Testosterone Gel And Cream Therapy For Men, Explained

Testosterone gel and cream are topical forms of testosterone replacement therapy for men with diagnosed low testosterone. Under a provider's direction, a measured dose is applied to the skin each day and absorbed into the bloodstream. Several testosterone gels are FDA-approved to treat hypogonadism associated with a medical condition, per their individual labels, and none are approved for low testosterone from aging alone (FDA, 2025). Marek Health prescribes these and other options only after lab testing and a provider evaluation, as part of its broader testosterone replacement therapy services.

Testosterone gel and cream are daily transdermal medications that carry testosterone through the skin and into circulation. Approved gels such as AndroGel, Testim, and Fortesta are cleared for men with primary or hypogonadotropic hypogonadism. Most testosterone creams sold in the United States are compounded, so they are not FDA-approved.

What types of testosterone gel and cream are available?

Men have two main categories to weigh, FDA-approved branded gels and compounded creams. The approved gels include AndroGel in 1% and 1.62% strengths, Testim, Vogelxo, and Fortesta. Testosterone products are approved only for men with diagnosed hypogonadism from a medical condition, not for low testosterone from aging alone (FDA, 2025).

Gels usually come in a metered pump or single-dose packets, which keeps daily dosing consistent. Creams are different. A compounding pharmacy mixes them for one client, and no testosterone cream carries FDA approval in the United States. Compounded does not mean equivalent to an approved product, and a man should know which one he is getting before he starts. For anyone weighing topical options against a shot, the trade-offs of cream versus injections come down to dosing rhythm and how steady blood levels stay.

What are the benefits of testosterone gel and cream?

In men with diagnosed deficiency, daily gel can raise testosterone toward the normal range for many men. In one trial, most men using 1.62% gel reached the targeted range, though individual response varies (Kaufman et al., 2011).

When a true deficiency is the cause, treatment may improve some related symptoms, most consistently libido and sexual function, and possibly energy and muscle mass (Bhasin et al., 2018). Gels also give steadier day-to-day levels than injections, which peak and dip between doses, and they avoid needles. Any benefit, when it occurs, generally develops gradually over weeks to months and depends on an accurate diagnosis. Knowing the signs of low testosterone helps, but treatment is intended to address a diagnosed deficiency, not to push normal testosterone higher.

What are the disadvantages of testosterone gel and cream?

The main drawbacks are daily upkeep, variable absorption, and the chance of passing the drug to other people. Only a small fraction of each dose is absorbed, and the amount varies by product and by individual, so two people on the same dose can land at different blood levels (FDA AndroGel label, 2025).

Daily use is a commitment. Miss days and levels drop. Compounded creams add the uncertainty of a product the FDA has not reviewed. Here is how topical gels and creams compare with other common forms:

What side effects and risks should men know?

The most watched risk is a rise in red blood cells. Testosterone can raise hematocrit, the concentration of red blood cells, and if it climbs too high a provider may pause therapy, check for contributing causes such as sleep apnea, and consider resuming at a lower dose (Bhasin et al., 2018). That is why a provider monitors hematocrit with bloodwork at the start and periodically during treatment.

Other effects include acne, fluid retention, and a rise in estradiol levels as some testosterone converts to estrogen. The FDA added a blood pressure warning to all testosterone labels in February 2025 and removed the older boxed cardiovascular warning (FDA, 2025). That change followed the TRAVERSE trial, which found testosterone noninferior to placebo for major adverse cardiac events, while also recording higher rates of atrial fibrillation and pulmonary embolism in the testosterone group (Lincoff et al., 2023). Testosterone can also suppress sperm production. Effects on fertility vary and may not fully reverse, so anyone considering future fertility should discuss options with a provider before starting, including ways to preserve fertility.

How is testosterone gel and cream applied?

Gels and creams go on clean, dry skin once a day, usually in the morning. Common sites are the shoulders, upper arms, or abdomen, depending on the product label. A man should wash his hands right after and let the area dry before dressing.

Transfer is the part people underestimate. Testosterone can rub off onto a partner or child through skin contact, an exposure that product labels specifically warn against in women and children. Covering the area with clothing once it dries, and washing the site before close contact, lowers that risk. Dosing itself is not a do-it-yourself decision. The right amount depends on a man's lab results and provider evaluation, not a fixed number copied from someone else.

What else should men know before starting?

Evaluation comes first. Guidelines call for more than one early-morning blood test showing a consistently low total testosterone, paired with symptoms, before treatment begins (Mulhall et al., 2018). A single low reading is not enough, and the gap between total and free testosterone matters when SHBG is unusual.

Monitoring continues after the first prescription, with testosterone and hematocrit rechecked at the start of therapy and periodically after (Bhasin et al., 2018). Because testosterone is a Schedule III controlled substance, access depends on a provider evaluation, applicable state law, and whether treatment is medically appropriate, so a prescription is required after evaluation. Current federal telemedicine flexibility for controlled substances runs through December 31, 2026, and state rules vary (DEA and HHS, 2025). A man can begin with a telehealth evaluation where permitted, then match his symptoms against what the testing shows. It also helps to ask up front how to stop treatment safely if he ever wants to come off.

For men with diagnosed low testosterone, testosterone gel and cream offer a steady, needle-free option. Results depend on diagnosis, monitoring, and an honest look at the risks, not on chasing a number. Decisions to start, adjust, or stop therapy should be made with a licensed provider, based on individual labs, symptoms, and goals.

Disclaimer: This blog post is intended for informational purposes only and should not be considered medical advice. Always consult a healthcare professional before making changes to your health routine.

FAQs

How do testosterone gel and cream work for low testosterone? 

They deliver testosterone through the skin into the bloodstream once a day. Only a small fraction of each dose is absorbed, and the amount varies between men. In men with diagnosed deficiency, gels can raise levels toward the normal range, and one trial reported most men reaching the targeted range, though individual response varies (Kaufman et al., 2011).

Are testosterone gel and cream FDA-approved? 

Branded gels such as AndroGel, Testim, and Fortesta are FDA-approved for men with hypogonadism from a medical condition. They are not approved for low testosterone due to aging alone (FDA, 2025). Most testosterone creams in the United States are compounded and are not FDA-approved.

What did the TRAVERSE trial show about heart safety? 

TRAVERSE enrolled 5,246 men with hypogonadism and cardiovascular risk. Testosterone was noninferior to placebo for major adverse cardiac events, at 7.0% against 7.3%. The testosterone group had higher rates of atrial fibrillation and pulmonary embolism (Lincoff et al., 2023).

Can testosterone gel transfer to other people? 

Yes. Skin contact can pass testosterone to a partner or child, an exposure that product labels specifically warn against in women and children. Washing hands after application and covering the area once it dries lowers the risk.

How often is monitoring needed on testosterone therapy? 

Guidelines recommend checking testosterone and hematocrit at the start of therapy and periodically after. If hematocrit climbs too high, a provider may pause treatment, look for contributing causes, and resume at a lower dose (Bhasin et al., 2018).

Does testosterone gel affect fertility? 

It can suppress sperm production. The effect varies between men and should not be assumed reversible, so men who want children should discuss fertility before starting (Mulhall et al., 2018).

References

• J Clin Endocrinol Metab. 2018;103(5):1715–1744

• J Sex Med. 2011;8(7):2079–2089

• J Urol. 2018;200(2):423–432

• N Engl J Med. 2023;389(2):107–117

• FDA. Class-wide labeling changes for testosterone products. 2025

• FDA. AndroGel prescribing information. 2025

• Fed Regist. 2025;90:61301