Testosterone Gel Side Effects: Transfer Risk, Skin Reactions and Monitoring

A father sits in a pediatric clinic with a question he is embarrassed to ask: his four-year-old has started growing pubic hair, and for the past eight months he has been rubbing testosterone gel onto his shoulders each morning. That exact story has appeared in medical case reports for more than fifteen years, and it is one reason searches for testosterone gel side effects are climbing as of September 2026.

The other reason is a label. In early 2025, US regulators rewrote the safety language on every prescription testosterone product after a 5,246-man cardiovascular trial, TRAVERSE, reported its results. Old warnings about heart attacks were softened, a new warning about blood pressure was added, and the boxed warning about accidental transfer to children stayed exactly where it was. Social media has since filled with before-and-after clips that mention none of this.

What follows is the honest version: what the gel does to skin, blood and the people you touch, graded by how strong the evidence really is.

What changed recently in testosterone gel safety labeling

Three dates explain today’s conversation. The first is 2009, when US regulators placed a boxed warning on testosterone gels after eight reports of young children, aged nine months to five years, developing enlarged genitals, pubic hair, advanced bone age or aggressive behavior following skin contact with a treated adult. That warning has never been removed.

The second is 2015, when labels across all testosterone products were updated to say the products were intended for men with low testosterone caused by a medical condition, not for the gradual decline that comes with age, and to flag a possible rise in heart attack and stroke risk seen in some observational studies.

The third is the TRAVERSE trial, published in the New England Journal of Medicine in June 2023. It randomized 5,246 men aged 45 to 80 with low testosterone and either existing heart disease or high cardiovascular risk to daily testosterone gel or an identical placebo gel, then followed them for a mean of about 33 months. Major adverse cardiac events (a composite of heart attack, stroke and cardiovascular death) occurred in 7.0% of the testosterone group and 7.3% of the placebo group, meeting the trial’s non-inferiority standard.

Secondary findings were less tidy. Atrial fibrillation, pulmonary embolism and acute kidney injury were each slightly more common on testosterone, and a 2024 analysis of the same trial found more clinical fractures in the treated men, 3.5% versus 2.5%, which the investigators had not expected.

In early 2025, US regulators responded by removing the general cardiovascular-outcome warning from class labeling, adding a warning that testosterone products raise blood pressure, and keeping the transfer warning intact. That is the regulatory landscape readers are now trying to interpret.

How testosterone gel works, and why the skin route shapes its side effects

Testosterone gel is an alcohol-based preparation that dries on the skin within minutes. The hormone passes into the outer skin layers and forms a small reservoir there, releasing slowly into the bloodstream over roughly a day. Clinicians prescribe it for hypogonadism, the medical term for a testosterone level that is persistently low because the testicles or the pituitary signaling that drives them is not working properly.

That reservoir has two consequences. The first is pharmacological: levels stay comparatively steady, without the high peaks and deep troughs that follow an injection. Observational comparisons consistently show that gels produce smaller rises in red blood cell count and fewer reports of mood swings than injectable forms, although head-to-head randomized data remain limited.

The second consequence is the transfer problem. For several hours after application, the skin surface still carries unabsorbed hormone. Anyone who touches that skin can pick some up, and a small child, whose own testosterone level is near zero, is exquisitely sensitive to even tiny amounts.

Testosterone is an androgen, a hormone that drives male-pattern features such as body hair, oily skin and muscle growth. A portion of it is converted by an enzyme called aromatase into estradiol, a form of estrogen. That conversion explains a cluster of side effects that surprise many men: breast tenderness, enlarged male breast tissue (gynecomastia) and fluid retention. Finally, extra testosterone from outside the body signals the brain to switch off its own stimulating hormones, which is why sperm production and testicle size can fall while on treatment.

Testosterone gel transfer to partner or child: how it actually happens

The transfer cases that reached regulators share a pattern. A man applies the gel, dresses or not, and then holds a toddler on his bare chest, lets a child sleep against his arm, or carries the child without washing his hands first. Months later the child has pubic hair, an enlarged penis or clitoris, a bone age far ahead of calendar age, or sudden aggression. Blood tests show adult-range testosterone in a preschooler.

Most of these changes faded once contact stopped. Some did not: advanced bone age can translate into an earlier end to growth and shorter final height, and a few children had genital enlargement that persisted after their hormone levels normalized. This is why the warning sits in a black box rather than a footnote.

