Compounded Testosterone Cream: The Definitive Guide

What is compounded testosterone cream?

Compounded testosterone cream is testosterone powder mixed into a cream base by a pharmacy for one person's prescription. It is rubbed into the skin once or twice a day, and the testosterone is transdermal (absorbed through the skin) into the blood. In the United States no testosterone cream is FDA-approved, so every testosterone cream there is compounded. [1], [2]

Compounding means a pharmacist makes a medicine to order instead of dispensing one from a factory. FDA's own summary is blunt: compounded drugs are not FDA-approved, which means FDA does not verify their safety, effectiveness or quality before they are marketed, and they should only be used when an approved drug cannot meet a patient's needs. [1]

The testosterone in a cream is plain testosterone, the same molecule the testicles make, with no chemical tail (no ester) attached. It is often described as "bioidentical". That word describes the molecule, not the product. The US National Academies of Sciences, Engineering, and Medicine (NASEM) found too little evidence to support compounded hormone therapy for low testosterone in men. The Endocrine Society sees "no rationale" for routinely prescribing custom compounded hormones. [3], [20], [21]

The only testosterone cream approved as a medicine that this guide found is AndroForte 5 in Australia, labeled for men whose low testosterone has been confirmed by symptoms and blood tests. It anchors the doses in this guide because it is the only cream with an official label, dose rules and published study data. [3], [22]

[1], [3], [23], [24], [25]

Testosterone cream is a controlled substance: Schedule III in the United States. It is also different from the approved testosterone gels (such as AndroGel), which have fixed strengths, US FDA labels and a boxed warning about transfer; see the testosterone gel guide. [14], [26]

Typical Compounded Testosterone Cream Protocols

The only labeled cream starts at 25 mg a day on the scrotum or 100 mg a day on the torso, once each morning; the scrotal dose is a quarter of the torso dose because scrotal skin absorbs far more. No guideline and no published clinic protocol gives a dose for compounded cream, so a compounded prescription rests on the prescriber's judgment and follow-up blood tests. [3], [6], [4]

Titration Adjusting the dose in steps

The AndroForte 5 label waits until after day 15, then checks blood testosterone: scrotal users at 3 hours (the peak) and 24 hours (the trough) after an application, torso users in the morning before applying. The dose moves by 0.25 mL on the scrotum or 1 mL on the torso, and the label recommends rechecking when switching between the scrotum and the torso or from another testosterone product. Guidelines give timing only for gels, not creams (see blood-test timing). The AUA adds that compounded testosterone may need more monitoring and dose changes than commercial products. [3], [4]

Breaks and cycles

Not applicable. Testosterone replacement is continuous treatment; no label or guideline describes planned breaks or cycles for cream. Stopping is a separate decision (what happens when you stop). [3], [27]

Read the units. A cream's strength is usually written as a percentage or as milligrams per millilitre (mg/mL): 5% is 50 mg/mL, 10% is 100 mg/mL and 20% is 200 mg/mL. The amount you apply is the strength times the volume. On AndroForte 5, 0.5 mL × 50 mg/mL = 25 mg. On a compounded 20% cream, 0.25 mL is 50 mg, twice AndroForte's scrotal starting dose in half the volume. Some compounded labels give strength per gram (mg/g) instead, and pump dispensers ("clicks") deliver different volumes: in one published case, one pump was about 0.5 mL, while men online describe 2 clicks as 0.5 mL in total. Ask the pharmacist what one pump delivers in mg. [3], [28], [29] The TRT dose calculator shows the same mg-to-mL arithmetic for injection vials.

Applied is not absorbed. A 100 mg daily cream is not comparable with a 100 mg injection. For AndroGel 1%, a gel, about 10% of the applied testosterone reaches the blood; no label gives an equivalent figure for any cream. That is why weekly totals for cream look far larger than injection doses: the two numbers measure different things. [30], [3]

These are labeled doses; prescribers adjust them using blood tests and symptoms. The ranges above are for adult men. For women, see testosterone therapy for women, which uses different products and far smaller doses.

Cautions for every schedule above. The label rules out testosterone in known or suspected breast or prostate cancer and in anyone allergic to the cream's ingredients (AndroForte contains almond oil). Cream on the skin can pass to partners and children (transfer). Testosterone can suppress sperm production (fertility). Hematocrit, blood pressure and PSA (prostate-specific antigen, a prostate blood test) need checking (monitoring). [3], [11]

Where schedules differ: compounded vs approved, scrotum vs torso, once vs twice a day, cream vs gel and blood-test timing ↓

What doses did cream studies use?

The rows are alternatives, not steps to move through. The two scrotal studies used 10 mg and 50 mg a day, the lowest and highest ends of anything published for cream; both fall at or under the label's scrotal maximum of 50 mg a day. [35], [23], [3]

What is compounded testosterone cream commonly used for?

