COMPOUND

Compounds / TRT and hormones

Testosterone Gel/Cream

Testosterone Topical (AndroGel 1%/1.62%, Testim, Fortesta, Vogelxo, Axiron, Androderm patch, Striant buccal, Natesto nasal)

TRT and hormones Topical FDA approved

Daily transdermal/topical testosterone delivery family. Includes hydroalcoholic gels (AndroGel, Testim, Vogelxo), metered-dose gel pumps (Fortesta), axillary solution (Axiron), patches (Androderm), buccal mucoadhesive (Striant), and intranasal (Natesto). Avoids injection but carries a unique boxed-warning risk of secondary virilization transfer to women and children.

At a glance

Half-life
~24 h Effective application interval is 24h; transdermal reservoir mimics steady-state. Underlying free T elimination t½ is 10-100 minutes once released. AndroGel label cites mean T t½ ~70 min systemically.
Routes
Topical
Evidence base
3 studies 2 human · 1 review

Mechanism

Testosterone diffuses from the topical vehicle through stratum corneum, accumulating in the dermis as a reservoir that releases T systemically over 24h. Steady-state serum T reached within 14-30 days of consistent daily application. Peak occurs 4-12h post-application. Skin absorption averages 9-14% of applied dose for 1% gels and 10-13% for 1.62%; remainder is unabsorbed and washes off or is transferable.

Dosing

Any amounts shown here are reported from published studies only. 2 of 3 catalogued studies involved human subjects. COMPOUND does not publish its own dosing guidance.

Published evidence

  1. Human RCT 2023

    Cardiovascular Safety of Testosterone-Replacement Therapy

    Lincoff AM, Bhasin S, Flevaris P, et al. N Engl J Med

    TRAVERSE used AndroGel 1.62% as the active arm; landmark CV safety data is specifically from topical T, not injectables. Non-inferior MACE outcome.

    PMID 37326322

  2. Human RCT 2011

    Pharmacokinetics and relative bioavailability of absorbed testosterone after administration of a 1.62% testosterone gel to different application sites in men with hypogonadism

    Miller J, Wang C, Ilani N, Arver S, et al. J Androl

    Abdominal application yields lower bioavailability than upper arms/shoulders, but both achieve eugonadal serum T.

    PMID 21454244

  3. Review 2018

    Testosterone Therapy in Men With Hypogonadism: Endocrine Society Clinical Practice Guideline

    Bhasin S, Brito JP, Cunningham GR, et al. J Clin Endocrinol Metab

    Endorses topical and IM as appropriate first-line; cautions on absorption variability and secondary exposure.

    PMID 29562364

Reported side effects

Secondary exposure / virilization of partners or children
Rare Serious · FDA BOXED WARNING across all topicals. Cases of precocious puberty in children and virilization in women reported. Strict hygiene rules: cover application site after dry, wash hands, no skin-to-skin until showered.
Application site reaction (gels)
Very common Mild · Erythema, dryness, pruritus; usually self-limited.
Application site reaction (Androderm patch)
Very common Moderate · Marked contact dermatitis in up to 30%. Pre-treatment with triamcinolone cream sometimes needed; major reason patch market collapsed.
Inadequate absorption / clinical failure
Common Moderate · Up to 30% of users do not achieve eugonadal levels on label dosing. Obese and high-SHBG users disproportionately affected.
Polycythemia
Occasional Moderate · Lower than IM esters at typical doses but still occurs.
PSA increase / prostate effects
Occasional Moderate · Class effect.
Estradiol elevation / gynecomastia
Occasional Mild · Less than IM peaks.
HPTA suppression
Very common Moderate · Universal class effect.
Striant gum/mouth irritation
Common Mild · Buccal-specific: gum tenderness, taste perversion, headache; primary reason Striant uptake limited.
Natesto nasal irritation / rhinorrhea / epistaxis
Common Mild · Intranasal-specific; requires TID dosing.

Interactions

  • Anastrozole Synergy

    AI for E2 management. Less commonly needed with topicals due to flatter PK.

  • HCG Synergy

    HPTA preservation (testicular size, fertility): same rationale as injectable TRT.

  • Household contacts Caution

    Skin-to-skin contact with women or children before showering causes secondary virilization (BBW). Cases of precocious puberty in children documented.

Storage

Room temperature. Gel sachets/pumps tightly closed; patches in original pouch until use.