Women are exposed the same way, usually a partner. Reported effects include new hair growth on the face and body, acne and, less often, changes in voice or menstrual cycle. Pregnant women face a separate concern, because fetal exposure to androgens can affect the development of a female fetus; product labels tell pregnant women not to handle the gel at all.

The evidence base here is observational by necessity, consisting of case series and pharmacokinetic studies in which volunteers touched treated skin at set intervals. Those studies found that direct skin-to-skin contact shortly after application could raise a partner’s testosterone level measurably, and that washing the application site with soap and water removed the great majority of residual hormone. Dried gel under clothing transferred far less. No one has run, or could ethically run, a randomized trial of exposing children.

How to lower transfer risk without giving up the gel

Transfer is the one testosterone gel side effect that is almost entirely preventable with habit rather than medicine. The product leaflet for each gel specifies where to apply it (upper arms, shoulders or abdomen, depending on the formulation), how long to let it dry, and how long to wait before skin contact or showering. Those intervals differ between products, so the rule that matters is the one printed on your own leaflet.

Beyond that, clinicians and product labels converge on a short list of habits:

• Wash your hands with soap and water the moment you finish applying, before you touch a door handle, a phone or a child.
• Let the gel dry completely, then cover the area with clothing. A T-shirt is a surprisingly effective barrier in exposure studies.
• Shower before any skin-to-skin contact if you are within the waiting window on your leaflet, including sex and co-sleeping.
• Never apply the gel to the genitals or to broken or irritated skin, and never let a partner or child apply it for you.
• Keep the container out of reach of children and dispose of used packaging where they cannot find it.

If you suspect a child or partner has been exposed, wash their contact area with soap and water right away and tell the prescribing clinician. In a child, the signs to watch for are new pubic or underarm hair, genital enlargement, a growth spurt, acne or unusual aggression; a pediatrician can confirm or rule out exposure with a blood test and, if needed, a bone-age X-ray.

Men who cannot reliably keep children off their torso, for example those caring for an infant, sometimes discuss alternative formulations with their clinician. That is a reasonable conversation, not a failure.

Testosterone gel skin irritation: what application-site reactions look like

The gel’s alcohol base does the useful work of carrying the hormone into the skin, and it also does the irritating work of drying it out. In clinical trials, roughly 5% or fewer of men reported an application-site reaction: redness, itching, dryness, a burning sensation or small bumps where the gel went on. For comparison, testosterone patches produced skin reactions in well over half of users in some studies, which is a large part of why gels displaced them.

Most irritation is mild and settles as the skin adjusts. Practical measures that clinicians suggest, consistent with product labeling, include rotating among the approved application areas, applying to clean, fully dry skin, waiting for the gel to dry before dressing, and avoiding freshly shaved or sunburned areas. Moisturizers and sunscreens applied to the same spot can change how much hormone is absorbed, so the leaflet’s instruction to keep the area free of other products is worth following.

Two things can masquerade as simple irritation. The first is allergic contact dermatitis, an immune reaction to an ingredient in the gel, which tends to produce a spreading, intensely itchy rash that returns with every application. The second is acne, which is a systemic androgen effect rather than a local one and can appear on the back, chest and face far from where the gel was applied.

A reaction that is severe, spreading, blistering or persistent after a few weeks is a reason to contact the prescribing clinician rather than to push through. Switching to a different gel formulation, a different base, or another delivery route resolves the problem for most men; that decision belongs to the clinician who knows your full picture.

Common testosterone gel side effects in the person using it

Most of what men notice on testosterone gel is the hormone doing what hormones do, just more of it. Acne and oily skin top the list, especially in the first few months, because androgens stimulate sebaceous glands. Men with a family history of male-pattern hair loss may find thinning accelerates. Both effects are dose-related in the sense that higher blood levels produce more of them, which is one argument for keeping levels in the normal range rather than above it.

Fluid retention shows up as mild ankle swelling or a few pounds of water weight; it matters most in men who already have heart or kidney disease. Breast tenderness or enlarged male breast tissue (gynecomastia) occurs in a minority and traces back to the conversion of testosterone into estradiol described earlier.

Mood effects run in both directions. Trials show small average improvements in mood, yet some men report irritability or restlessness, and sleep can be disrupted. Headache is listed on every label. Urinary symptoms, such as a weaker stream or needing to go at night, can worsen in men with an enlarged prostate.