Its purpose is the same as every form of testosterone replacement therapy (TRT): replacing testosterone in men whose bodies cannot make enough because of a medical cause, confirmed by symptoms and repeated morning blood tests. The AndroForte 5 label is written for exactly that group. [3], [31]

Why a cream rather than an approved product? The reasons prescribers and patients give fall into a few groups, and the evidence behind each differs:

• No needles, and a daily routine. Many men who fear needles or react to injection oils ask about cream; that is a frequent topic in public forums (community). [38], [39]
• Scrotal application. US gel labels forbid applying gel to the genitals, while the AndroForte label allows the scrotum, where a small dose goes a long way. In the US, a scrotal product is therefore compounded by definition. [26], [30], [3]
• Flexible strengths and allergy. Compounding can make strengths or bases that approved products do not offer, and can leave out an ingredient a person is allergic to. NASEM says compounded hormones should be limited to a documented allergy or a needed dosage form that no approved product provides, and that "patient preference alone should not determine" their use. [20], [40]
• Cost. The AUA notes that compounded gels and creams "are routinely less expensive than branded forms". Prices vary widely; see cost. [4]

What does testosterone replacement improve?

In trials of men with low testosterone, testosterone mainly improves sexual desire and activity. In the Testosterone Trials, which gave a gel to men 65 and older, it also improved erectile function and lifted mood a little. It did not improve energy, and walking did not improve in the physical function trial itself. Those large trials did not test cream. [41]

Cream-specific outcome data are thin. In a 4-week Japanese trial, a 2% scrotal cream raised testosterone but did not improve an aging-symptom questionnaire, while a new 2% gel at the same 10 mg dose did. In a 24-week Indonesian trial in older men with memory complaints, 50 mg of scrotal cream raised testosterone, free testosterone and DHT and lowered the pituitary signal luteinizing hormone (LH); it was not designed to test low-testosterone symptoms. [23], [35]

How long does testosterone cream take to work?

Blood levels rise fast: the AndroForte label reports testosterone rising from the first hour after an application and reaching the normal range within 24 hours. Symptoms change more slowly, and no study has timed them on cream. For any form, the Canadian Urological Association tells men to expect changes in sex drive, energy and sexual function after 3 months or longer. Changes in body composition and bone take 6 months or more. [3], [33] See the results timeline guide.

Where do compounded testosterone cream protocols differ?

There is only one cream label, and it is Australian. Everything else about cream, from strength to site to how often to apply it, is decided prescription by prescription, so the real disagreements are about whether to compound at all, where to apply, how often, and when to test.

Compounded or approved: what do guidelines say?

Guidelines lean firmly toward approved products. The AUA recommends that "commercially manufactured testosterone products should be prescribed rather than compounded testosterone, when possible" (a conditional recommendation). Its reason is that compounded testosterone shows "considerable variation in potency and quality, even between samples from the same pharmacy". The Canadian Urological Association warns of "significant variability of testosterone concentrations" in compounded products, and the Endocrine Society's 2016 statement finds "no rationale for routine prescribing" of custom compounded hormones. [4], [33], [21]

The counterpoint is practical. The AUA itself notes that compounded gels and creams are usually cheaper than branded products. NASEM accepts a documented allergy or a needed dosage form as valid reasons. And in the US, anyone who wants a cream, or wants to apply testosterone to the scrotum, has no approved option. [4], [20], [26]

The accuracy data behind the guidelines' caution are in Does compounded cream contain what the label says?

Scrotum or torso?

Where the cream goes changes the dose more than anything else. Scrotal skin is thin and lets steroids through easily. The AndroForte label starts at 25 mg on the scrotum and 100 mg on the torso, and Australia's Pharmaceutical Benefits Scheme (PBS) criteria add that the cream "must be applied to the scrotum, where possible". [6], [3], [42]

The trade-off is DHT. A 24-week trial in 162 men tested a 2.5% gel that was washed off 10 minutes after each application. 25 mg a day on scrotal skin gave levels equivalent to testosterone patches, while 125 mg on other skin gave higher levels. Prostate size, PSA and prostate symptoms did not differ between the groups. Scrotal application raises DHT more (why). [43]

Other sites (shoulders, arms, inner thighs) are common on compounded prescriptions, but only the scrotum and torso have label dosing. Men online describe large differences between sites on the same cream, such as one man's result above 1,500 on the scrotum and 310 with the same amount on the shoulders (units not stated). [3], [44]

Once or twice a day?

The label says once daily, preferably in the morning. Twice-daily schedules are common on compounded prescriptions and in forum accounts, usually to avoid an afternoon "crash", but no label, guideline or published protocol gives a twice-daily cream schedule. Scrotal single doses kept testosterone in the normal range for at least 12 hours (12.5 mg) and more than 16 hours (25 and 50 mg). [3], [45], [46]

When a prescriber splits a dose, the daily total is still the number that matters: 50 mg twice a day is 100 mg a day, twice the label's scrotal maximum.

Is cream the same as gel?

