
The main limitations are skin rash/irritation at application sites and poor patch adherence to skin. 2
Monitoring Requirements
Measure testosterone levels 2-3 months after initiating patch therapy or any dose change, then every 6-12 months once stable levels are confirmed. 1
For patches specifically:
- Testosterone can be measured at any time, though peak values occur 6-8 hours after application 2, 1
- Target mid-normal testosterone range (500-600 ng/dL) 2
- Monitor hematocrit/hemoglobin for erythrocytosis (occurs in 2.8-17.9% depending on dose) 1
- Check PSA and perform prostate examination 1
- Assess lipid panel 1
Safety Considerations
The FDA warns of possible increased cardiovascular risk with all testosterone preparations, though patches may carry lower risk than intramuscular injections. 1 Some evidence suggests intramuscular injections are associated with greater risk of cardiovascular events, hospitalizations, and deaths compared with transdermal preparations. 2
Patches carry significantly lower erythrocytosis risk than intramuscular injections. 1 The dose-dependent nature of erythrocytosis with transdermal preparations allows for easier dose adjustment compared to long-acting injections. 2
Testosterone replacement increases prostate volume to levels equivalent to eugonadal men but does not typically worsen voiding symptoms or cause urinary retention at higher rates than placebo. 1
Duration of Therapy
Continue testosterone replacement until clinical reassessment indicates otherwise, as replacement therapy is usually life-long for classical hypogonadism. 5 For age-related hypogonadism, continue as long as clinical symptoms that benefit from testosterone persist. 4