Then there are the effects nobody puts in a transformation video. External testosterone suppresses the pituitary hormones that tell the testicles to make their own hormone and sperm. Testicle size often falls, sperm counts can drop to levels that make conception difficult, and this can take months to recover after stopping, sometimes longer. Sleep apnea, a condition where breathing repeatedly pauses during sleep, can be unmasked or worsened; the evidence here is largely expert opinion and small studies, but the association is taken seriously enough to appear in guidelines.

What the evidence actually says about heart, blood pressure and blood counts

Here it helps to sort claims by the quality of the data behind them.

Randomized trial evidence (strongest). TRAVERSE is the only large trial powered to measure cardiovascular events, and it found no excess of heart attack, stroke or cardiovascular death over about three years in men with low testosterone and high baseline risk. The Testosterone Trials, a set of seven coordinated placebo-controlled studies in 790 men aged 65 and over published in 2016, were too small for hard outcomes but did observe more growth of non-calcified plaque in coronary arteries on imaging in the treated group, a finding whose clinical meaning is still unresolved.

Randomized evidence on blood pressure. Dedicated studies using ambulatory blood pressure monitoring, where a cuff records readings around the clock, found that testosterone products raise average systolic pressure by a few millimeters of mercury. That is modest for one person and meaningful across a population, which is why the 2025 label change added it as a class-wide warning.

Secondary signals (hypothesis-generating). TRAVERSE recorded more atrial fibrillation, pulmonary embolism, acute kidney injury and fractures in the testosterone arm. These were not the trial’s primary question, so they could be chance; equally, they could be real. Honest clinicians describe them as signals that need confirmation, not as proven harms or proven non-harms.

Blood counts. Hematocrit, the percentage of blood volume made up of red cells, rises on testosterone because the hormone stimulates red cell production. When it climbs too high, a state called erythrocytosis, blood thickens and clot risk rises. Gels raise hematocrit less than injections in observational comparisons, but the rise is still the most common reason clinicians adjust or pause treatment.

Expert opinion. Guidelines advise against starting testosterone within several months of a heart attack or stroke, or in uncontrolled heart failure. No trial has tested those situations, which is precisely why guidance is cautious.

Prostate, PSA and cancer risk: what screening looks like on testosterone

For decades the working assumption was that testosterone fed prostate cancer the way gasoline feeds a fire. The modern evidence is more measured. PSA, or prostate-specific antigen, is a protein the prostate releases into the blood; its level tends to rise modestly when a man with low testosterone starts treatment, partly because the prostate had been under-stimulated. In TRAVERSE, rates of high-grade prostate cancer over roughly three years did not differ between testosterone and placebo, and the Testosterone Trials saw no increase in prostate cancer over one year.

Those are reassuring but short windows for a cancer that often grows slowly, and no trial has followed men for a decade or more. Guidelines therefore treat known prostate cancer, or a suspicious examination or PSA, as a reason not to start testosterone until a urologist has evaluated the situation. That is expert opinion informed by biology rather than a trial result.

Monitoring reflects the same caution. Endocrine Society and urology guidelines recommend a baseline PSA before starting in men over 40, a repeat check in the first year of treatment, and after that a return to the standard age-based prostate cancer screening conversation. For prostate cancer screening generally, mainstream guidance frames it as a shared decision beginning around age 50 for men at average risk and around 45 for men at higher risk, including Black men and those with a father or brother diagnosed with the disease.

A PSA that jumps sharply, or a prostate that feels abnormal on examination, triggers referral rather than reassurance. Benign enlargement of the prostate, which is common with age, can also become more symptomatic on testosterone, so new urinary symptoms belong in the same conversation.

Fertility, testicle size and enlarged male breast tissue (gynecomastia)

Three side effects deserve their own space because they are common, predictable and rarely mentioned in marketing.

The first is fertility. The brain controls testosterone production through two pituitary hormones, luteinizing hormone and follicle-stimulating hormone, which instruct the testicles to produce testosterone and sperm respectively. Gel-delivered testosterone tells the brain that levels are fine, those signals shut down, and sperm production can fall dramatically within months. Observational studies find that recovery after stopping usually takes six to twelve months and occasionally longer. A man who wants to father children, now or later, should say so before the first application; clinicians have alternative strategies to discuss, and that discussion is theirs to lead.

The second is testicular shrinkage, which follows from the same shut-down. It is cosmetic for most men but distressing for some, and it is a reliable indicator that the body’s own production has been suppressed.