Not milligram for milligram. A 30-day crossover study enrolled 16 men, and 14 were in the final analysis. In it, 100 mg a day of AndroForte 5 on the torso gave the same blood levels as 50 mg a day of a 1% gel, so the cream needed twice the applied amount. In the Japanese trial, 10 mg on the scrotum raised total testosterone to 9.86 ng/mL with the 2% gel but 7.30 ng/mL with the 2% cream. Bases, strengths and absorption differ, so switching between a cream and a gel needs new blood tests. [37], [3], [23]

When should blood be drawn on cream?

On cream, the time since the last application changes the result a lot, and only the AndroForte label gives cream-specific timing. Guidelines give timing for gels, which behave similarly but not identically.

[3], [4], [31], [25], [27]

Scrotal cream peaks within a few hours. The label reports an average time to peak of 3.3–5.3 hours for the study it describes, while that study's own abstract reports 1.9–2.8 hours. Torso cream peaked much later, around 14.8 hours. A single case report of scrotal compounded cream measured 1,204.7 ng/dL within 2 hours, far above guideline targets. [3], [6], [47]

That spread explains most confusing results. A draw 3 hours after scrotal cream measures the peak; a draw 24 hours later measures the trough; a result without its timing is hard to interpret. Write down when you applied the cream, where, and how much, next to every result. See TRT blood work.

What happens when you stop compounded testosterone cream?

The cream leaves the body within days; your own hormone production takes much longer to return.

• The last application. No study has measured how fast levels fall after stopping a cream. For comparison, the AndroGel 1.62% label says levels return to about their starting point within 48–72 hours of the last dose, and the AndroGel 1% label says by the fifth day. [26], [30]
• Your own testosterone. Testosterone on the skin switches off the pituitary's signals to the testicles, just as injections do: in the 24-week cream trial, LH fell. How fast LH and follicle-stimulating hormone (FSH) recover depends on the original cause of low testosterone and how long treatment lasted; in men with a lasting cause, low testosterone is expected to return. [35], [3], [27]
• Sperm. No cream-specific recovery data exist. In contraceptive trials of 1,549 healthy men given hormones, sperm counts returned to 20 million per mL in 67% within 6 months, 90% within 12 months and 100% within 24 months. [48]
• Children and partners. Stopping also ends transfer risk: in one published case, a young boy's testosterone fell from 1,460 ng/dL to 20 ng/dL within 2 months of his father stopping a compounded cream. [7]

See stopping TRT for the full picture.

How does compounded testosterone cream compare with other forms?

It is a daily topical, like the approved gels, but with no fixed strength or label outside Australia. Compared with injections, levels rise and fall within each day instead of peaking after each shot. Whether skin products raise red blood cells less is not settled: in trials, gel raised hematocrit about 3.0 points and injections about 4.0, a difference that was not statistically significant. Compared with approved gels, a compounded cream trades a checked product for flexibility. [3], [10], [4]

How is testosterone absorbed through the skin?

The outer layer of skin soaks up testosterone and releases it into the blood over the day, so the skin, not the liver or a depot, sets the pace. The AndroForte label says the testosterone half-life is "controlled by skin permeation", that the skin route avoids the liver's first pass, and that daily swings are similar in size to the body's own daily rhythm. Testosterone itself lasts only 10 to 100 minutes once it is in the blood. [3], [30]

How much gets through depends on the skin. Thin scrotal skin absorbs much more than the torso or arms, and the Iyer study noted scrotal skin's "high steroid permeability". No primary source gives the percentage of a cream dose absorbed at any site. [6], [3]

What do blood levels look like across a day?

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Scrotum or torso: how high, how fast, when to test

Measured peak after one scrotal dose

11 healthy men with their own testosterone switched off, AndroForte 5 (5%). Shaded band: the study normal range, 6.2–26.9 nmol/L (180–780 ng/dL).

12.5 mg (0.25 mL)

Peak 19.8 ± 3.8 nmol/L (about 570 ng/dL). In the normal range for at least 12 hours.

25 mg (0.5 mL)

Peak 21.9 ± 2.8 nmol/L (about 630 ng/dL). In the normal range for more than 16 hours.

50 mg (1 mL)

Peak 28.8 ± 3.8 nmol/L (about 830 ng/dL). In the normal range for more than 16 hours.

DHT

Peaked at 4.5–4.9 nmol/L at every dose, above the normal range of 0.24–2.21 nmol/L.

When it peaks, and when to test

Scrotum (25 mg start)

Average peak 3.3–5.3 hours after applying. The label checks blood at 3 hours (peak) and 24 hours (trough), after day 15.

Torso (100 mg start)

Average rise about 7.7 nmol/L, peaking about 14.8 hours after applying. The label checks blood in the morning before the next application, after day 15. Day 30 average level 11.4 ± 5.2 nmol/L (about 330 ng/dL), vs 11.3 ± 3.7 on 50 mg of a 1% gel.

Scrotal cream peaks within hours and torso cream much later, so a cream result means little without the time since the last application.

