From the Guidelines
The current dose of 40.5mg daily testosterone gel should be adjusted to achieve a mid-normal range testosterone level, and I recommend increasing the dose to 50mg daily and rechecking the serum testosterone level in 4-6 weeks, as the goal for testosterone replacement therapy is typically to achieve levels between 500-800 ng/dL 1. The testosterone level of 352 ng/dL drawn before applying daily testosterone gel is in the low-normal range, suggesting the need for dose adjustment. When monitoring testosterone replacement, blood should be drawn in the morning before gel application to capture the trough level, which has been done correctly in this case. Key considerations for adjusting the dose include:
- Achieving mid to upper-normal range levels (500-800 ng/dL) to adequately address symptoms while minimizing side effects
- Monitoring not only testosterone levels but also hematocrit, PSA (in men over 40), and lipid profile every 6-12 months
- Applying the gel to clean, dry skin of shoulders, upper arms, or abdomen (not genitals) and allowing it to dry completely before dressing
- Avoiding washing the application site for at least 2 hours after application to ensure proper absorption Recent studies, such as the 2024 guideline for the primary prevention of stroke, have provided higher-quality evidence on the safety and efficacy of testosterone replacement therapy, and support the use of transdermal testosterone preparations, such as gel, to achieve normal serum testosterone concentrations 1.
From the FDA Drug Label
The patient's daily dose was titrated up or down in 20.25 mg increments if the predose serum testosterone value was outside the range of 350 ng/dL to 750 ng/dL. The current testosterone level is 352 ng/dL, which is within the target range of 350 ng/dL to 750 ng/dL. Based on this information, the current dosing of 40.5mg daily does not need to be adjusted. 2
From the Research
Testosterone Replacement Monitoring
- The user's current testosterone level is 352 ng/dL, which is above the threshold of 300 ng/dL considered for testosterone replacement therapy 3.
- The user is currently taking 40.5mg of daily testosterone gel, and the testosterone level was drawn before applying the gel.
Comparison to Study Findings
- A study from 2008 recommends assessing testosterone levels when an adult man exhibits signs of hypogonadism, and as part of normal medical screening in men starting at age 40 to 50 years, to establish a baseline 3.
- Another study from 2022 found that oral testosterone undecanoate therapy can restore testosterone levels to the normal range in hypogonadal men without requiring dose adjustment 4.
- A 2024 study found that testosterone replacement therapy improved sexual activity, hypogonadal symptoms, and sexual desire in middle-aged and older men with hypogonadism and low libido 5.
- A 2005 study found that clomiphene citrate can elevate serum testosterone levels and improve the testosterone/estrogen ratio in men with hypogonadism 6.
- A 2025 study found that testosterone replacement therapy was associated with an increase in neutrophil and monocyte counts, which was associated with an increased risk of venous thromboembolism events 7.
Considerations for Testosterone Replacement Therapy
- The user's testosterone level is above the threshold for testosterone replacement therapy, but it is essential to consider the individual's symptoms and medical history when determining the best course of treatment.
- Regular monitoring of testosterone levels and adjustment of therapy as needed is crucial to ensure the effectiveness and safety of testosterone replacement therapy 3.