Androgel and testosterone gel: how it works, side effects and transfer

Androgel is testosterone gel you rub on your skin every day, usually on your shoulders or upper arms. Your skin absorbs a small share, roughly a tenth of what you apply, and releases it into your blood across the day. In the Netherlands you will also come across Testogel and Tostran alongside Androgel.

The big win of a gel is that no needle is involved and your level stays flat day to day.

There is a downside you will find on few Dutch pages. The gel stays on your skin after application, and what sits on your skin can transfer to someone else.

Which testosterone gels are available in the Netherlands?

Three brand names turn up most often: Androgel, Testogel and Tostran. Androgel and Testogel hold the same active substance at the same strength and go on comparable areas. Tostran is stronger per gram of gel and uses a pump.

Which one you get depends on what your doctor prescribes and what your pharmacy stocks. The Farmacotherapeutisch Kompas lists dosing and cautions per preparation.

For most men the differences between these three are small. The application area is where they genuinely diverge.

How does testosterone gel behave across the day?

After application your testosterone climbs over a few hours and then drifts back down until you apply again the next day. So you get a daily wave rather than the weeks-long curve of an injection. Many men find that steadier.

It also makes the timing of a blood draw matter. A result taken two hours after application looks different from one taken just before.

Bhasin and colleagues noted in 2018 that the delivery forms differ mainly in how stable the level stays, not in which molecule ends up in your blood.

One practical detail: gel needs time to dry. Showering or swimming soon after application can wash part of it off.

Can testosterone gel transfer to someone else?

Yes. Testosterone sitting on your skin can transfer to another person through direct skin contact, and in children and women that is not without consequence. It is why manufacturers advise covering the application area with clothing and washing your hands afterwards.

This is not a theoretical risk. Cavender and Fairall described a child entering puberty early after contact with an adult's testosterone gel in the Journal of Sexual Medicine in 2011. Nelson and colleagues reported two children with virilisation after exposure to a topical androgen in 2013.

Deskins and colleagues published a case in 2022 in which father-to-child transfer led to physical changes.

The numbers are small, and with normal use and covered skin it happens rarely. But this is the side effect that does not land on you.

If you have young children at home, or share a bed with a partner, this is exactly the sort of thing to raise with your doctor beforehand. With an injection it does not apply.

Which side effects are reported with Androgel?

The most reported side effects of testosterone gel are skin reactions where you apply it, acne, itching and a rise in red blood cells. Tender or swollen breast tissue and fluid retention also occur. Skin complaints are where a gel differs from an injection.

The rise in red blood cells is milder with gels than with injections. Ohlander and colleagues saw that difference clearly in their 2018 review.

On heart and vessels, the most important trial used a gel. The TRAVERSE study by Lincoff and colleagues in 2023 followed more than five thousand men and found no increase in heart attacks or strokes versus placebo, though it did see more atrial fibrillation and pulmonary embolism.

What can happen to your breast tissue is covered in our piece on gynaecomastia in men.

Gel or injection: what does the choice hang on?

The choice usually hangs on three things: how you feel about needles, what your household looks like and how stable you want your level. A gel is daily work without a needle, with a small transfer risk. An injection is four to twenty moments a year, without that risk.

Picture two men with the same result of 8.9 nmol/l. The first lives alone and works from home, the second has a three-year-old daughter who climbs onto his lap every morning. Same treatment, a very different conversation.

That is exactly why I think the household question matters. It appears in almost no online overview.

We cover the long-acting injection in Nebido experiences and the ester mix in Sustanon. The overview of every form sits in our guide to TRT and testosterone therapy.

Which values run alongside a gel?

With a gel a doctor usually looks at the same values as with an injection: your testosterone, your haematocrit and your PSA, often with oestradiol added. The difference is mainly the timing of the draw, because your level moves within a single day.

What haematocrit means is on our marker page for haematocrit, and what your testosterone value means on total testosterone.

If you want a baseline before talking to your doctor, a testosterone test gives you one. Note the timing of your last application alongside it.

If you notice skin complaints, or someone joins your household and you are unsure about contact with the gel, take that back to your prescribing doctor.

Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.

References

• Bhasin S, et al. Testosterone therapy in men with hypogonadism. Journal of Clinical Endocrinology and Metabolism, 2018. PMID 29562364
• Lincoff AM, et al. Cardiovascular safety of testosterone-replacement therapy. New England Journal of Medicine, 2023. PMID 37326322
• Ohlander SJ, et al. Erythrocytosis following testosterone therapy. Sexual Medicine Reviews, 2018. PMID 28526632
• Cavender RK, Fairall M. Precocious puberty secondary to topical testosterone transfer: a case report. Journal of Sexual Medicine, 2011. PMID 21114766
• Nelson D, et al. Virilization in two pre-pubertal children exposed to topical androgen. Journal of Pediatric Endocrinology and Metabolism, 2013. PMID 23729604
• Deskins SJ, et al. Clitoromegaly secondary to exogenous androgen exposure from paternal skin to skin transfer. Cureus, 2022. PMID 36475158
• Farmacotherapeutisch Kompas, monographs for cutaneous testosterone. Accessed 2026.