The third is enlarged male breast tissue (gynecomastia). Aromatase, an enzyme concentrated in fat tissue, converts a portion of testosterone into estradiol. In men with more body fat, that conversion is more active, so estrogen-driven breast tenderness and tissue growth are more likely. The evidence on frequency is observational; labels list it as a known effect without a precise rate. Any firm lump, one-sided swelling or nipple discharge is a reason to be examined rather than to assume it is a hormone effect, because breast cancer, although rare in men, does occur.

None of these effects has a self-management fix. Each is something to report to the prescribing clinician, who may adjust the treatment plan or investigate further.

Testosterone gel monitoring blood tests: what gets checked and when

Monitoring is the part of treatment that turns a list of possible side effects into a manageable set of numbers. Guidelines from the Endocrine Society and major urology bodies broadly agree on the schedule below; individual clinicians adapt it to a man’s age, health and findings.

When	What is checked	Why it matters
Before starting	Two morning testosterone levels on separate days; hematocrit; PSA in men over 40; blood pressure; sleep apnea and fertility history	Confirms the diagnosis and sets a baseline so later changes can be judged
3 to 6 months	Testosterone level timed to the gel; hematocrit; PSA; blood pressure; review of symptoms and application technique	Checks that absorption is adequate and catches early rises in red cells or PSA
12 months	Hematocrit; PSA; blood pressure; symptom review	Confirms stability before moving to a longer interval
Every year after	Hematocrit; PSA per screening guidance; blood pressure; bone density where osteoporosis is a concern	Long-term surveillance of the effects most likely to accumulate quietly

Two numbers do most of the work. The first is the testosterone level itself, measured at a time of day that reflects steady-state absorption from the gel; levels that remain low despite consistent use often point to absorption problems rather than the wrong product. The second is hematocrit. Labels and guidelines cite a ceiling above which treatment should be paused or adjusted, and reaching it is the single most common reason for a change in plan. The decision about what to do at that point belongs to the prescribing clinician, not to the patient or an online forum.

Blood pressure deserves a mention of its own since the 2025 label change. A home cuff, used the way a clinician recommends, gives better data than a single clinic reading, and a sustained rise is worth reporting rather than waiting for the next visit.

How do you feel after testosterone gel? The first signs it is working

Men expecting a switch to flip are usually disappointed; men expecting nothing are sometimes pleasantly surprised. A widely cited 2011 review that pooled trial data on the time course of effects gives a realistic map. Sexual interest tends to change first, often within about three weeks, and plateaus by roughly six weeks. Mood and energy shift over a similar window of three to six weeks, with the full effect taking a few months. Erections, particularly morning erections, can take three to six months to improve. Muscle strength changes become measurable at around twelve to sixteen weeks, and bone density changes need six months or more to register on a scan.

Two caveats matter. The first is that the gel’s steady delivery means there is no early rush of the kind some men describe after an injection; the experience is gradual by design. The second is the size of the placebo effect. In the Testosterone Trials, men on placebo gel also reported meaningful improvements in sexual function and mood, and the real difference attributable to testosterone was modest. Feeling better in the first month is good news, but it is not proof the hormone is responsible.

What a clinician considers a sign of adequate treatment is not a feeling at all; it is a blood level in the normal range at the first follow-up, combined with a symptom review. Men who feel no different after three to six months with levels confirmed in range often have symptoms that were never caused by low testosterone, and guidelines suggest that is a reasonable point to reassess whether to continue. That reassessment is the prescribing clinician’s call.

What are the positive effects of testosterone gel, according to trials?

A fair account of side effects has to sit next to a fair account of benefits, and the benefits are real but smaller than the internet suggests.

The Testosterone Trials, published in 2016 across seven coordinated placebo-controlled studies in men aged 65 and over with confirmed low levels, remain the most careful look at what the gel does for symptoms. Sexual activity and desire improved modestly; the effect on erections was smaller. Walking distance in a six-minute test improved slightly across the full group. Mood improved a little, while a measure of vitality did not reach statistical significance. Anemia, meaning low red cell count, corrected in a substantial share of men who had it. Bone density increased measurably on scans. Cognitive function, tested in men with age-associated memory impairment, did not improve at all.

TRAVERSE, which was designed for safety rather than benefit, nonetheless recorded modest improvements in sexual function and small reductions in depressive symptoms over its follow-up. It did not find the sweeping gains in energy or body composition that drive much of the online enthusiasm.

