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Testosterone Gel for Gender-affirming Hormone Therapy: What, Where, and How

Everything you need to know about testosterone gel for HRT.

A blue and purple gradient with a shirtless torson applying gel to their upper arms.

Illustrations by Leo Mateus.

Testosterone gel is one route that many transgender, non-binary, and gender-fluid people use to take testosterone for gender masculinizing hormone therapy. The gel is applied to and absorbed through the skin (transdermal) and can induce more gradual changes than injectable testosterone

What is testosterone gel?

Many transgender and non-binary people looking to change their gender through testosterone hormone therapy will choose T gel if they have a fear of needles or are looking for more gradual changes. According to the World Professional Association of Transgender Health (WPATH), transdermal testosterone achieves the same masculinizing effects as injectable testosterone, though the time frame differs. Intramuscular testosterone cypionate or enanthate is injected every 1-2 weeks which can cause hormone levels to fluctuate cyclically. Because testosterone gel is applied daily, hormone levels stay more consistent in the body. 

These two methods of testosterone therapy are most common in healthcare. Some less common routes are androderm patches, injectable testosterone undecanoate, and testosterone pellets. To learn more about these, take a look at this article

Common side effects and things to consider when taking testosterone:

When you first start your testosterone HRT journey, you might feel an increased sense of energy and confidence. This can be an exciting new time and you might be feeling a range of emotions. Many trans men and trans masculine people report feeling happier, healthier, and more at ease with themselves. Alongside these positive changes, there are some side effects that you should be aware of when taking testosterone.

Do not use testosterone gel if you're pregnant, have coronary artery disease, or have untreated polycythemia. People with a history of breast cancer or estrogen-dependent cancers should consult their oncologist before starting testosterone HRT. Always consult your provider for medical advice before adding hormones to your care routine. 

The common effects of testosterone HRT include physical changes such as the development of facial hair, increased hair growth most often seen in more body hair, acne, increased muscle mass, and cessation of menstruation

The most common side effect of testosterone gel is irritation of the site of application or acne. Other side effects of testosterone are hair loss, migraines and headaches, and fluctuations in mental health. For more information on testosterone and its side effects check out this article

Though not a side effect, it's important to know that the gel can transfer to someone else through skin-to-skin contact. Waiting a few hours before having skin-to-skin contact after application will allow the hormones to be fully absorbed into the body. FOLX provides testosterone gel in a pump with varying strength and volume to allow for the best care plan for each person.

How do I apply testosterone gel?

Where & how to apply T gel depends on what feels best to the person applying it.

Testosterone gel is applied by rubbing the dose directly from the pump bottle onto the skin. The gel can be pumped into the hand to apply onto the body, or directly onto the body. 

The main goal when applying testosterone gel is to put it in areas that:

  • aren’t particularly bendy (think: backs of knees)
  • won’t rub off on others, which could give them a non-consensual dose of T
  • will be covered by clothing

Common locations to apply T gel are generally:

Upper arms & shoulders: areas that would be covered by a t-shirt, for example, avoiding the armpits and inside of the elbows if possible

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Front & back of thighs: areas that would be covered by shorts, for example, avoiding behind the knees

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The abdomen: There is some data that suggests testosterone gel doesn't get absorbed as well when it is rubbed onto the abdomen, but it is not strong data. If the abdomen is the most convenient area for you, it should be fine.

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Finally, there is no need to wear gloves while applying T gel, but don’t forget to wash those hands after, as not to get the gel on anyone (pets included) or anything else. It is okay to have skin-to-skin contact with others with the areas of the skin where there is no T gel.

Don’t forget to let the gel dry!

After the T gel has been applied, it is important to let it fully dry before putting on clothing and going about the day. This is important because while it is still wet, it could run off onto the clothing which decreases the amount that is absorbed, and therefore decreases the dose absorbed by the body.

Even when it is dry, the gel continues to be absorbed through the skin for up to 5-6 hours, meaning application time should be taken into consideration when planning to shower, apply lotion/moisturizer, swim, exercise, or just generally get sweaty.

One more tip for labs and T gel.

When it comes time to get labs, make sure to take a shower between the last gel application and labs, and put on a clean shirt so that the lab needle doesn’t accidentally get T gel on it during the blood draw, making your T levels look like they are through the roof!

How is testosterone gel used outside of gender-affirming hormone therapy?

Testosterone gel is not exclusive to transgender men, trans masculine people, non-binary folks, or other people who are fluid in their gender identity. Many cisgender men, four to five million in America in fact, do not produce enough of testosterone, a condition called hypogonadism. These folks will also use testosterone gel to supplement their androgen levels. 

What are the different doses of testosterone gel?

Many brand name testosterone gels (Testim or Androgel) will come in packets dosed at 25mg or 50mg or pumps that dispense 12.5mg or 20.25mg

For those ready to get started with FOLX for testosterone, the process begins here. For existing FOLX members with questions about testosterone gel, don't hesitate to schedule time with a clinician. And for those who’ve just got some more questions, read up on testosterone here, and feel free to reach out to us at support@folxhealth.com.