For those prescribed topical gel, they should always be counseled about the proper anatomic site to apply the testosterone order gel (in the shoulder and upper portion of the arm, carefully avoiding the phlebotomy site). It is worth noting that product insert material for testosterone gels may not mention the risk of contamination to phlebotomy. For those using testosterone topical gel, contamination of the venipuncture site by gel has previously been reported in a few case reports 20,21. A repeated total testosterone measurement was scheduled a week later, and it also came back elevated with a concentration of 1291 ng/dL (44.8 nmol/L). The primary care physician called the patient to discuss this result, and the patient indicated he had applied testosterone gel earlier in the morning to the same arm in which he received venipuncture for the testosterone concentration. A repeated measurement 2 weeks later was 19 ng/dL (0.7 nmol/L); however, the patient admitted being inconsistent with testosterone gel application.
Clinical guidelines for management of male hypogonadism and treatment of gender dysphoria often recommend periodic monitoring of serum testosterone (e.g., 1 month after starting therapy, then 3–6 months, and then annually) 11,13. In those with prostate glands, high testosterone concentrations can worsen benign prostatic hyperplasia and theoretically accelerate growth of pre-existing prostate cancer (if present) . Regardless of clinical indication, excessively high doses of testosterone have risk of adverse effects, including acne, polycythemia, hypertension, dyslipidemia, and elevated cardiovascular risk 6,7,16,17. The high testosterone concentrations prompted further work-up, including retesting and endocrinology consultation. Commonly used formulations of testosterone include intramuscular, transdermal patch, and topical gel, each of which has differing pharmacokinetics and practical challenges. Clinicians and laboratory specialists should stay attentive to this common form of contamination and instruct patients accordingly. If your partner is rubbing testosterone gel in for you, make sure they use gloves.
Concentrations well beyond 100 nmol, and especially into the 1 µmol to 100 µmol range, for total testosterone are highly unlikely, even in those abusing testosterone for athletic/aesthetic purposes. While pharmacokinetic data gathered in humans administered varying doses of testosterone online pharmacy esters either intramuscularly or subcutaneously vary considerably depending upon the route of administration and sampling method, these data generally show that only quantities used as part of testosterone abuse are capable of reaching concentrations of 100 nmol or greater on a consistent basis. In healthy eugonadal men, testosterone is produced primarily by the Leydig cells of the testicles and results in the total daily production of approximately 6–7 mg/day, although a range of 3–10 mg total testosterone production is often cited as well 1,2,3,4,5,6,7,8,9,10.
This same group’s work was used in lay press articles to claim that even levels of testosterone seen with TRT can "lead to a catastrophic loss of brain cells" . The typical replacement doses utilized for TRT would not be expected to reach this concentration on average (see Table 1) 29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46. Several groups have investigated the potential neurotoxicity of testosterone in vitro by utilizing human and rodent cell lines 25,26,27,28. Testosterone levels may generally decline with advancing age and may eventually reach a point of "testosterone deficiency," although there are other causes of low testosterone, including certain injuries, medications, obesity, illnesses, radiation exposure, and genetic conditions 13,14,15,16,17. Observational data in humans concerning the potential for deleterious changes in brain structure and platform.giftedsoulsent.com function are limited by their inherent design as well as significant potential confounders. FDA now requires stronger warnings on the product labels about the risk of accidental exposure. In most cases, the adverse effects went away when the child was no longer exposed to the drug.
In most cases, the concentrations studied in vitro are unlikely to be reached in the human brain. It has been increasingly speculated that aside from more well-established side effects, testosterone may cause neurological damage. Due to declining buy testosterone booster levels from a variety of causes, testosterone replacement therapy (TRT) is increasingly utilized, while testosterone is also abused for aesthetic and performance-enhancing purposes. The risk of secondary exposure can be limited by hand-washing immediately after application of the gel, covering of the area with clothing, and limiting direct contact of skin with family members. This change in dose led to inadequate therapy, with a later increase in dose by another healthcare provider. Endocrinology documented that this very high value was likely a result of either gel contamination or a laboratory error. Approximately 3 months later, the patient reported being pleased with the masculinizing effects including growth of facial hair, deepening of the voice, and enlargement of the clitoris.
In this instance, it is known that blood concentrations of testosterone overestimate the levels found in the human brain by 3–10 fold 51,52,53,54. While doses of exogenous testosterone normally utilized for TRT purposes are unlikely to elevate plasma buy testosterone without prescription to concentrations that have been shown to have neurotoxic potential in vitro, it is even more unlikely once tissue distribution is considered. Just as with pharmacological targets, utilizing extreme concentrations may not accurately reflect the actual risk of cell/tissue damage 49,50. These concentrations have not been reached in studies utilizing supraphysiological doses of exogenous buy testosterone gel (see Table 1). Other authors have indicated that concentrations of 100–500 µmol are typically reached with a supraphysiological dose of 600 mg of testosterone enanthate weekly , which is also incorrect (see Table 1). Comparison of in vivo testosterone plasma concentrations with neurotoxic in vitro concentrations. Furthermore, even amongst those that are abusing testosterone, consistent concentrations of this magnitude in plasma are not expected, except for those using quantities of 500–600 mg or more of testosterone cypionate/enanthate weekly (see Table 1) 30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46.
Men and women have different physiologic ranges, different evidence bases for treatment, and different monitoring goals. Supraphysiologic levels may increase adverse effects without improving the intended therapeutic outcome. Monitoring should also focus on clinical response and signs of androgen excess (Parish et al., Climacteric, 2021).
Unfortunately, the Food and Drug Administration (FDA) has received reports about these products causing adverse effects in children. Adverse effects can occur in children and women who are accidentally exposed to the drug. However, some products may vary, so it is important to talk to your pharmacist and read that package insert for how and where to apply the gel. It is important in maintaining bone health, energy levels, mood, and sexual desire. This section collects any data citations, data availability statements, or supplementary materials included in this article. Lastly, the current study was performed in the United States, and there are differences in the formulation and available doses of marketed testosterone prescriptions in other countries. Location of application will influence risk of contaminating venipuncture sites , , .
