7 Unwanted Topical Testosterone Side Effects - Healthline

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HealthlineSubscribe7 Unwanted Topical Testosterone Side Effects

Medically reviewed by Joseph Brito III, MD — Written by Ann Pietrangelo and Kristeen Cherney — Updated on June 27, 2023

What is topical testosterone?
Types of topical testosterone
Who shouldn't use it?
Side effects
Other risks
Alternatives
When to see a doctor
FAQs
Takeaway

Topical testosterone most commonly causes skin problems like itching or rash. In those with female anatomy, specifically, it can cause unwanted hair growth, acne, or birth defects in pregnant people.

Young male using topcial testosterone — Getty Images/supersizer

Language Matters

In this article, we use “male and female” to refer to someone’s sex as determined by their chromosomes, and “men and women” when referring to their gender (unless quoting from sources using nonspecific language).

Sex is determined by chromosomes, and gender is a social construct that can vary between time periods and cultures. Both of these aspects are acknowledged to exist on a spectrum both historically and by modern scientific consensus.

What is topical testosterone?

Testosterone is a typically male hormone that’s mainly produced in the testicles. It helps the male body develop sex organs, sperm, and sex drive.

The hormone also helps maintain male features such as muscle strength and mass, facial and body hair, and a deepened voice. Your testosterone levels typically peak in early adulthood and slowly decrease with age.

Topical testosterone is a prescription drug that’s applied to your skin. It’s used to treat hypogonadism, a condition of having low testosterone that can be caused by Klinefelter’s syndrome, primary testicular failure, or undescended testicles among other conditions.

The Food and Drug Administration (FDA) has approved topical testosterone in gel form. However, some people prefer compounded testosterone creams (where a pharmacy mixes testosterone with a creamy base), because they find them easier to use and less likely to be transferred by touch. Otherwise, the effects of gels vs. creams are not very different.

Types of topical testosterone

There are several different types of topical testosterone that are available. Here are some of the most common types:

Testosterone gels

Testosterone gels are applied directly to your skin, usually in the armpit, upper arm, shoulder, or inner-thigh areas. AndroGel is a common brand name for this medication.

Testosterone creams

While not as common as gel versions, testosterone creams may also be sold in specialty pharmacies. The application instructions are the same for both testosterone gels and creams. No matter which version you use, make sure it’s completely absorbed into your skin to reduce transfer to others.

Testosterone patches

Testosterone replacement therapy may also be applied to the skin via patch form. A new patch is applied daily to your arm, abdomen, back, or thigh. It’s recommended that you rotate the site of application to reduce possible skin irritation.

Who shouldn’t use topical testosterone?

Topical testosterone is a treatment for hypogonadism that may occur with age. However, such products aren’t intended as a treatment for lower testosterone levels as a result of aging. The FDA strongly advises against the use of topical testosterone for such purposes, due to potential cardiovascular risks associated with these products.

While the data on the relationship between heart disease and testosterone replacement therapy is conflicting, prescription testosterone products may increase the risk of heart attack and stroke. If you have a history of such conditions or are considered at high risk, talk with your doctor about whether topical testosterone is safe for you to use.

Additionally, topical testosterone may not be recommended for males with a history of urinary issues, or for those at high risk for prostate cancer. While testosterone is not known to cause prostate cancer, it may fuel its growth if already present.

You also shouldn’t use topical testosterone if you have:

suspected breast cancer
blood clots
untreated sleep apnea
an elevated red blood cell count
plans to have children

Topical testosterone side effects

While topical testosterone can be helpful to males with hypogonadism, it can also cause unexpected topical and hormonal side effects.

Skin problems

The most common side effects of topical testosterone are skin reactions. Because you apply topical testosterone directly to your skin, you may develop a reaction at the application site. Symptoms can include:

burning
blistering
itching
soreness
swelling
redness
rash
dry skin
acne

Make sure you always apply the medication on clean, unbroken skin. Follow the application directions on the package carefully and report any skin reactions to your doctor.

Urinary changes

Topical testosterone can also affect your urinary tract and may worsen symptoms of benign prostatic hyperplasia (BPH). Some people may need to urinate more than usual, including during the night. You may feel an urgent need to urinate, even when your bladder isn’t full.

Other symptoms include trouble urinating and blood in the urine. If you’re using topical testosterone and have urinary trouble, talk with your doctor.

Breast changes

Hypogonadism can cause gynecomastia (enlarged breasts) in males. It’s rare, but the use of topical testosterone can bring on unwanted changes to the breasts. This is because your body changes some testosterone into a form of the hormone estrogen, which can result in your body forming more breast tissue. Changes to the breasts can include:

tenderness
soreness
pain
swelling

If you’re concerned about changes to your breasts while using topical testosterone, see your doctor right away.

Feeling out of sorts

Topical testosterone can leave you feeling a bit out of sorts. Symptoms aren’t common, but they can include feeling dizzy, lightheaded, or faint. Sometimes topical testosterone use can cause hot flashes or pounding sounds in the ears.

