Testosterone Patches: Do People Still Use Them For TRT?

Testosterone patches are no longer available in the United States. Androderm, the only FDA-approved transdermal testosterone patch, was permanently discontinued by AbbVie in 2023 (ASHP, 2023). No generic version was ever approved, and no manufacturer has stepped in to produce a replacement. For men with diagnosed hypogonadism who previously relied on prescribed testosterone, several alternative formulations remain available, including gels, injections, oral capsules, and implantable pellets.

Understanding what testosterone patches were, why they left the market, and how other delivery methods compare is still relevant for patients evaluating their options. Marek Health provides telehealth evaluations for men who meet the diagnostic criteria for testosterone deficiency. This article covers the history of testosterone patches, the current formulation landscape, and what clinical guidelines say about safety monitoring for all forms of TRT.

What Are Testosterone Patches?

Testosterone patches were a transdermal delivery system designed to release testosterone through the skin over a 24-hour period. Applied once daily (typically in the evening), the patch provided a relatively steady release designed to approximate the body's natural diurnal testosterone pattern.

Androderm was the only branded product in this category. It came in 2 mg/day and 4 mg/day strengths, and clinicians could combine patches to reach the prescribed dose. The patch was applied to clean, dry skin on the back, abdomen, thighs, or upper arms, and the application site was rotated every 24 hours, with at least 7 days before reusing the same spot.

Testosterone replacement therapy (TRT) refers to the medical use of exogenous testosterone to treat men with confirmed testosterone deficiency caused by a diagnosed medical condition, such as primary or secondary hypogonadism. The FDA approves testosterone products for this specific indication, not for age-related testosterone decline (FDA, 2025).

Why Were Testosterone Patches Discontinued?

AbbVie (through its subsidiary Allergan) permanently stopped manufacturing Androderm in early 2023. The American Society of Health-System Pharmacists (ASHP) formally listed the shortage on March 13, 2023, confirming Allergan was the sole supplier and that production had ceased (ASHP, 2023).

The discontinuation was reportedly driven by quality concerns with the patch manufacturing process. Rather than address those issues, AbbVie chose to exit the product entirely.

Skin irritation was a persistent clinical limitation throughout Androderm's time on the market. Application-site reactions (redness, itching, blistering, burning) were among the most frequently reported side effects. This contributed to patient dissatisfaction and, for some, prompted switches to other formulations. The combination of manufacturing difficulties and a shifting market favoring gels and injectables made commercial continuation less viable.

No generic testosterone patch was ever FDA-approved in the US. As of 2026, no pharmaceutical company has announced plans to produce one. Patients who previously used patches have been transitioned to creams, gels, or injections under their provider's guidance.

Patches vs. Injections, Gels, and Oral Formulations

Each testosterone formulation carries distinct pharmacokinetic properties, application requirements, and side effect profiles. Below is a comparison of the major delivery methods.

Injections using testosterone cypionate or enanthate are among the most widely prescribed formulations. They allow flexible dosing intervals and tend to produce larger peak-to-trough swings in serum testosterone compared to transdermal options. Some men prefer the convenience of less frequent dosing, while others find the fluctuations less tolerable.

Gels provide steady serum levels similar to what patches delivered but carry a risk of secondary transfer to household contacts through skin-to-skin contact. Oral testosterone undecanoate (Kyzatrex) offers a needle-free alternative that is taken with meals to aid absorption, though it requires twice-daily dosing.

Side Effects and Safety of Testosterone Therapy

The largest randomized cardiovascular safety dataset for testosterone therapy comes from the TRAVERSE trial, a study of 5,246 men aged 45-80 with hypogonadism and cardiovascular disease or risk factors. TRAVERSE found that testosterone (transdermal gel) was noninferior to placebo for major adverse cardiac events (7.0% vs. 7.3%; HR 0.96, 95% CI 0.78-1.17). The trial also recorded higher rates of atrial fibrillation and pulmonary embolism in the testosterone group (Lincoff et al., 2023).

