What are the proper usage and potential side effects of testosterone cream for a patient with low testosterone levels?

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Patient Education Handout: Testosterone Cream

What is Testosterone Cream?

Testosterone cream is a topical medication applied to your skin to treat low testosterone levels (hypogonadism). The cream absorbs through your skin and raises testosterone to normal levels, helping improve symptoms like low sex drive and erectile dysfunction. 1, 2

How to Apply Your Testosterone Cream

Application Instructions

  • Apply once daily to clean, dry skin 3
  • Best application sites: Upper arms and shoulders provide the most consistent absorption 4
  • Amount: Use exactly the dose prescribed by your doctor (typically 20.25-40.5 mg per application) 3
  • Timing: Apply at the same time each day, preferably in the morning 1

Step-by-Step Application

  1. Wash and dry the application area thoroughly
  2. Apply the cream to the prescribed area (arms/shoulders)
  3. Wash your hands immediately with soap and water after application 3
  4. Allow the area to dry for several minutes before dressing
  5. Cover the application site with clothing once dry 3
  6. Wait 2 hours before swimming or showering to ensure maximum absorption 3

CRITICAL SAFETY WARNING: Preventing Transfer to Others

Protecting Children and Women

Children and women must NEVER touch areas where you applied testosterone cream. Accidental exposure can cause serious problems: 1, 3

In children, contact may cause:

  • Early puberty and enlarged genitals
  • Premature pubic hair growth
  • Aggressive behavior
  • Increased erections 1, 3

In women, contact may cause:

  • Unwanted facial/body hair growth
  • Acne
  • Voice deepening
  • Other masculinizing effects 1, 3

Prevention Steps You MUST Follow

  • Always wash application sites with soap and water before any skin-to-skin contact with others 3
  • Keep the area covered with clothing after the gel dries 3
  • Never let children or women touch unwashed application sites 1, 3
  • If accidental contact occurs, immediately wash the exposed person's skin thoroughly with soap and water 3
  • Call your doctor immediately if a child or woman shows any signs of testosterone exposure 3

What to Expect from Treatment

Benefits You May Experience

Sexual function improvements (most reliable benefit):

  • Increased sex drive and libido 2, 5
  • Better erectile function 2, 5
  • Improved sexual satisfaction 1, 2

Other potential improvements:

  • Increased energy and sense of well-being (modest improvement) 2, 5
  • Better mood (small improvement) 2
  • Increased muscle mass and decreased body fat 2, 5
  • Stronger bones 2, 5

Realistic Expectations

Testosterone therapy provides LITTLE TO NO benefit for: 1, 2

  • Physical strength or athletic performance
  • Memory or thinking ability
  • General fatigue or tiredness
  • Depression

Your symptoms should improve within 3-6 months. If you don't notice improvement in sexual function after 12 months, your doctor may stop the medication. 1, 2

Possible Side Effects

Common Side Effects

  • Skin reactions at application site (redness, itching) 1
  • Acne or oily skin 1
  • Increased red blood cell count (your doctor will monitor this) 1
  • Fluid retention (mild ankle swelling) 1

Serious Side Effects - Call Your Doctor Immediately

  • Urinary problems: difficulty starting urination, frequent nighttime urination, weak urine stream 3
  • Breathing problems or sleep disturbances 3
  • Chest pain, shortness of breath, or dizziness 1
  • Prolonged or frequent erections lasting more than 4 hours 3
  • Swelling of ankles or legs 3
  • Yellowing of skin or eyes 3

Important Monitoring Requirements

Required Blood Tests

Your doctor will check: 1, 2

  • Testosterone levels: At 2-3 months, then every 6-12 months
  • Blood count (hematocrit): To check for too many red blood cells
  • PSA (prostate test): If you're over 40 years old
  • Liver function: Periodically during treatment

Target testosterone level: 450-600 ng/dL (mid-normal range) 1

Who Should NOT Use Testosterone Cream

Absolute Contraindications

DO NOT use testosterone cream if you: 1, 3

  • Have or had prostate cancer
  • Have or had breast cancer
  • Are trying to father a child (testosterone stops sperm production)
  • Have a red blood cell count (hematocrit) above 54%
  • Had a heart attack or stroke in the past 3-6 months

Special Precautions

Fire Safety

Testosterone cream is flammable. Avoid fire, flames, and smoking until the application site is completely dry. 3

Fertility Warning

Testosterone cream will STOP sperm production and make you infertile while using it. 1 If you want to have children now or in the future, tell your doctor BEFORE starting treatment. Alternative medications can preserve your fertility. 1

Cardiovascular Considerations

If you have heart disease or have had a heart attack or stroke, wait 3-6 months after the event before starting testosterone therapy. 1

Storage and Disposal

  • Store at room temperature (68-77°F) 3
  • Keep out of reach of children and pets 3
  • Dispose of used containers in household trash in a way that prevents access by children or pets 3
  • Never share your medication with anyone else 3

When to Contact Your Doctor

Call your doctor if you experience:

  • Signs of testosterone exposure in family members (see safety warning above)
  • No improvement in symptoms after 3-6 months
  • Worsening urinary symptoms
  • Chest pain, shortness of breath, or leg swelling
  • Prolonged erections
  • Mood changes or increased aggression
  • Any other concerning symptoms

Questions to Ask Your Doctor

  • What specific symptoms should improve with my treatment?
  • When should I expect to notice benefits?
  • How often do I need blood tests?
  • What are my target testosterone levels?
  • Should I continue treatment if I want to have children in the future?

Remember: Testosterone cream is prescribed specifically for YOU. Never share it with others, and always follow your doctor's instructions exactly. 3

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Testosterone Injection Treatment for Male Hypogonadism

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

5
Guideline

Evaluation and Management of Secondary Hypogonadism

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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