These symptoms may be fleeting and can disappear on their own. If they continue to be a problem, talk with your doctor.

Emotional effects

Most males can tolerate testosterone treatment quite well, but a small number develop emotional side effects from the hormonal changes. These can include:

rapid mood swings
overreaction to everyday situations
nervousness
anxiety
crying
paranoia
depression

Although emotional side effects are rare, they can be serious. Be sure to discuss any symptoms with your doctor.

Sexual dysfunction

Testosterone plays a big role in a male’s sex drive. But in rare cases, topical testosterone can negatively affect your sex life. It may cause problems such as:

loss of desire
inability to get or maintain an erection
erections that happen too often and last too long

Call your doctor if you have any of these symptoms and they bother you.

Transfer through touch

Topical testosterone can cause side effects in females and children who come in contact with it by touching your skin or clothing, so it’s best to let the applied medication try completely before coming in contact with others.

Children may develop aggressive behavior, enlarged genitals, and pubic hair. Females may develop unwanted hair growth or acne. Testosterone transfer is especially dangerous for pregnant people because it can cause birth defects.

To prevent these problems, don’t allow skin-to-skin contact of the treated area with other people. Keep the treated area covered or wash it well before letting others touch you. Also, don’t allow others to touch any bedding and clothing that may have absorbed testosterone from your skin.

Alternative testosterone options

Testosterone injections

These medications are injected into your skin by a doctor about every 1 to 2 weeks, although long-acting treatments may be available that only require injections every 10 weeks.

Nasal gel

Testosterone is also available via a nasal gel that’s pumped into each nostril 3 times daily. Aside from the most common side effects of testosterone therapy, some nasal gels may also cause nasal congestion or irritation.

Buccal tablets

Testosterone buccal tablets work via absorption in the gums. These are applied to your gums twice daily.

Pellets

Another option involves the surgical placement of testosterone pellets under your skin. This procedure is repeated every 3 to 6 months.

When to see a doctor

If you’re experiencing possible symptoms of hypogonadism, it’s important to see a doctor for an exact diagnosis. Testosterone levels may decrease with age, but some of the associated symptoms, such as fatigue and weight gain, may also be related to other underlying health conditions.

Once a doctor prescribes topical testosterone, they will discuss the potential side effects of the medication with you before use. However, you should seek emergency medical help right away if you experience any of the following:

shortness of breath
chest pain
slurred speech
pain or weakness on one side of your body

Frequently asked questions about topical testosterone

Are there long-term effects of topical testosterone?

Yes. Some of the long-term concerns associated with topical testosterone include an increased risk for cardiovascular disease and related events, such as heart attack and stroke. However, the evidence is mixed. A doctor can help you determine whether the potential benefits of topical testosterone outweigh the possible risks.

What drugs react with topical testosterone?

Topical testosterone may interact with corticosteroids, insulin, and oral anticoagulants. Tell your doctor if you take any of these types of medications before starting testosterone replacement therapy.

Can you get topical testosterone over the counter?

Topical testosterone is available by prescription only. While some over-the-counter (OTC) products may claim to increase testosterone levels, these don’t contain the same active ingredients. They may also be unsafe.

Tell your doctor about any testosterone-promoting herbs or supplements you’re currently taking.

Takeaway

Topical testosterone is a powerful prescription drug that you should only use under your doctor’s supervision.

It may cause side effects other than the ones we’ve mentioned, so talk with your doctor if you have questions. Some side effects may clear up on their own, but some may require medical attention. Be sure to report any side effects to your doctor.

Also be sure to tell your doctor if you have any other health conditions, including:

diabetes
allergies
prostate cancer
heart disease

Tell them about other OTC and prescription medications and supplements you’re taking and ask about any possible drug interactions.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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Adrol A. (2015) Testosterone replacement therapy and the risk of prostate cancer.https://pubmed.ncbi.nlm.nih.gov/25865848/
Dietary supplements marketed for weight loss, bodybuilding, and sexual enhancement: What the science says. (2018).https://www.nccih.nih.gov/health/providers/digest/dietary-supplements-marketed-for-weight-loss-bodybuilding-and-sexual-enhancement-science
Enlarged male breast tissue (Gynecomastia). (2016).https://my.clevelandclinic.org/health/diseases/16227-enlarged-male-breast-tissue-gynecomastia
FDA drug safety communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. (2018).https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-cautions-about-using-testosterone-products-low-testosterone-due
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Snyder PJ, et al. (2016). Effects of testosterone treatment in older men.https://www.nejm.org/doi/full/10.1056/NEJMoa1506119
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Ullah MI, et al. (2014). Transdermal testosterone replacement therapy in men.https://www.dovepress.com/transdermal-testosterone-replacement-therapy-in-men-peer-reviewed-fulltext-article-DDDT

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Medically reviewed by Joseph Brito III, MD — Written by Ann Pietrangelo and Kristeen Cherney — Updated on June 27, 2023

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