Recommended Dose of Topical Testosterone Cream in Males
The recommended starting dose of topical testosterone gel for adult males with hypogonadism is 40.5 mg of testosterone (equivalent to 2 pump actuations or one 40.5 mg packet) applied once daily in the morning to the shoulders and upper arms. 1
Initial Dosing Protocol
- Start with 40.5 mg of testosterone gel 1.62% applied topically once daily to clean, dry, intact skin of the shoulders and upper arms 1
- Apply in the morning for optimal absorption and to mimic physiological testosterone patterns 2
- The application area should be limited to what would be covered by a short-sleeve t-shirt 1
- Do not apply to the abdomen, genitals, chest, armpits, or knees as these sites have different absorption characteristics 1
Dose Adjustment Range
- Minimum dose: 20.25 mg (1 pump actuation or one 20.25 mg packet) 1
- Maximum dose: 81 mg (4 pump actuations or two 40.5 mg packets) 1
- Dose titration should be based on pre-dose morning serum testosterone levels measured at approximately 14 days and 28 days after starting treatment 1
Target Testosterone Levels and Titration
Target mid-normal testosterone levels of 450-600 ng/dL during follow-up monitoring to optimize clinical response while minimizing adverse effects 2
Dose Adjustment Algorithm:
- If testosterone >750 ng/dL: Decrease daily dose by 20.25 mg 1
- If testosterone 350-750 ng/dL: Continue current dose 1
- If testosterone <350 ng/dL: Increase daily dose by 20.25 mg 1
Application Instructions
- Use the palm of the hand to spread gel across the maximum surface area of shoulders and upper arms 1
- Wash hands thoroughly with soap and water immediately after application 1
- Cover application sites with clothing once the gel has dried 1
- Avoid swimming, showering, or washing the application site for a minimum of 2 hours after application to ensure adequate absorption 1
Monitoring Schedule
- Measure testosterone levels at 2-3 months after treatment initiation or any dose change 3, 2
- Once stable levels are achieved, monitor every 6-12 months 3, 2
- Monitor hematocrit/hemoglobin, PSA (in men over 40), and assess for adverse effects at each visit 3, 2
Important Safety Considerations
Children must avoid contact with unwashed or unclothed application sites due to risk of secondary exposure and virilization 1
- Patients should wash the application site thoroughly with soap and water before any anticipated skin-to-skin contact with others 1
- The gel is flammable until dry—avoid fire, flames, or smoking during this period 1
- Withhold treatment if hematocrit exceeds 54% 3, 2
Comparative Formulation Notes
While the 1.62% gel formulation is the FDA-approved standard, older formulations exist:
- AndroGel 1% can be started at 50-100 mg daily with similar application sites 2
- The 1.62% formulation has increased viscosity and reduced application volume compared to 1% formulations 4
- Application site matters: Arms/shoulders provide superior absorption compared to chest/abdomen or legs 5
Alternative Dosing Context
For the specific scenario of micropenis in prepubertal males with hypogonadotropic hypogonadism, 10% topical testosterone cream applied twice daily for 3 weeks has demonstrated significant penile growth response, though this is a specialized pediatric indication distinct from adult testosterone replacement 6