Androgen — Male Hypogonadism
Pregnancy: Contraindicated — virilisation of female fetus; women must avoid contact with gel
Testosterone
Brand names: Testogel (gel), Nebido (IM depot), Testim (gel), Sustanon (IM)
Adult dose
Dose: Gel: 50 mg (5 g gel) topically once daily. Nebido (TU): 1000 mg IM every 10-14 weeks
Route: Transdermal (gel) / Intramuscular (depot)
Frequency: Gel: daily; IM depot: every 10-14 weeks (after loading doses)
Max: Gel: 100 mg/day (if tolerated and levels subtherapeutic); IM: 1000 mg per dose
Nebido loading: 1000 mg at weeks 0 and 6, then every 10-14 weeks. Gel: apply to shoulders/arms/abdomen — do not apply to genitals; cover site after application; wash hands
Paediatric dose
Dose: Seek specialist opinion N/A/kg
Route: IM
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Delayed puberty in adolescent males: specialist endocrinology/urology initiation only
Dose adjustments
Renal
Use with caution — fluid retention may worsen renal impairment
Hepatic
Avoid in hepatic impairment — hepatotoxicity with oral forms; parenteral/transdermal preferred
Paediatric weight-based calculator
Delayed puberty in adolescent males: specialist endocrinology/urology initiation only
Clinical pearls
- Diagnosis requires: two early morning testosterone levels below 12 nmol/L plus symptoms of hypogonadism — do not treat low testosterone without symptoms
- PSA and DRE mandatory before starting — testosterone is contraindicated in prostate cancer; baseline PSA required for monitoring
- Haematocrit monitoring: testosterone stimulates erythropoiesis; haematocrit above 54% or polycythaemia requires dose reduction or therapeutic venesection
- Gel transfer to female partners or children: cover treated area, wash hands thoroughly, shower before close contact — female virilisation and premature puberty in children reported
- Fertility: testosterone suppresses spermatogenesis; men desiring fertility should be referred for gonadotrophin therapy (hCG/FSH) instead
Contraindications
- Prostate cancer (current or suspected)
- Male breast cancer
- Polycythaemia
- Sleep apnoea (worsens)
- Pregnancy (women — virilisation of female fetus)
Side effects
- Polycythaemia (raised haematocrit — thrombosis risk)
- Erythrocytosis
- Acne and oily skin
- Fluid retention
- Sleep apnoea exacerbation
- Testicular atrophy and impaired spermatogenesis
- Gynaecomastia (paradoxically, via aromatisation to oestrogen)
- Transfer to female partners/children (gel)
Interactions
- Warfarin (increases INR — monitor closely)
- Insulin / antidiabetics (testosterone improves insulin sensitivity — may need dose reduction)
- Ciclosporin (increases ciclosporin levels)
Monitoring
- Testosterone level (trough, 3-6 months after initiation then annually)
- PSA and DRE (annually)
- Haematocrit / FBC
- Lipid profile
- Bone mineral density (DEXA at baseline if hypogonadism long-standing)
Reference: BNFc; BNF 90; NICE NG227 (Testosterone for male hypogonadism); EAU Male Hypogonadism Guidelines 2024; Endocrine Society Guidelines 2018. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.