Recognizing the Side Effects of Testosterone Cream for Men

Men with low testosterone levels are turning to testosterone replacement therapy. Testosterone cream, also known as topical testosterone, is among the more practical options. Unlike testosterone injections, you apply topical testosterone directly to your skin.

Men apply testosterone cream to their abdomen, shoulders, upper arms, groin, and scrotum. Using topical testosterone consistently can help alleviate low testosterone symptoms such as mood swings, a decrease in sexual desire, fatigue, and fewer spontaneous erections. But it’s important to remember that testosterone treatment isn’t without risk.

Whether you’re thinking about trying testosterone cream yourself or supporting someone who is, you’ll want a clear picture of potential side effects, drug interactions, and serious health risks.

Key Takeaways

• Testosterone cream is a common form of testosterone replacement therapy. You apply it directly to your skin to help improve symptoms of low testosterone, such as fatigue and reduced libido.
• Using topical testosterone carries potential side effects. Mild skin reactions like redness or itching are common. 
• More serious risks of testosterone replacement therapy can include mood changes, fluid retention, sleep apnea, and breast tenderness.
• Testosterone therapy has been associated with an increased risk of cardiovascular disease and blood clots, but this is no longer supported by current research.
• Drug interactions are possible, which could lead to blood clotting problems. TRT therapy can interact with blood thinners, insulin, and some dietary supplements, increasing the risk of side effects or affecting other medications’ effectiveness.
• Report any chest pain or trouble breathing to your doctor immediately.
• Always follow your doctor's instructions. Wash your hands after applying topical testosterone and let it dry fully before dressing. You should wait for the cream to absorb (at least two to four hours) before skin-to-skin contact or intimacy with your partner.
• Store testosterone cream securely out of reach of children and pets.
• Regular blood tests are done to track testosterone levels, liver function, red blood cell counts, and prostate health.
• If you miss a dose, apply it as soon as you remember, but never double up. Overdosing can cause severe headaches and dizziness. Get immediate medical help if this occurs.
• Discuss your needs with your doctor. The most effective testosterone treatment depends on your health history, lifestyle, and preferences. Share all medications and over-the-counter supplements you take, particularly if you have a history of blood vessel problems, to avoid harmful interactions.
• A healthy diet, regular exercise, weight management, and stress reduction can all help support more stable testosterone levels alongside treatment, contributing to natural testosterone production.

Types of Testosterone Products for Low Testosterone

Before you choose any testosterone therapy, it helps to understand the range of options. Testosterone replacement comes in several dosage forms: creams, gels, injections, patches, nasal gel, and buccal tablets.

Testosterone Injections

Testosterone injections remain one of the most widely used treatments. These are typically given every week or two and deliver a steady level of hormone into the bloodstream. Some men prefer testosterone injections because they don't have to remember to apply cream or gel on a daily schedule.

Topical Testosterone

Because they are simple to use, topical testosterone products like creams and gels are well-liked. Over time, testosterone is absorbed through the skin when applied topically. However, there is a risk of transference to others through skin-to-skin contact when using creams. This is particularly crucial if you share a home with a partner or children.

Topical testosterone is associated with a lower risk of elevating hemoglobin or hematocrit compared to injectable forms, as it delivers more stable, physiologic hormone levels without the sharp peaks and troughs seen with injections. This mimics the body’s natural testosterone production more closely.

Nasal Gel

Another choice is nasal gels. They are less likely to spread to other men and are simpler for some men to use. Talk with your doctor about which type of testosterone medication best suits your needs in terms of treatment, lifestyle, and health.

Managing and Storing Topical Testosterone

If your doctor recommends topical testosterone, they will provide you with comprehensive application instructions. You will typically use it once daily at the same time every day. Regular use keeps your testosterone levels closer to the normal range.

After applying topical testosterone, remember to wash your hands. Allow the cream to dry completely before dressing. This lowers the chance of testosterone transfer to others, particularly children and pregnant women.

Store topical testosterone at room temperature, away from direct sunlight and moisture. Because it’s considered a controlled substance, keep it in a secure place, out of reach of children and pets.

Is Testosterone Therapy Safe?

Any testosterone replacement therapy comes with possible side effects, including topical testosterone. Some are mild, while others can be more serious.

Typical skin reactions include redness, itching, or a slight rash, where the topical testosterone is applied. Usually, these go away as your body adapts. These reactions often improve as your body adapts or may be related to the base cream or gel used. Many patients find relief simply by switching to a different formulation.