The pattern across randomized evidence is consistent: in men who genuinely have low testosterone, treatment produces modest, measurable improvements in libido, mood, anemia and bone, with little effect on memory and uncertain effects on stamina. In men whose levels were normal to begin with, there is no randomized evidence of benefit and all of the side effects still apply. That asymmetry is the strongest argument for confirming the diagnosis with two properly timed morning blood tests before anyone picks up a tube.

How long should you take testosterone gel?

The honest answer is that duration depends on why the level was low in the first place, and that the decision is revisited rather than made once.

Some causes are permanent. Men with Klinefelter syndrome, a genetic condition in which the testicles cannot produce enough hormone, men who have lost testicular function to surgery, injury or cancer treatment, and men with pituitary damage will usually need testosterone for life, because the body has no way to resume its own production. For them the gel is replacement in the literal sense, and monitoring continues indefinitely.

Other causes are potentially reversible. Obesity, poorly controlled diabetes, sleep apnea, certain medicines and heavy alcohol use all lower testosterone, and observational studies show that significant weight loss or treating sleep apnea can raise levels without any hormone. Guidelines suggest that in these men the underlying condition should be addressed, and that the need for ongoing treatment should be reconsidered periodically.

A third group, men with the gradual decline that accompanies aging, sits in a gray zone where guidelines are cautious and the long-term evidence thin. Many clinicians propose a defined trial period of three to six months, with blood levels confirmed in range, followed by a frank conversation about whether the benefit justifies continuing.

Whatever the cause, stopping is not something to do alone. Testosterone from outside the body suppresses natural production, so symptoms often return and can briefly worsen when treatment ends, and recovery of the body’s own output takes months. If you are thinking about stopping, changing or pausing, bring it to the prescribing clinician first; there are usually better and worse ways to do it, and only they can see your whole picture.

Common myths about testosterone gel side effects

Viral claims about testosterone tend to be confidently wrong in both directions. A few corrections, each tied to the evidence above.

Myth: testosterone gel causes heart attacks. The largest randomized trial to date, in men already at high cardiovascular risk, found no excess of heart attack, stroke or cardiovascular death over about three years. What it did find were small signals for atrial fibrillation, clots in the lung and kidney injury, plus a rise in blood pressure confirmed in separate studies. The accurate statement is "no proven increase in major cardiac events, several unresolved secondary signals, and a known effect on blood pressure."

Myth: it is harmless if you are over 40 and tired. Tiredness without a confirmed low level is not an indication, and the randomized evidence of benefit in men with normal levels is nonexistent. The side effects, including reduced fertility and raised hematocrit, do not need a diagnosis to occur.

Myth: once the gel is dry, there is no transfer risk. Drying reduces transfer substantially; it does not eliminate it. Exposure studies still detected hormone transfer from dried, uncovered skin, which is why labels specify both clothing and a washing window.

Myth: gels do not raise red blood cells the way injections do. They raise them less, on average, in observational comparisons. They still raise them, and hematocrit remains the most frequent reason for a change in plan on gel.

Myth: testosterone helps you conceive. The opposite is true. It suppresses the pituitary hormones that drive sperm production and can make conception difficult for months.

Myth: it causes rage. Trials show small average improvements in mood. Irritability is reported by some men, more often with the peaks of injections than with the steady levels of gel, and it is a reason to speak with the clinician, not evidence of a universal effect.

When to see a doctor about testosterone gel side effects

Most testosterone gel side effects are mild and belong in the notes for the next scheduled visit. A smaller set should prompt a same-day call or emergency care.

Seek emergency care for:

• Chest pain or pressure, sudden shortness of breath, or coughing up blood, which can signal a heart attack or a clot in the lung.
• Sudden weakness or numbness on one side, slurred speech, facial drooping or a sudden severe headache, which are signs of stroke.
• Pain, warmth and swelling in one calf or thigh, which can indicate a clot in a leg vein.
• An erection lasting more than four hours, which is a medical emergency.

Contact the prescribing clinician promptly for:

• Any sign of exposure in a child or partner: new pubic or body hair, genital enlargement, acne, a growth spurt or unexplained aggression in a child; new facial hair, acne or voice change in a woman.
• A partner who becomes pregnant, so handling precautions can be reinforced.
• Loud snoring with witnessed pauses in breathing, or new daytime sleepiness.
• Swelling of the ankles or feet, rapid weight gain, or a sustained rise on a home blood pressure monitor.
• A breast lump, one-sided breast swelling or nipple discharge.
• New or worsening difficulty passing urine.
• A spreading, blistering or persistent rash at the application site.
• Persistent low mood, unusual irritability, or thoughts of self-harm.
• Yellowing of the skin or eyes, dark urine or persistent nausea, which are rare but need evaluation.

