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Testosterone Gel and BMI

If your patients or clients include older men, it’s likely that some have low testosterone (also called hypogonadism). Testosterone is an important hormone for men. It’s responsible for secondary sex characteristics like facial hair and a deepening voice. It also contributes much to a man’s sex life.

Testosterone levels naturally decline as men age. Some experts call this andropause and liken it to the estrogen decreases associated with female menopause, although this comparison is not entirely accurate. Testosterone declines for men tend to be more subtle than the estrogen declines in women.

Still, low testosterone can be troublesome. Men may feel fatigued and weak. They may lose muscle mass and gain body fat. And they often develop sexual problems, such as low sex drive and erectile dysfunction.

Some men replenish their testosterone through a prescription testosterone 2% gel. However, the effects of body mass index (BMI) on this type of therapy have not been widely studied.

New Research

In November 2013, the Journal of Sexual Medicine published a study by American researchers who examined the issue. They worked with 149 men between the ages of 18 and 75 who had baseline testosterone levels below 250/300 ng/dL. (According to the U.S. National Institutes of Health, a range of 300 – 1,000 ng/dL is considered normal.)

The men were divided into three groups based on their baseline BMIs. Tertile 1 included men with BMIs less than or equal to 29.1 kg/m2. The BMIs of men in Tertile 2 ranged from 29.2 to 32.4 kg/m2. Men in Tertile 3 had BMIs greater than 32.4 kg/m2).  The mean ages for the men in Tertiles 1, 2, and 3 were 52.9, 54.0, and 54.2, respectively.

Each man used a testosterone 2% gel for 90 days. The gel was applied to the front and inner thigh. If needed, the dosage could be adjusted at specified points during the study.

After 90 days, the researchers found that 79.1% of the men in Tertile 1, 79.5% of the men in Tertile 2, and 73.8% of the men in Tertile 3 had testosterone levels in the normal range. Men with BMIs greater than 32.4 kg/m2 needed higher doses of testosterone to reach this goal, however.

The researchers found that the treatment was generally well tolerated, even for men who had increased doses. The most common adverse events were skin reactions, upper respiratory infections, and sinusitis.

Using Testosterone With Care

If you have a patient considering testosterone gel therapy, here are a few points to keep in mind:

·         Therapy should be conducted under a doctor’s care. Only a qualified physician can determine the proper dose of testosterone for that individual patient. A doctor can also do a thorough examination to determine whether a man’s symptoms are indeed cause by low testosterone or whether other factors are involved.

·         Men should be cautioned about over-the-counter testosterone supplements, which are widely marketed. Again, testosterone therapy should be done under a physician’s guidance. Over-the-counter preparations can be risky. (Click here to learn more about these risks.)

·         Men using a testosterone gel should follow the doctor’s instructions carefully and read the accompanying medication guide. The application area should be covered to avoid transferring the gel to others, especially women and children. This guide, provided by the U.S. Food and Drug Administration, provides more information on the proper use of testosterone gel.

For More Information

We provide comprehensive information on low testosterone here. Your colleagues and managers may also provide details relevant to your particular clinical site.

Print this article or view it as a PDF file here: Testosterone Gel and BMI


The Journal of Sexual Medicine

Dobs, Adrian, MD, et al.

“Testosterone 2% Gel Can Normalize Testosterone Concentrations in Men with Low Testosterone Regardless of Body Mass Index”

(Full-text. First published online: November 28, 2013)

Medline Plus


(Page updated: March 22, 2012)

Sexual Medicine Society of North America

“Risks and Realities of OTC Testosterone Supplements”

(April 9, 2013)

U.S. Food and Drug Administration

“Testosterone Gel”

(Medication guide. February 2012)