Testosterone Gel Application to Shoulders
Testosterone gel 1.62% should be applied to the shoulders and upper arms at a starting dose of 40.5 mg (2 pumps) once daily, as this application site provides superior testosterone absorption compared to other body sites and is the FDA-approved location for this formulation. 1
Recommended Dosing and Application Site
The shoulders and upper arms are the preferred and FDA-approved application sites for testosterone gel 1.62%, specifically covering the area that would be covered by a short-sleeve t-shirt. 1
Standard starting doses for shoulder/upper arm application:
- 1.62% testosterone gel: 40.5 mg (2 pumps) applied once daily 2
- Alternative starting dose: 20.25 mg (1 pump) for lower initial dosing 1
- Dose range: 20.25-81 mg daily depending on response 3
Application Technique for Shoulders
For pump formulation: 1
- Prime new bottles by pushing pump down 3 times over sink (discard this gel)
- Apply gel directly to clean, dry skin of shoulders and upper arms
- Distribute doses between both shoulders when using multiple pumps (e.g., 1 pump per shoulder for 2-pump dose)
- Allow gel to dry completely before dressing (approximately 5 minutes)
- Avoid showering, swimming, or bathing for at least 2 hours after application 1
For packet formulation: 1
- Tear packet completely at dotted line
- Squeeze contents into palm or apply directly to application site
- Distribute between both shoulders/upper arms as needed
- Wash hands immediately with soap and water after application 1
Why Shoulders Are Superior to Other Sites
The arms/shoulders application site achieves significantly higher testosterone levels compared to other anatomical locations. Research demonstrates that arm/shoulder application produces superior absorption compared to chest/abdomen or legs (A > C ≥ L, P = 0.011). 4
Specifically, applying testosterone gel to four different sites (including abdomen) resulted in only 23% higher testosterone levels despite using four times the skin surface area, indicating that location matters more than surface area. 5
When comparing abdominal versus upper arm/shoulder application of 1.62% gel, abdominal application showed approximately 30-40% lower bioavailability, though both sites achieved eugonadal levels. 6
Critical Safety Considerations
Do not apply testosterone gel to: 1
- Abdomen (for 1.62% formulation specifically)
- Penis or scrotum
- Chest
- Armpits (axillae)
- Knees
Transfer prevention is essential: 1
- Cover application site with clothing after gel dries
- Wash hands immediately after application
- Avoid skin-to-skin contact with partners or children at application site 3
The gel is flammable until dry - avoid smoking or open flames until completely dried. 1
Monitoring Requirements
Initial monitoring schedule: 2
- Recheck testosterone levels at 2-3 months after starting or any dose change
- Target mid-normal range (450-600 ng/dL)
- Once stable, monitor every 6-12 months
For topical preparations, testosterone levels can be measured at any time after reaching steady state (achieved within 48-72 hours), as levels remain relatively stable throughout the day. 2
Dose Titration Based on Shoulder Application
If testosterone levels are outside target range at 2-3 month check: 2, 1
- Below target: Increase by 1 pump increment (20.25 mg)
- Above target: Decrease by 1 pump increment
- Maximum dose: 81 mg daily (4 pumps) 1
If no symptom improvement occurs after 3-6 months despite achieving target levels, discontinue therapy as there is no benefit to continuing treatment. 2