Testosterone 1% Gel Dosing
The typical starting dose for 1% testosterone gel (such as AndroGel 1%) is 50 mg applied topically once daily, with titration up to 100 mg daily based on serum testosterone levels measured 2-3 months after initiation. 1
Initial Dosing
- Start with 50-100 mg of 1% testosterone gel applied once daily to the skin. 1
- The gel should be applied to clean, dry skin of the upper arms and shoulders (or abdomen as an alternative site). 2
- Application takes approximately 6-8 minutes and the gel dries in less than 5 minutes, leaving no residue. 2
Dose Titration Strategy
- Measure serum testosterone levels 2-3 months after starting therapy or after any dose change. 1, 3
- Target mid-normal testosterone values (300-1,000 ng/dL range). 1, 3
- Dose adjustments can be made at 2-6 week intervals during the titration phase, with modifications typically occurring on days 14,28, and 42 in clinical trials. 4
- Once stable eugonadal levels are achieved, monitor every 6-12 months. 1, 3
Application Site Considerations
- The surface area of application has only a modest impact on serum testosterone levels—applying to four different sites versus one site increased testosterone levels by only 23% despite four times the skin area. 2
- Apply to upper arms/shoulders as the primary site, with abdomen as an acceptable alternative. 4, 2
Monitoring Timing
- Serum testosterone levels peak approximately 2 hours after gel application and reach their lowest point at 23 hours post-application. 5
- For injectable formulations, measure levels midway between injections, but for transdermal gels, timing of blood draw is less critical as levels are more stable throughout the day. 3
- Consider measuring both peak (2 hours post-application) and trough (23 hours post-application) levels if inadequate response is suspected, as only 36.7% of patients maintained adequate levels at trough despite adequate peak levels. 5
Critical Safety Warnings
- Counsel patients about transfer risk to partners and children through skin-to-skin contact. 1
- Patients should wash hands immediately after application and cover the application site with clothing once dry. 1
- Transdermal formulations have lower rates of erythrocytosis compared to injectable testosterone. 3
- Cardiovascular risk factors should be assessed before initiating therapy, though transdermal preparations may have lower cardiovascular risk than injectables due to more stable serum levels. 1, 3
Practical Advantages and Disadvantages
- Advantages: Easy daily application, good skin tolerability, and more stable testosterone levels compared to injections. 1
- Disadvantages: Higher cost than injectable formulations and risk of transfer to others. 1
- The gel is generally well tolerated with the most common adverse events being mild to moderate skin reactions. 6