AndroGel Starting Dose
The recommended starting dose of AndroGel 1% is 50 mg (5 grams of gel) applied once daily in the morning, with titration up to 100 mg daily based on serum testosterone levels measured 2-3 months after initiation. 1
Initial Dosing
- AndroGel 1% should be started at 50-100 mg testosterone applied topically once daily. 1
- The gel must be taken with food if using oral formulations, though this applies to oral testosterone undecanoate rather than topical AndroGel. 2
- Application should occur in the morning for optimal physiologic testosterone delivery. 1
Application Sites and Technique
- Apply to clean, dry, intact skin of the shoulders and upper arms (or abdomen in some formulations). 1
- The gel should be allowed to dry completely before dressing to minimize transfer risk to partners or children. 1
- Some newer hydroalcoholic gel formulations can be washed off 10 minutes after application, reducing interpersonal transfer risk. 3
Dose Titration Protocol
- Measure serum testosterone levels 2-3 months after treatment initiation or any dose change. 1, 4
- Target mid-normal testosterone range (approximately 300-1,000 ng/dL). 1, 5
- Adjust dosage based on these levels: minimum 50 mg daily, maximum 100 mg daily for AndroGel 1%. 1
- For the 1.62% formulation, doses can range from 1.25 g to 5.0 g gel (20.25 mg to 81 mg testosterone), with adjustments possible at days 14,28, and 42. 5
Ongoing Monitoring
- Once stable testosterone levels are achieved, monitor every 6-12 months. 1, 4
- Check hemoglobin/hematocrit approximately every 3 months to detect polycythemia. 2
- Monitor prostate-specific antigen (PSA) and assess for benign prostatic hyperplasia symptoms before and during treatment. 2
- Assess blood pressure regularly, as testosterone can cause BP increases that may elevate cardiovascular risk. 2
Advantages of Transdermal Formulations
- Transdermal testosterone provides more stable serum levels compared to injectable formulations, avoiding the peaks and troughs associated with intramuscular injections. 4, 6
- Peak-trough fluctuations with gel are approximately 2.7 pg/mL versus 26.7 pg/mL with intramuscular testosterone. 6
- Injectable testosterone may carry greater cardiovascular risk due to fluctuating levels, though evidence remains conflicting. 1, 4
- Erythrocytosis occurs less frequently with transdermal preparations compared to injectables. 1
Key Safety Considerations
- The primary risk unique to gels is inadvertent transfer to partners or children through skin contact. 1
- Patients must wash hands immediately after application and cover application sites with clothing once dry. 1
- Skin irritation occurs in some patients but rarely requires discontinuation (approximately 1 in 12 affected patients). 7
- Cost is typically higher for transdermal preparations compared to injectable testosterone. 1
Clinical Efficacy Timeline
- Sexual function and mood parameters improve rapidly within the first few weeks and are maintained throughout treatment. 7
- Lean body mass increases and fat mass decreases are evident but may not be accompanied by significant strength gains. 7
- Bone mineral density improvements occur gradually over months to years of treatment. 7