In 11 healthy men whose own testosterone had been switched off with another hormone, single scrotal doses of 12.5, 25 and 50 mg produced average peaks of 19.8, 21.9 and 28.8 nmol/L (about 570, 630 and 830 ng/dL). Levels stayed in the normal range for at least 12 hours after 12.5 mg and more than 16 hours after 25 or 50 mg. On the torso, 100 mg raised testosterone by about 7.7 nmol/L on average, peaking around 14.8 hours after application; after 30 days, the average level over the day was 11.4 nmol/L (about 330 ng/dL). [3], [6]

Individual results vary far more than averages suggest. The label says absorption is "variable between individuals", and forum accounts on similar daily amounts range from below pretreatment levels to above 2,000 ng/dL (community). [3]

Why does scrotal application raise DHT?

Scrotal skin is thought to turn more testosterone into dihydrotestosterone (DHT), a stronger androgen, through an enzyme called 5-alpha reductase. After single scrotal doses, DHT peaked at 4.5–4.9 nmol/L on average, above the label's normal range of 0.24–2.21 nmol/L, whatever the dose. [3], [6], [49]

The pattern is old and consistent. With scrotal testosterone patches in the 1980s and 1990s, the DHT-to-testosterone ratio tripled (from 0.2 to 0.6). DHT stayed about three times higher over 7 to 10 years (1.3 to 3.9 nmol/L), with normal hemoglobin and low PSA throughout. In a small study of a compounded gel, DHT rose nearly tenfold (20.5 to 199.2 ng/dL) in 6 weeks. [49], [50], [51]

What it means is less clear. The AndroForte label says there is "no evidence to suggest that high circulating DHT concentrations have a deleterious effect on the prostate and cardiovascular safety profile", and the 24-week scrotal gel trial found no prostate differences. No study has measured hair loss on scrotal testosterone. [3], [43]

What is in the cream?

AndroForte 5 is an oil-in-water cream containing almond oil and preservatives called hydroxybenzoates (parabens), which matter for anyone with a nut or paraben allergy. Compounded bases vary by pharmacy, and US compounders are not required to supply a full product label or package insert. Men online describe itching that changed when the pharmacy switched bases. [3], [20], [52]

How should testosterone cream be stored?

Follow the label or the pharmacy's instructions; the two differ because only the approved cream has a studied in-use period.

[3]

A beyond-use date is the pharmacy's own expiry date for a compounded product. How long a cream stays at strength depends on its base and container. One laboratory study found testosterone at 0.1% and 20% stayed stable for 180 days in one commercial cream base and pump container. That result says nothing about other bases. [53]

Showering and swimming. No study has tested washing after cream. Gel labels say to wait at least 2 hours (AndroGel 1.62%) or 5 hours (AndroGel 1%). In a gel study, washing 2 or 6 hours after application lowered the day's exposure by 10–14%, and washing at 10 hours made no difference. [26], [30], [54]

For carrying cream on a trip, see traveling with testosterone.

What does compounded testosterone cream do to fertility, estrogen and red blood cells?

These three effects come with every form of testosterone; each has its own hub guide. Here is what is specific to cream.

Fertility. Testosterone through the skin suppresses sperm production like other forms: in two trials, AndroGel 1.62% markedly reduced sperm production, while enclomiphene did not. The AndroForte label warns of suppressed sperm production. Guidelines advise against testosterone for men trying to conceive. See TRT and fertility. [11], [3], [4]

Estrogen. Some testosterone becomes estradiol. After single scrotal doses and over 24 weeks of scrotal cream, estradiol did not change significantly; in 11 men on scrotal patches for 7 to 10 years it rose from 52.3 to 71.3 pmol/L. No study shows fewer estrogen side effects on cream. See estrogen on TRT. [6], [35], [50]

Red blood cells. In a network meta-analysis of 29 randomized trials, gel raised hematocrit by about 3.0 percentage points more than placebo, compared with 4.0 for enanthate or cypionate injections. That difference between gel and injections was not statistically significant, and no trial measured cream. In one clinic's records, hematocrit above 50% occurred in 12.8% of 47 men on gels and 66.7% of 57 men on injections, but the injection group was younger and started with higher hematocrit. Cream still raises it: in a UK clinic cohort on scrotal cream, average hematocrit rose from 43.9% to 46.1% over a year. See hematocrit on TRT. [10], [55], [56]

What do we actually know about testosterone cream in people?

Enough to know that cream raises testosterone, and where on the body it works best. Not enough to know how compounded creams perform over years: no outcome trial has tested a US compounded cream, and none has compared any cream with injections.

Which studies used testosterone cream or scrotal testosterone?

The controlled cream trials used fixed doses for 4 to 24 weeks, so the longer-term safety picture comes from trials of other testosterone forms.

What did the large trials of other forms find?

• TRAVERSE (about 5,200 men at high heart risk, daily testosterone gel for an average of 21.7 months): heart attack, stroke or heart death in 7.0% vs 7.3% on placebo (hazard ratio 0.96), which met the trial's safety margin. Atrial fibrillation, acute kidney injury, lung clots and fractures were more common, and about 61% stopped their study gel early (full results and limits). [12], [13], [57]
• Testosterone Trials (790 men aged 65 or older, gel for 1 year): small gains in sexual function and mood; no gain in energy or walking in the physical function trial. [41]

Because cream and gel are both daily topicals, gel trials are the closest large evidence; whether compounded creams, with their variable strength and higher scrotal DHT, behave the same over years is not known.

