COMMON INITIAL DOSING REGIMENS

• Typical starting doses range from 10–20 mg of testosterone daily, applied as a thin layer. Adjustments are made based on serum testosterone levels and clinical response, with dose ranges up to 100 mg daily.

MECHANISM OF ACTION

• Testosterone cream delivers testosterone through the skin into systemic circulation. The drug is absorbed transdermally, bypassing first-pass hepatic metabolism. Steady-state serum testosterone levels are achieved with consistent daily application.

COMMON SIDE EFFECTS

• Dermatologic: Skin irritation, erythema, or rash at the application site. Transfer of testosterone to others through skin contact, particularly affecting women or children, resulting in androgenic effects.

• Endocrine: Gynecomastia, testicular atrophy, and suppression of endogenous testosterone production.

• Cardiovascular: Hypertension, polycythemia (elevated hematocrit), and potential increased risk of cardiovascular events.

• Dermatologic: Acne, oily skin, and hair loss due to androgenic activity.

• Metabolic: Weight gain, alterations in lipid profiles (e.g., decreased HDL), and fluid retention.

• Psychological: Mood swings, aggression, or increased libido.

• Rare: Deep vein thrombosis or pulmonary embolism in predisposed individuals.

CONTRAINDICATIONS

• Absolute: Known or suspected prostate cancer, breast cancer in men, and hypersensitivity to testosterone cypionate or its components.

• Relative: Severe heart failure, sleep apnea, erythrocytosis (hematocrit >54%), and uncontrolled hypertension. Caution is also advised in patients with a history of thromboembolic events or liver dysfunction.

MORE INFORMATION

• FDA Safety Data Sheet can be found here

• Georges E. Sexual precocity in the setting of parental use of a compounded testosterone cream: case report and review of the literature. J Pediatr Endocrinol Metab. 2023 [PubMed Link]

• Iyer R. Pharmacokinetics of testosterone cream applied to skin. Andrology. 2017 [PubMed Link]

• Bhasin S. Effects of long-term testosterone treatment on cardiovascular outcomes in men with hypogonadism: Rationale and design of the TRAVERSE study. Am Heart J. 2022 [PubMed Link]

• Greenberg DR. Association of testosterone replacement therapy with atrial fibrillation and acute kidney injury. J Sex Med. 2024 [PubMed Link]

• Corona G. Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opin Drug Saf. 2014 [PubMed Link] 

• Lombardi G. Estrogens and health in males. Mol Cell Endocrinol. 2001 [PubMed Link] 

• Bhasin S. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 [PubMed Link]

• Winters SJ. Current status of testosterone replacement therapy in men. Arch Fam Med. 1999 [PubMed Link]

• Borst SE. Cardiovascular risks and elevation of serum DHT vary by route of testosterone administration: a systematic review and meta-analysis. BMC Med. 2014 [PubMed Link]

• Hoffman BM. Cardiovascular disease risk, vascular health and erectile dysfunction among middle-aged, clinically depressed men. Int J Impot Res. 2010 [PubMed Link] 

• Sharma R. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J. 2015 [PubMed Link]

• Finkelstein JS. Gonadal steroids and body composition, strength, and sexual function in men. N Engl J Med. 2013 [PubMed Link]

• Khera M. Adult-Onset Hypogonadism. Mayo Clin Proc. 2016 [PubMed Link]

• Mlynarz N. Effects of Testosterone Replacement Therapy on Metabolic Syndrome in Male Patients-Systematic Review. Int J Mol Sci. 2024 [PubMed Link]

• Mahmoud M. The Effects of Testosterone Replacement Therapy in Adult Men With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Systematic Review and Meta-analysis. Clin Transl Gastroenterol. 2025 [PubMed Link]

• Grossmann M. Indications for testosterone therapy in men. Curr Opin Endocrinol Diabetes Obes. 2024 [PubMed Link]

• Dengri C. Testosterone supplementation and stroke in young adults: a review of the literature. Front Neurol. 2024 [PubMed Link]

• Cruickshank M. The effects and safety of testosterone replacement therapy for men with hypogonadism: the TestES evidence synthesis and economic evaluation. Health Technol Assess. 2024 [PubMed Link]

• de Silva NL. Cardiovascular disease and testosterone therapy in male hypogonadism. Ann N Y Acad Sci. 2024 [PubMed Link]

• De Silva NL. Male hypogonadism: pathogenesis, diagnosis, and management. Lancet Diabetes Endocrinol. 2024 [PubMed Link]

• Theodorakis N. Testosterone therapy for functional hypogonadism in middle-aged and elderly males: current evidence and future perspectives. Hormones (Athens). 2024 [PubMed Link]

• Gallegos JL. Testosterone replacement therapy for hypogonadism: A primer for primary care. Nurse Pract. 2024 [PubMed Link]

• Pencina KM. Effect of Testosterone Replacement Therapy on Sexual Function and Hypogonadal Symptoms in Men with Hypogonadism. J Clin Endocrinol Metab. 2024 [PubMed Link]