Testosterone gives a man many of his male characteristics: big and strong muscles, a healthy sexual appetite, high energy levels, etc. But sagging testosterone levels cause a variety of symptoms that can reduce the quality of life for many older men. Testosterone therapy raises hormone levels to therapeutic levels to relieve these symptoms and restore quality of life. Topical testosterone, which is applied to the skin rather than taken internally, is one of the easiest and most common modes of delivery.

Testosterone production declines naturally in the aging male body. The Cleveland Clinic says that 20% of men older than 60 years and 30% to 40% of those over 80 years have lower testosterone levels than younger men. Some medical disorders, such as stressful illnesses, surgery, heart attack, and cancer, can hasten this process and cause more serious testosterone deficiencies in some men.

Symptoms of Low Testosterone

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Men with low testosterone experience symptoms that reduce the quality of life by altering male characteristics and impairing normal sexual function. Signs and symptoms of low testosterone may include:

  • Erectile dysfunction and infertility
  • Reduced beard and body hair growth
  • Decreased muscle mass
  • Decreased bone mass
  • Development of breast tissue

Low testosterone can also cause mental and emotional changes, including fatigue, lackluster libido, and difficulty concentrating, as well as hot flashes. Many of these symptoms are similar to those experienced during menopause in women, often called andropause in men.

Testosterone Treatment

Hormone replacement therapy using testosterone increases a man’s hormones to therapeutic levels to relieve these symptoms. Several treatment modes are available, including gels, injections, patches, gums, and implantable pellets. There is no testosterone pill because long-term oral use of this hormone can cause liver damage.

Each delivery mode has its own benefits and drawbacks. Injections into the muscle are safe and effective, but symptoms may increases between doses. Testosterone gum is a putty-like substance the user places between his cheek and upper gum. A surgeon can place testosterone pellets under a man’s skin but these require replacement every 3 to 6 months.

Topical Testosterone

Low testosterone is a chronic problem that requires a long-term solution. Topical testosterone provides that lasting solution to persistent symptoms and is available as a patch or gel. The patient applies a patch to his back, abdomen, upper arm, or thigh, changing the location of the patch each night to avoid skin irritation. Topical testosterone in gel form is effective and convenient because it does not require injections or surgery and it causes less irritation to the skin than patches. As topical testosterone gel dries, the patient’s body absorbs the medication through his skin.

There are many name-brand topical testosterone products available today. These products are available by prescription only. AndroGel and Testim are types of testosterone gels applied to the upper arm and shoulder. The patient applies Axiron under his armpit. Fortesta is a topical testosterone delivered via a pump spray that the user applies to his inner thigh.

Unwanted Side Effects of Topical Testosterone

Like all medications, testosterone therapy carries risks. All modes of testosterone therapy can contribute to sleep apnea, stimulate noncancerous growth of the prostate and growth of existing prostate cancer, enlarge the breasts, and limit sperm production. A January 2014 study published in PLOS One suggests testosterone therapy may increase the risk of heart attack, although the U.S. Food and Drug Administration says they have “not concluded that FDA-approved testosterone treatment increases the risk of stroke, heart attack, or death.

There are risks specific to topical testosterone preparations. One potential side effect is the possibility of transferring testosterone to another person through physical contact. Young children exposed to topical testosterone through skin-to-skin contact with a man using this medication may show signs of puberty, according to the AndroGel manufacturer’s website. To reduce this risk, the consumer should cover the application area with clothing until he has washed the area. He should wash the area thoroughly if he expects another person to have physical contact with the skin on his shoulders or upper arms.

Topical testosterone treats the symptoms of low testosterone levels and restores quality of life for men who suffer from andropause. Today’s topical testosterone treatments provide safe and effective symptom relief for most men with few side effects. Any man concerned about low testosterone levels, or the safety and effectiveness of male hormone replacement therapy, should talk with his doctor about using topical testosterone.


  1. AndroGel [important safety information]. AndroGel website. http://www.androgel.com/important-safety-information.
  2. Axiron website. http://www.axiron.com.
  3. Faiman C. Male hypogonadism. Cleveland Clinic website. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/male-hypogonadism.
  4. Finkle WD, Greenland S, Ridgeway GK, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLOS One. 2014; 9(1): e85805. http://www.plosone.org/article/fetchObject.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0085805&representation=PDF.
  5. Fortesta website. http://www.fortestagel.com/index.aspx.
  6. Testim website. http://www.testim.com.
  7. U.S. Food and Drug Administration. Safety Announcement: FDA evaluating risk of stroke, heart attack and death with FDA-approved testosterone products. January 31, 2014. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM383909.pdf.