How does testosterone cream work?

Testosterone passes through the outer layer of skin into small blood vessels over the day, so levels rise within hours of an application and drift down before the next one. The label describes the skin, not the body's clearance, as what sets the pace. [3]

Once in the blood, it acts like the body's own hormone. Some is converted to DHT, more so on scrotal skin, and some to estradiol. [3], [49]

Why it switches off your own production. The brain senses testosterone from any source. When levels are adequate, the pituitary lowers LH, the signal that tells the testicles to make testosterone, and FSH, which drives sperm production. On cream, LH fell in the 24-week trial and in the compounded gel study. [3], [35], [51]

Why it raises red blood cells. Androgens stimulate red blood cell production; that is why hematocrit is checked on every form of testosterone. [3], [10]

What are the risks and unanswered questions?

Is compounded testosterone cream safe?

Testosterone itself has well-known risks that apply to cream too; what is uncertain is the product. The AndroForte label lists transfer to other people, higher red blood cell counts, breast enlargement and fluid retention. It also lists higher blood pressure, prostate effects and reduced fertility. A compounded cream adds an unchecked dose, an unlisted base and no long-term safety studies of its own. [3], [1], [5]

Does compounded cream contain what the label says?

Not reliably. The clearest test comes from Toronto: researchers handed the same prescription (50 mg of testosterone gel or cream once daily) to 10 compounding pharmacies and tested two batches from each, a month apart.

• Only 5 of 10 pharmacies (first batch) and 3 of 10 (second batch) made a product within 20% of the prescribed strength.
• Two made products more than 20% too strong.
• One made a product with essentially no testosterone.
• Only 3 of the 10 products were creams; the other 7 were gels.
• The approved gels used as controls were accurate.

[5]

FDA has documented the same problem in the United States: in 2019 it wrote to a compounding pharmacy that had distributed a testosterone 2 mg/gram cream measured at 126% of its labeled strength. An older FDA sampling survey from 2001 found that 10 of 29 compounded products failed at least one quality test, though none of them was a testosterone product. [58], [59]

Why can it happen? Pharmacies that compound for individual prescriptions (under section 503A of US law) are exempt from FDA approval and from federal manufacturing-quality rules (current good manufacturing practice, or CGMP), and state pharmacy boards oversee them day to day. Larger "outsourcing facilities" (section 503B) must follow CGMP and are inspected by FDA on a risk-based schedule. [60], [61], [1]

In practice this means a blood test is the only check a man has that his cream contains what he was prescribed. The AUA advises prescribers of compounded testosterone to "consider performing additional monitoring and dose adjustments". Pharmacy accreditation exists, but no source reviewed shows that it guarantees each batch. [4]

Can testosterone cream transfer to a partner or child?

Yes, and this is the most serious avoidable risk of any testosterone applied to the skin. Cream left on the skin passes to another person by direct contact. In women it can cause facial or body hair, a deeper voice and menstrual changes; in children it can cause early puberty and genital growth. The AUA makes it a strong recommendation, with its highest evidence grade, that clinicians discuss transfer with every man using a gel or cream. [3], [4]

Three published case reports describe young boys affected by a father's testosterone cream:

• A 3.5-year-old had 6 months of genital growth and a growth spurt, with testosterone of 1,460 ng/dL. His father had used a compounded cream for about a year. The boy's level fell to 20 ng/dL within 2 months of stopping. [7]
• A boy aged 2 years 7 months developed pubic hair and advanced bone age with testosterone of 371 ng/dL, similar to an adult man's; it returned to 10 ng/dL after his father stopped. [8]
• A 2.67-year-old showed marked virilization (masculine changes) after presumed long-term exposure to his father's cream. [9]

No controlled study has measured transfer from cream, but gel studies show how large it can be and what prevents it. After direct skin contact with a man's gel-treated abdomen, women's testosterone rose 86–185% from baseline. A T-shirt cut transfer by about 40–48% from the abdomen and prevented it from the upper arms and shoulders. Washing the site before contact brought women's average levels back to baseline. [62], [63]

The AndroForte label's precautions:

• Wash your hands with soap and water after applying.
• Cover the area with clothing once the cream has dried.
• Wash the area before any skin-to-skin contact; with scrotal use, wash the genital area with a damp warm cloth before sex.
• Pregnant women must avoid contact with the application site.
• Anyone touched by unwashed skin should wash that area as soon as possible.

[3]

A European safety review in 2025 also recommended a warning about transfer to pets for gels. [64] See TRT and fertility for pregnancy planning.

What side effects are reported?

The AndroForte label lists these side effects:

• Skin and hair: increased body hair, hair loss, and oily skin (seborrhoea) or other skin reactions.
• Breasts: breast enlargement (gynecomastia) and sensitive nipples.
• Body and mood: fluid retention, weight gain, mood changes, nervousness and worsening sleep apnea.
• Prostate: prostate enlargement and urinary symptoms.
• Blood and circulation: a rise in red blood cells (polycythemia), changes in cholesterol, higher blood pressure and blood clots.
• Sexual: frequent or prolonged erections and shrinking testicles.