In February 2025, the FDA issued class-wide labeling changes for all testosterone products based on these findings. The agency removed the prior cardiovascular boxed warning, added a new blood pressure warning supported by ambulatory blood pressure monitoring (ABPM) studies, and retained the Limitation of Use language stating testosterone isn't approved for age-related decline (FDA, 2025).

Common side effects of testosterone therapy (across all formulations) include acne, fluid retention, breast tissue tenderness or enlargement (gynecomastia), and elevated hematocrit. Erythrocytosis, a rise in red blood cell concentration, is among the more serious monitoring concerns. The risk of hematocrit elevation may differ between formulations, and a provider considers this when selecting the appropriate delivery method. Hematocrit is monitored regularly, and a provider may adjust the formulation, dose, or frequency based on individual response. More detail on this risk is covered in Marek Health's article on hematocrit management during TRT.

Sleep apnea is another known risk that warrants screening before and during testosterone therapy.

Testosterone Therapy and Fertility

Exogenous testosterone is associated with suppression of LH and FSH, which may reduce sperm production in some men. The degree of suppression varies between individuals, and recovery of spermatogenesis after discontinuing testosterone is not predictable.

Men who are planning to conceive or wish to preserve the option should discuss this with their provider before starting TRT. Adjunctive therapies such as hCG or enclomiphene, sometimes used off-label, may support spermatogenesis during treatment, though individual response is variable. More on this topic is available in the guide on fertility during TRT.

The Endocrine Society recommends counseling all men of reproductive age about fertility suppression before initiating testosterone therapy (Bhasin et al., 2018).

TRT Formulations Available Today

With testosterone patches no longer on the market, the remaining FDA-approved delivery methods include transdermal gels (AndroGel, Testim, Fortesta, Vogelxo), injectable esters (testosterone cypionate and enanthate), oral testosterone undecanoate (Kyzatrex and similar products), buccal systems (Striant), and implantable pellets (Testopel).

Compounded testosterone formulations (creams, gels, and injectables prepared by compounding pharmacies) are also available through some providers. These are not FDA-approved and carry different quality oversight compared to branded products. When compounded testosterone is prescribed, patients should be informed it isn't equivalent to an FDA-approved formulation (FDA, 2025).

The choice of formulation depends on patient preference, lifestyle, tolerance of application requirements, and clinical factors such as hematocrit trends and free versus total testosterone response. A licensed clinician determines the appropriate product and dose based on lab results and clinical evaluation.

How Is Testosterone Therapy Monitored?

The AUA recommends confirming testosterone deficiency through repeated lab testing and a clinical evaluation of symptoms (Mulhall et al., 2018). Both the AUA and the Endocrine Society stress that a low lab value alone doesn't meet the diagnostic threshold (Bhasin et al., 2018).

Once TRT begins, regular lab work tracks the body's response and flags potential adverse effects. The Endocrine Society recommends periodic monitoring of hematocrit, PSA (prostate-specific antigen), estradiol, blood pressure, and lipid panels, with frequency determined by the prescribing provider based on individual risk factors (Bhasin et al., 2018).

Testosterone is a Schedule III controlled substance under the Anabolic Steroid Control Act. It requires a valid prescription based on a legitimate medical purpose and clinical evaluation. Telemedicine prescribing is permitted under a temporary DEA flexibility through December 31, 2026, where state law allows. Permanent rules are pending.

Starting testosterone therapy is a decision made between a patient and a licensed provider, based on confirmed lab findings, symptom assessment, and a discussion of the expected benefits and risks. Patients considering testosterone replacement should work with a provider to confirm the diagnosis, select the appropriate formulation, and establish a monitoring plan.

Testosterone patches may no longer be an option, but the clinical principles they introduced (steady daily dosing, reduced injection burden) still inform how providers approach discontinuation and transitions between formulations today.

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.

References

• ASHP Drug Shortage Detail: Testosterone Transdermal System. March 13, 2023

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

• FDA Class-Wide Labeling Changes for Testosterone Products. February 28, 2025

• J Urol. 2018;200(2):423-432

• N Engl J Med. 2023;389:107-117