Other adverse effects of testosterone may include:

• Mood changes
• Swelling or fluid retention in the lower limbs
• Changes in body hair growth
• New sleep issues or worsening sleep apnea
• Breast enlargement or tenderness

Topical testosterone should only be used by men. It should not be used by pregnant women, who are at risk of delivering a baby with a birth defect.

Testosterone Cream for Men Side Effects

Topical testosterone can also contribute to cardiovascular complications like cardiovascular disease. Some men may experience an increase in blood pressure. Others may be at risk for developing blood clots. These clots can lead to a heart attack or stroke, which is why regular monitoring is so important to maintain normal levels.

When to Seek Medical Care

Get medical help right away if you ever have chest pain, trouble breathing, a really bad headache, or unusual sweating while using topical testosterone.

Furthermore, severe liver issues (such as liver disease and potential allergic reactions) have been linked to oral testosterone due to the 'first-pass effect'. This is when the drug is metabolized by the liver before entering circulation, potentially leading to hepatotoxicity.

Additionally, topical testosterone may affect red blood cell counts (particularly if used at higher-than-prescribed doses), raising concerns about blood thickening and potential clotting. While earlier studies suggested a possible link to venous thromboembolism (VTE), more recent research has not found a consistently increased risk of VTE in men undergoing testosterone replacement therapy.

Blood Clotting and Cardiovascular Issues

Over the years, researchers have disputed the safety of testosterone therapy for heart health. According to some research, men who use testosterone replacement therapy have a higher risk of heart attacks and strokes, while other studies find no discernible difference.

According to some research, men who use testosterone replacement therapy have a higher risk of heart attacks and strokes, while other studies find no discernible difference. Most recently, the TRAVERSE study, the largest randomized controlled trial to date, followed more than 5,000 men receiving testosterone therapy for nearly three years and found no significant increase in major cardiovascular events compared to placebo (Snyder et al., 2023). These findings suggest that when testosterone therapy is appropriately prescribed and monitored, it may not carry the cardiovascular risks once feared.

In any case, you must monitor your heart health. Your doctor should schedule routine blood tests to manage blood pressure and cholesterol and to prevent blood clots.

Before using topical testosterone, talk to your doctor about any past heart disease, blood vessel issues, or clotting disorders.

Drug Interactions and Topical Testosterone

All forms of testosterone can interact with other medications, including insulin, blood thinners, and certain dietary supplements. These interactions can affect how your body absorbs or processes your treatments.

For instance, testosterone may make anticoagulant drugs more effective, increasing the chance of bleeding. Additionally, it can change blood sugar levels, which is important if you have diabetes.

Tell your doctor about all your prescriptions, over-the-counter medications, and herbal supplements.

What Happens If You Take Too Much Testosterone or Miss a Dose?

Try to stick to your regular dosing schedule, and if you forget a dose, apply the missed dose when you remember. But if it’s nearly time for your next dose, just skip the missed one. Don’t double up because doing so will increase your likelihood of experiencing side effects.

Testosterone Overdose

Contact your doctor, clinic, or poison center immediately if you suspect you have overdosed. An overdose of testosterone gel or cream can occur if you use too much or apply it more often than prescribed.

Dizziness, excruciating headaches, and abrupt mood swings are all possible overdose symptoms.

Observations and Follow-Ups

There is no "set it and forget it" approach to testosterone therapy. Frequent testing and regular follow-ups are necessary to manage side effects.

Your doctor will perform regular blood tests to check:

• Levels of testosterone
• Blood pressure increases
• The number of red blood cells
• Your liver function, to rule out a serious liver problem
• PSA (prostate-specific antigen) levels

These findings will assist your doctor in determining whether to change the type of testosterone replacement medication you are taking or modify the dosage.

Tell your doctor about any new symptoms, such as abnormal fatigue, decreased spontaneous erections, or changes in sexual function.

References

Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., ... & Yialamas, M. A. (2018). Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715–1744.

U.S. Food and Drug Administration (FDA). (2015). FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use.

MedlinePlus. (2023). Testosterone topical. National Library of Medicine.

Mayo Clinic. (2023). Testosterone therapy: Potential benefits and risks as you age. Retrieved from Healthline. (2022). Testosterone replacement therapy: What you should know. Retrieved from Nieschlag, E., & Nieschlag, S. (2014). Testosterone deficiency: a historical perspective. Asian Journal of Andrology, 16(2), 161–168.

Medscape. (2022). Testosterone topical (prescribing information). 

Snyder, P. J., Bhasin, S., Cunningham, G. R., Matsumoto, A. M., Stephens-Shields, A. J., Cauley, J. A., ... & Ellenberg, S. S. (2023). Effects of testosterone treatment in older men. The New England Journal of Medicine, 388(13), 1111–1120.