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testosterone transdermal gel (AndroGel, Foresta, Testim, Axiron)

Indications: - androgen replacement therapy for andropause - gender-affirming hormone therapy [7] Dosage: - AndroGel 1% & 1.62%: - start 50 mg* QD (5 g Androgel) - 4 pumps of 1% [2]; 2 pumps of 1.62% - apply to shoulders, upper arms, or abdomen - increase to 75 mg QD & then to 100 mg QD if needed - serum testosterone 2 weeks after starting Androgel - Foresta 2% - start 40 mg (4 pump actuations) QD in AM - apply to thighs - max dose: 70 mg QD - Testim 1% - start 50 mg* QD - apply to shoulders or upper arms - increase to 100 mg QD if needed - Axiron 2% - start 60 mg (2 pump actuations) QD - one pump actuation applied to each underarm - increase to 90 mg QD & then to 120 mg QD if needed - reduce to 30 mg if needed * mg of testosterone Adverse effects: - use by older men with mobility problems may increase cardiovascular risk [3] - not associated with subclinical atherosclerosis [4]* - skin-to-skin transfer to women & children with virilization - increased risk of - gynecomastia - polycythemia - venous thromboembolism (GRS9) [6] - see testosterone * trial only assessed atherosclerosis progression, not cardiovascular events [4] Laboratory: - large within-individual variations in serum testosterone levels, thus 2-hour post-application serum testosterone is a poor indicator of serum testosterone on another day [5] Notes: - application to underarms & to thighs is an attempt to reduce skin-to-skin transfer to women & children

Interactions

drug adverse effects of androgens

General

testosterone topical; testosterone transdermal

References

  1. Prescriber's Letter 8(2):supplement 2001
  2. Prescriber's Letter 18(3): 2011 CHART: Comparison of Testosterone Products Detail-Document#: 270301 (subscription needed) http://www.prescribersletter.com - Prescriber's Letter 18(12): 2011 Comparison of Testosterone Products Detail-Document#: 271209 (subscription needed) http://www.prescribersletter.com
  3. Basaria S et al, Adverse Events Associated with Testosterone Administration N Engl J Med June 30, 2010 PMID: 20592293
  4. Basaria S et al Effects of Testosterone Administration for 3 Years on Subclinical Atherosclerosis Progression in Older Men With Low or Low-Normal Testosterone Levels. A Randomized Clinical Trial. JAMA. 2015;314(6):570-581 PMID: 26262795 http://jama.jamanetwork.com/article.aspx?articleid=2425744
  5. Swerdloff RS, Pak Y, Wang C et al Serum Testosterone (T) Level Variability in T Gel-Treated Older Hypogonadal Men: Treatment Monitoring Implications. J Clin Endocrinol Metab. 2015 Sep;100(9):3280-7 PMID: 26120790
  6. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  7. NEJM Knowledge+ Endocrinology