Testosterone belongs to a group of hormones called androgens (male hormones). Testosterone is responsible for the growth and development of the male sex organs as well as male sex characteristics such as chest hair, facial hair, pubic hair, voice changes, and muscle growth. A deficiency of testosterone can result in underdeveloped testes or erectile dysfunction (difficulty getting or keeping an erection).

Testosterone nasal gel is used to treat testosterone deficiency. Testosterone nasal gel should only be used if testosterone deficiency has been confirmed by symptoms and blood tests.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended starting dose of testosterone nasal gel is 11 mg of testosterone (one pump from the actuator device into each nostril) 2 times a day, at least 6 hours apart. The last dose of the day should be administered at least 1 hour before laying down to sleep. Spread the doses out as evenly as possible throughout the hours that you are awake. Your doctor may increase your daily dose to a maximum of 11 mg three times daily, depending on results of blood tests and how you are feeling.

Before using the pump for the first time, prime the pump by holding the pump upside down and pressing on the actuator 10 times. Use soap and warm water to wash away any gel that comes out of the tube. Wipe the tip of the actuator with a clean, dry tissue.

To use this medication:

1. Blow your nose before using it.
2. Remove the cap from the dispensing device.
3. Place your right index finger on the pump of the device.
4. Using a mirror to guide you, slowly insert the tip of the device into the left nostril until the tip of your index finger reaches the base of your nose.
5. Tilt the device so the opening on the tip is in contact with the outside wall of the nostril. This ensures that the gel is applied to the wall of the nose.
6. Slowly press the pump until it stops.
7. When you remove the device from the nose, wipe the tip along the inside of the nostril wall to completely transfer the gel.
8. Repeat this for the other nostril.
9. Once the gel has been applied to both nostrils, wipe the tip of the applicator clean with a clean, dry tissue. Replace the cap on the dispenser.
10. Press on the nostrils just below the bridge of your nose and lightly massage the nose.
11. Avoid sniffing or blowing your nose for 1 hour after applying the gel.
12. Avoid laying down for 1 hour after administering this medication to avoid post-nasal drip.

Before using this medication, thoroughly read the patient information provided. If you are not sure how to use it or have questions about how to use it, contact your doctor or pharmacist.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Each metered dose pump actuation contains 5.5 mg of testosterone in 122.5 mg of gel. Nonmedicinal ingredients: castor oil, colloidal silicon dioxide, and oleoyl polyoxylglycerides.

Do not use this medication if you:

• are allergic to testosterone or any ingredients of the medication
• are female (especially if you are pregnant or breast-feeding)
• have, or are suspected to have, prostate or breast cancer

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• acne
• changes in sexual desire or drive
• cough
• decreased sperm production
• difficulty sleeping due to breathing problems
• dizziness
• hair loss, thinning hair, or baldness
• headache
• metallic and/or unpleasant taste
• muscle pain
• nasal irritation (e.g., abnormal or unpleasant odour, nose bleeds, nasal discomfort, runny nose, congestion or sneezing)
• weight gain

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• breast soreness or enlargement
• high blood pressure
• increased or irregular heart rate
• mood changes
• signs of enlarged prostate (urinary problems: change in frequency or colour, dribbling, pain or straining when urinating, weak urine stream, small urine amounts)
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• signs of heart failure (e.g., shortness of breath; fatigue; swelling in legs, ankles, feet)
• swelling of ankles and legs (for people with heart, liver, or kidney problems)
• symptoms of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• prolonged (more than 4 hours) or painful erections, or erections that happen too often
• signs of a blood clot in the arm or leg (tenderness, pain, swelling, warmth, or redness in the arm or leg) or lungs (difficulty breathing, sharp chest pain that is worst when breathing in, coughing, coughing up blood, sweating, or passing out)
• signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
• signs of stroke (e.g., sudden or severe headache, sudden loss of coordination, vision changes, sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood tests: Your doctor may recommend that you have regular blood tests while using this medication to check whether the medication is working and whether you are having certain side effects. Also, the use of testosterone may interfere with a number of laboratory tests. Tell all health professionals administering these tests that you are using this medication.

Breast and prostate cancer: Long-term use of androgens, including testosterone, may increase your risk of developing breast or prostate cancer. Discuss any concerns you may have with your doctor.

Diabetes: Testosterone nasal gel may cause a loss of blood glucose control, and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Men and the heart: Testosterone can cause increased blood pressure and may cause fluid to build up in the body. Both conditions can increase the risk of certain types of heart disease.

There may be an increased risk of heart-related events (e.g., heart attacks, stroke, heart-related death) in men who take testosterone hormone replacement medications. Before you start treatment, tell your doctor if you have diabetes or heart disease, have had a previous heart attack or stroke, or have cardiovascular risk factors (e.g., high blood pressure, smoking, or cholesterol). If you have any of these conditions, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: The liver plays an important role in breaking down and removing testosterone from the body. Certain androgens have also been linked to decreased liver function, which can become life-threatening. If you have reduced liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Nasal problems: Due to a lack of long-term safety information, this medication should not be used by people who have a history of nasal problems, sinus disease, nasal or sinus surgery, a nasal fracture within the previous 6 months, a nasal fracture that caused a deviated septum, or inflammatory disorders affecting the lining of the nose such as Sjögren's syndrome.

Nasal sprays: Testosterone nasal gel may be used with decongestant nasal sprays (e.g., oxymetazoline).  It should not be used with any other nasal sprays.

Prostate problems: Men with benign prostatic hypertrophy (BPH), an enlarged prostate gland, may experience an increase in their symptoms. If you have BPH, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Sleep disorders: Treatment with testosterone may cause sleep apnea (interruption of breathing during sleep). If you have sleep apnea or risk factors for sleep apnea, such as being overweight or having a chronic lung disease, discuss this with your doctor.

Sperm counts: This medication may reduce sperm counts if high doses are used or if it is used for a prolonged period.

Pregnancy and breast-feeding: This medication should not be used by women, especially pregnant or breast-feeding women. It may have unwanted effects on the developing child, including masculinization of female children. Pregnant or breast-feeding women should avoid skin contact with testosterone application sites on men who are using this medication.

Children: Testosterone use can cause growth in children to be stopped early. If this medication is being used to treat males with delayed puberty due to decreased hormone production, the child's final height may be lower than expected. Use of this medication by children should be carefully supervised by the doctor.

Seniors: Seniors may have an increased risk for prostate enlargement and should be evaluated for prostate cancer before starting testosterone replacement therapy.

For a full list of interactions, use the Drug Interaction Checker available on the Drugs.com website.

If you are taking other medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.