Every one of these is a reason to talk, not to adjust the gel yourself. The prescribing clinician has your blood results, your history and your other medicines, and the decision to continue, pause, change or investigate belongs with them. Keeping the follow-up appointments that come with the prescription is the single most effective way to catch problems before they become emergencies.

Frequently asked questions

How do you feel after testosterone gel?

Most men notice nothing dramatic in the first days, because the gel delivers hormone steadily rather than in a surge. Over three to six weeks some report more sexual interest and a modest lift in mood or energy; erections and strength take months longer. In trials, men on placebo gel also reported improvement, so early good feelings are encouraging but not proof. Blood levels at the first follow-up tell the clinician whether treatment is adequate.

What are the first signs that testosterone is working?

The earliest change is usually sexual interest, often within about three weeks, followed by mood and energy over three to six weeks. Improved morning erections typically take three to six months, measurable strength changes around twelve to sixteen weeks, and bone density changes six months or more. A testosterone level in the normal range at the first blood test is the sign clinicians weigh most heavily.

How long does testosterone gel take to work?

Blood levels reach a steady state within days, but symptoms follow a slower timetable. Pooled trial data suggest libido changes within weeks, mood within one to two months, erections and muscle within three to six months, and bone over six months or longer. Guidelines suggest that men who feel no different after three to six months with confirmed normal levels should discuss with their clinician whether to continue.

What are the positive effects of testosterone gel?

In men with confirmed low testosterone, randomized trials show modest improvements in sexual desire and activity, small gains in mood and walking distance, correction of anemia, and increased bone density. They show no improvement in memory or thinking, and little change in vitality. In men whose levels are normal, there is no randomized evidence of benefit, while all of the side effects still apply.

How long should you take testosterone gel?

It depends on the cause. Permanent causes such as Klinefelter syndrome, testicular loss or pituitary damage usually mean lifelong treatment with ongoing monitoring. Reversible causes such as obesity or sleep apnea may allow reassessment once the underlying problem is treated. Age-related decline sits in a gray zone where many clinicians propose a defined trial period. Stopping should always be planned with the prescribing clinician, because symptoms can return and natural production takes months to recover.

Can testosterone gel transfer to my partner?

Yes. Skin-to-skin contact with the application site, particularly in the hours after applying, can raise a partner’s testosterone level, and women have developed facial hair, acne and voice changes from repeated exposure. Pregnant women should not handle the gel at all. Washing hands after applying, covering the site with clothing, and showering before contact within the window on your product leaflet reduce the risk substantially.

What should I do if a child touches my testosterone gel application site?

Wash the child’s contact area with soap and water right away and tell both the prescribing clinician and the child’s pediatrician. Watch for new pubic or underarm hair, genital enlargement, acne, a growth spurt or unusual aggression over the following weeks. A pediatrician can check a blood testosterone level and, if needed, a bone-age X-ray. Most changes fade once exposure stops, but advanced bone age can be lasting, so early reporting matters.

Why does testosterone gel cause skin irritation?

The gel’s alcohol base carries the hormone into the skin and also dries it, producing redness, itching, dryness or burning in roughly 5% or fewer of users. Rotating approved sites, applying to clean dry skin and avoiding shaved or sunburned areas help. A spreading, blistering or persistent rash may be allergic contact dermatitis and should be reported, since the clinician may switch formulations.

What blood tests are needed while using testosterone gel?

Guidelines recommend a testosterone level and hematocrit at three to six months, PSA in men over 40 within the first year, then hematocrit and PSA annually, with blood pressure checked throughout. Two morning testosterone tests on separate days are needed before starting to confirm the diagnosis. A rising hematocrit is the most common reason for a change in plan, and the prescribing clinician decides what that change should be.

Does testosterone gel raise blood pressure or affect the heart?

Studies using around-the-clock monitoring show testosterone products raise systolic blood pressure by a few millimeters of mercury on average, which led to a 2025 class-wide label warning. The large TRAVERSE trial found no excess of heart attack, stroke or cardiovascular death over about three years, but recorded small secondary signals for atrial fibrillation, lung clots and kidney injury that remain unresolved. Men with recent heart events are generally advised not to start.

References

• MedlinePlus: Testosterone Topical
• Cleveland Clinic: Low Testosterone (Male Hypogonadism)

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.