What is Testosterone gel used for?
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Low testosterone (hypogonadism)
How Testosterone gel works
Testosterone gel is a testosterone replacement that acts like the natural sex hormone. Testosterone is responsible for the development and maintenance of many male features. Testosterone gel works by adding or replacing testosterone in the body to normal and healthy levels.
What are the risks and warnings for Testosterone gel?
Testosterone gel can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Early puberty or development of male features
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Risk factors: Unwashed or unclothed application sites
Testosterone gel can be transferred to other people through skin-to-skin contact with the site where the medication was applied. The risk of transfer is higher when the application site is unwashed or unclothed. Females and children should avoid contact with unwashed or unclothed application sites of those using testosterone gel because exposure can cause early symptoms of puberty in children and development of male features in females.
Children can experience enlargement of the penis or clitoris, development of pubic hair, more erections, higher sex drive, aggressive behavior, or faster bone aging. Females can experience deepening of the voice, acne, absence of menstrual periods, or more facial and body hair. If you’re pregnant and expecting a baby girl, coming in contact with testosterone gel can cause your baby to develop male features. If you notice any of these symptoms, talk to your provider immediately as you might need to stop the medication temporarily until the cause is known.
Follow all application instructions carefully to prevent any accidental exposure from happening. After applying testosterone gel, wash your hands with soap and water right away. If skin-to-skin contact is expected, be sure to wash the application area thoroughly with soap and water to remove any medication. If another person accidentally touches the unwashed or unclothed area of your skin where the medication was applied, they should wash the area of contact with soap and water as soon as possible.
High red blood cell count and blood clots
Testosterone gel can raise your red blood cell count, which can cause blood clots. Your provider might have you perform regular blood tests to check that your red blood cell count is in the normal range.
Testosterone gel itself can cause life-threatening blood clots in your legs or lungs. Symptoms of a blood clot in the legs include leg pain, swelling, or redness. Symptoms of a blood clot in the lungs include difficulty breathing or chest pain. Let your provider know if you have any of these symptoms and seek medical help right away as you might have to stop the medication.
Heart attack and stroke
Testosterone gel itself might cause heart attack, stroke, or sudden cardiac (heart-related) death. Get emergency help right away if you have chest pain, cold sweats, left arm pain, difficulty breathing, trouble walking, trouble speaking, or weakness on one side of the body, since you might have to stop taking the medication.
Potential for misuse, addiction, and dependency
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Risk factors: Taking more testosterone gel than prescribed | Taking testosterone gel with other medications containing testosterone
Testosterone gel is a controlled substance because it has a risk of misuse, dependency, and addiction. Misuse is when it’s taken for medical reasons other than prescribed. Misusing testosterone gel can cause serious problems involving the heart and mental health, such as heart attack, heart failure, stroke, liver problems, depression, delusions, hallucinations, and aggression.
Continued misuse of testosterone gel can lead to addiction. Addiction can cause behaviors, such as taking a higher dose than prescribed, spending a lot of time trying to get the medication when there are problems with availability, having trouble stopping the medication even if you want to stop, prioritizing medication use over other responsibilities, and experiencing withdrawal symptoms if you stop taking the medication suddenly.
And finally, testosterone gel can cause dependency. Dependency is when you rely on the medication to function normally and have withdrawal symptoms (e.g., depression, trouble sleeping, lowered sex drive) when you lower the dose or stop the medication suddenly. Remember to take testosterone gel as prescribed to lower the risk of misuse, addiction, and dependency.
Worsening symptoms of enlarged prostate and prostate cancer
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Risk factors: History of enlarged prostate
Taking testosterone gel can worsen certain symptoms in people with an enlarged prostate, or benign prostatic hyperplasia (BPH). Let your provider know if you experience any changes in your urinary routine, such as more urination at night, feeling like you need to urinate more often or immediately, trouble urinating, accidentally urinating, or urinating slowly.
Testosterone gel may raise your risk of prostate cancer. Your provider might have you perform occasional blood tests and physical check-ups before and during treatment with testosterone gel. Testosterone gel isn’t recommended if you have prostate cancer because it can worsen your cancer.
Liver problems
Using certain forms of testosterone, such as methyltestosterone and testosterone enanthate intramuscular injection, for long periods of time can cause life-threatening liver problems. This isn’t a known risk of testosterone gel but it’s important to look out for signs and symptoms of liver damage. Let your provider know if you’re experiencing stomach pain, light-colored stools, dark urine, or if your skin or the whites of your eyes turn yellow because you might need to stop the medication.
Swelling in the arms and legs (edema)
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Risk factors: History of heart, liver, or kidney conditions | Taking other medications that cause swelling like corticosteroids
Testosterone gel can cause your body to hold onto more salt and water, which can lead to swelling in your arms and legs and sudden weight gain. This is more likely to happen if you’re taking other medications that cause swelling, such as corticosteroids (e.g., prednisone, methylprednisolone (Medrol)). It can be more serious in people with heart, liver, or kidney conditions. Talk to your provider if you have any of these symptoms because you might need to stop the medication.
Breathing problems during sleep (sleep apnea)
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*Risk factors: History of sleep apnea | Obesity | History of lung disease *
Testosterone gel can worsen symptoms in people who have breathing problems in their sleep. This is more likely to happen to people who also have a history of obesity or lung disease. If you experience more daytime sleepiness or if your partner notices that you stop breathing in your sleep more often, talk to your provider.
High calcium in the blood
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Risk factors: History of cancer | Taking other medications that cause high calcium in the blood
Testosterone gel can cause high calcium in the blood, especially in people with cancer. High calcium levels can lead to symptoms such as muscle weakness, frequent urination, thirst, stomach pain, and blood in the urine. During treatment with testosterone gel, your provider might have you perform regular blood tests to make sure your calcium levels are within the normal range.
What are the side effects of Testosterone gel?
Common Side Effects
- Skin irritation
- Skin rash
- Itchiness
- High red blood cell count
- Enlarged prostate
- Acne
Other Side Effects
- Headache
- Enlargement of male breasts
- Trouble sleeping
- Abnormal dreams
- Urinary tract infection
- More urination
- Muscle weakness
- Hair loss
- Lower sex drive
- Changes in mood
- Changes in appetite
- Depression
- Nervousness
- Anxiety
- Dizziness
- Nausea
- Sweating
- Changes in smell
- Changes in taste
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