Signs such as irritability, nervousness, weight gain and frequent erections can mean too high a dose. [3]

Skin reactions were less common on scrotal skin than elsewhere in the patch era: in 60 men, allergic reactions occurred in 12% with non-scrotal patches and none with scrotal patches. The AndroForte label calls skin reactions and red-cell rises "at the lowest end of the risk scale" for skin delivery. [65], [3]

Does testosterone cream affect the heart?

No heart-outcome trial has tested cream. The best evidence comes from TRAVERSE, a randomized trial of about 5,200 men aged 45 to 80 with heart disease or high heart risk, given daily 1.62% testosterone gel or a placebo gel. Among the 2,596 men who used testosterone gel and the 2,602 who used placebo gel, it found:

• Heart attack, stroke or heart death: 182 men (7.0%) on testosterone vs 190 (7.3%) on placebo; hazard ratio 0.96, with a 95% confidence interval of 0.78 to 1.17. The top of that range stayed below the trial's safety margin of 1.5, so a large rise in risk was ruled out. [12], [13]
• Heart rhythm: atrial fibrillation 3.5% vs 2.4%. [13]
• Kidneys: acute kidney injury 2.3% vs 1.5%. [13]
• Clots: venous clots 1.7% vs 1.2%, including pulmonary embolism 0.9% vs 0.5%. [13]
• Fractures: 91 of 2,601 men (3.50%) vs 64 of 2,603 (2.46%), counting every randomized man. [57]

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TRAVERSE: absolute results

Testosterone gel (2,596 men)Placebo gel (2,602 men)

Heart attack, stroke or heart death

Testosterone 7.0% vs placebo 7.3% (182 vs 190 men; hazard ratio 0.96, 95% CI 0.78–1.17; met the 1.5 safety margin)

Nonfatal rhythm problems needing treatment

Testosterone 5.2% vs placebo 3.3%

Atrial fibrillation

Testosterone 3.5% vs placebo 2.4%

Clinical fracture

Testosterone 3.5% vs placebo 2.5% (91 of 2,601 vs 64 of 2,603 in the full analysis set)

Acute kidney injury

Testosterone 2.3% vs placebo 1.5%

Venous clots (all)

Testosterone 1.7% vs placebo 1.2%

Pulmonary embolism

Testosterone 0.9% vs placebo 0.5%

About 5,200 men aged 45–80 at high heart risk; daily gel; mean treatment 21.7 months; about 61% stopped their study gel. A trial of an approved gel, not of cream.

Its limits matter for cream. TRAVERSE tested only an approved gel, the average man used it for 21.7 months, about 61% stopped their study gel early, and it enrolled men at high heart risk. It did not test compounded products or the higher DHT of scrotal application. In July 2026 the Endocrine Society summarized it as showing no meaningful rise in heart attack or stroke over 1 to 4 years, but more lung clots and fractures, and said long-term safety is still not established. [12], [13], [66]

Blood pressure. All testosterone products can raise blood pressure; the AndroForte label advises caution with high blood pressure, and in February 2025 FDA added blood-pressure warnings to every US testosterone label. Several men online describe sharp rises on cream (community). [3], [67]

See TRT and heart health for the full picture.

Could testosterone cream affect the prostate?

Testosterone can enlarge the prostate and raise PSA slightly; in TRAVERSE, PSA rose about 0.15 ng/mL more than on placebo at 12 months. In TRAVERSE, which excluded men with PSA above 3.0 ng/mL, high-grade prostate cancer occurred in 5 of 2,596 men on testosterone (0.19%) vs 3 of 2,602 on placebo (0.12%), a difference that was not significant. The scrotal gel and patch studies found no prostate differences or rising PSA, but they were small. [68], [43], [50] See TRT and the prostate.

The AndroForte label contraindicates testosterone in known or suspected prostate cancer, as current US labels do, and asks for a prostate exam and PSA at least yearly, twice yearly in older or higher-risk men. [3], [69]

Is compounded testosterone cream legal? Is it FDA approved?

Checked September 2026. Rules differ by country and change often.

United States. No testosterone cream is FDA-approved; compounded cream is legal only with a valid prescription, and testosterone is a Schedule III controlled substance whatever its form. The key points:

• Compounding law. A 503A pharmacy compounds for an individual prescription and is overseen mainly by its state board; a 503B outsourcing facility follows CGMP and is inspected by FDA. [60], [1]
• Copies of approved drugs. FDA's 2018 guidance limits 503A pharmacies from regularly making "essentially copies" of commercially available drugs unless the prescriber records on the prescription a change that makes "a significant difference" for that patient. It is nonbinding guidance, and FDA says it does not intend to act when a pharmacy fills four or fewer such prescriptions a month. [40]
• Testosterone as a bulk ingredient. For outsourcing facilities, testosterone sits in FDA's 503B "Category 1: bulk drug substances under evaluation" (list updated March 21, 2025), not on the final list. [70]
• Recommendations, not rules. In July 2020 NASEM recommended that FDA's advisers review testosterone for its "Difficult to Compound List" and that compounded testosterone carry boxed warnings like approved products. FDA's difficult-to-compound list exists only as a March 2024 proposed rule, with no final action on testosterone. [20], [71]
• Labels. In February 2025 FDA added TRAVERSE results and blood-pressure warnings to approved testosterone labels. On June 18, 2026 HHS announced that FDA is requesting further changes (removing the age-related limitation, contraindicating testosterone only in metastatic prostate cancer and revising the prostate-enlargement warning); these are requests and are not yet in any label. Compounded creams carry no FDA label at all. [67], [19]
• Telehealth. Temporary rules let clinicians prescribe controlled medicines such as testosterone without an in-person visit through December 31, 2026; a permanent Drug Enforcement Administration (DEA) special-registration rule is still under review. [72], [73]

Canada. Testosterone is a Schedule IV controlled substance and prescription-only. No testosterone cream is among Health Canada's approved products. Compounding is regulated by the provinces and territories, and Health Canada's policy says it "must not be used as a means to bypass the federal drug review and approval system". [16], [74], [75], [33]

United Kingdom. Testosterone is a Class C controlled drug (Schedule 4 Part II), prescription-only. No testosterone cream has current UK product information; the licensed topicals are gels. A doctor can order an unlicensed "special", made or imported for an individual patient, and the BSSM describes 5% cream as licensed in Australia and available for import into the UK. [15], [76], [24], [25]

Australia. Testosterone is a Schedule 4 (prescription-only) medicine with extra controls on possession. AndroForte 5 has been approved since July 11, 2014, and is listed on the PBS, whose criteria ask for scrotal application where possible. [17], [3], [22], [42]

European Union. Rules are set nationally, and this guide did not verify the status of testosterone creams in individual member states. See TRT in Europe.

A "research use only" label on a cream does not make it legal, tested or the same as a prescribed product.

Is testosterone cream banned in sport? Does it show up on a drug test?

Yes. Testosterone is on the World Anti-Doping Agency (WADA) Prohibited List in class S1, banned in and out of competition, and the 2027 list keeps that from January 1, 2027. The AndroForte label warns athletes that it may cause a positive test. Athletes with a medical need can apply for a therapeutic use exemption, which WADA grants only when low testosterone has an organic cause (such as a testicular or pituitary disorder), not for age, obesity or earlier steroid use. [18], [77], [3], [78]

Who should be especially cautious?

• Anyone living with children or a pregnant partner. Transfer is the cream-specific risk; the label says pregnant women must avoid contact with application sites. [3]
• Men who want children now or soon. Testosterone suppresses sperm production, and guidelines advise against it for men trying to conceive. [4], [3]
• Men with prostate or breast cancer. Contraindicated on the AndroForte label and current US labels. [3], [69]
• Heart, kidney or liver disease, or high blood pressure. Fluid retention and blood-pressure rises can worsen these; the label says to monitor closely. [3]
• A history of clots or a high hematocrit. The label advises caution with clotting disorders, and several guidelines treat a high starting hematocrit as a reason not to start. [3], [31], [34]
• Sleep apnea, epilepsy or migraine. The label lists each as a caution. [3]
• Nut or paraben allergy. AndroForte contains almond oil and hydroxybenzoates; compounded bases may contain other ingredients. [3]
• Women and children. These guides are for men. Testosterone is contraindicated in pregnancy, and AndroForte is not labeled for anyone under 18; use in teenagers is specialist care only. [3]
• Drug-tested athletes. Banned at all times. [18]
• People taking other medicines; see the next question.

Can testosterone cream be taken with other medicines?

The AndroForte label lists these interactions:

• Blood thinners (oral anticoagulants). Testosterone can increase their effect; the label advises more frequent blood-clotting tests (INR and prothrombin time), especially when starting and stopping. [3]
• Insulin and diabetes medicines. Testosterone can lower blood sugar and insulin needs. [3]
• Corticosteroids or ACTH. Together they can increase fluid retention. [3]
• Ciclosporin, bupropion and oxyphenbutazone. Testosterone can raise ciclosporin levels and toxicity, may lower the seizure threshold with bupropion, and can raise oxyphenbutazone levels. [3]

UK labels for several testosterone products (not creams) and a 2025 European safety review add that combining testosterone with SGLT2-inhibitor diabetes medicines has been linked to higher red-cell counts. Testosterone can also lower thyroxine-binding globulin, which changes total thyroid hormone results without changing thyroid function. Bring a full list of everything you take, including supplements and anything else applied to the skin, to a pharmacist or doctor. [79], [64], [3]

What does compounded testosterone cream cost?

Checked September 2026.

There is no official price. The AUA says compounded gels and creams are "routinely less expensive than branded forms", but gives no figures. The only published prices come from a 2015 Canadian study in Toronto, where a 30-day supply cost $57.32 to $160.71. Insurance coverage for compounded products varies by plan; no official source summarizes it. Men online describe paying very different amounts for the same strength (community). [4], [5]

What should be monitored while using compounded testosterone cream?

The AndroForte label asks for testosterone levels after day 15, periodic hemoglobin, hematocrit, liver tests and cholesterol, and yearly prostate and breast checks. The numbers for acting on results come from guidelines. Use this summary to prepare questions for your prescriber; it is not a personal testing plan. [3]

[3], [26], [31], [4], [34], [27]

The European urology guideline monitors testosterone and hematocrit at 3, 6 and 12 months and then yearly, and the Canadian Urological Association uses its own hematocrit trigger of 55%. [32], [33] See TRT blood work and hematocrit on TRT.

Doserly

Where guidelines draw the hematocrit line on TRT

On-treatment hematocrit (%) at which each body acts.

Each bar runs from 46% (left) to 56% (right); the shaded part is 48–50%, where most guidelines take care before starting.

Society for Endocrinology (UK, 2022)

Above 50% (0.50 L/L)

VA (US, January 2026)

Above 51%: adjust the dose · above 54%: stop

AUA (US, 2018, reconfirmed 2024)

54% or higher

Endocrine Society (2018)

Above 54%

EAU (Europe, 2026)

Above 54% (summary table: 54% or higher)

BSSM (UK, 2023)

Above 54%

ICSM (2024)

Keep below 54%

EAA (Europe, 2020)

Above 54%

CUA (Canada, 2021)

55% or higher, if it persists

Product labels (US, UK, Canada)

No number: labels say “elevated”

No trial has tested which line prevents clots or heart events.

Write down the timing and the batch. For every testosterone result, note when and where you last applied the cream, how much, and the date on the pharmacy label. On cream, a result without its timing is hard to interpret, and a sudden change on an unchanged dose can point to a different batch. [3], [5]

What do people in public communities report?

Public forums hold every kind of cream story: men who feel better within days, men whose levels barely move, and men who stopped after acne, blood pressure spikes or worries about their families. The accounts below come from public Reddit threads from the past year and are described without identifying anyone. Most are US compounded creams; a few are Australian AndroForte users. The amounts men describe are what they reported, often well above the label's doses, and are not protocols.

What do the positive reports look like, and how long do they take?

Energy, mood and sex drive are the usual good news, often within days to weeks. One man started 200 mg a day of scrotal cream after episodes of marked fatigue. He described little change for the first few days, then better focus, energy, sleep and mood from late in the first week to about 6 weeks. He tried 300 mg briefly and went back to 200 mg. Another, on 1 mL a day for about 10 months after a starting level of 7.1 nmol/L, described better mood and motivation within days and a later level around 25 nmol/L. [80], [81]

Men who switch away also report what they miss. One man who had used scrotal cream for about 18 months moved to cypionate injections for cost and provider reasons. His energy stayed good but his sex drive nearly disappeared, and his hematocrit went from 49% on cream to about 55% on injections. [82]

Does everyone respond?

No. A man using 20% cream on his forearm for about 6 months felt only slightly better and still tested near the low end of normal; raising the dose was too expensive, so he planned injections despite disliking needles. Another man's level 14 hours after his last scrotal application came back at 83, below his pretreatment 230, after 3 months of feeling little different; his clinician suspected a lab error. A third reported a level of 300 after 4 months, compared with 446 before treatment, having skipped the application before the test. [83], [84], [85]

Some men report inconsistency on an unchanged routine: good mornings and flat mornings, or a level that jumped after 10 months on the same dose. [86], [87]

Why do the numbers vary so much?

Site and timing, mostly. One man's result was above 1,500 ng/dL on 200 mg a day of scrotal cream; his urologist halved the dose, and the same amount on his shoulders had given only 310. Another, on 150 mg a day split between the scrotum and shoulders, measured 2,242 ng/dL three hours after his morning scrotal application, and his LH and FSH were near zero. A man using 20% cream measured 293 about 24 hours after an application and 771 on an afternoon after a morning application. [44], [88], [89]

Replies in these threads repeatedly make the same point the label does: a cream result means little without the hours since application. See when blood should be drawn.

What do people say about dose units and strengths?

Confusion is common. Strengths range from 5% to 30% (300 mg/mL), and doses are described in clicks, pumps, mL, grams and mg. One man found his prescription was 10 mg/mL (1%), which he worked out as 5 mg a day. Another started a 5% AndroForte tube without understanding an instruction to use "two pumps" on an applicator marked in mL. A third asked whether 2 clicks of a 200 mg/g cream was a high dose. [90], [91], [29]

Many describe amounts above the only label's maximum. One man on a 30% (300 mg/mL) cream described applying 150 mg twice a day, later about 250 mg a day over three applications. After about 90 days his total testosterone was 1,874 and estradiol 78 (units not stated). He reported acne, oily skin and testicular shrinkage before lowering the dose. [92], [93]

What unwanted effects come up?

• Acne. Back, chest and shoulder acne is the most common complaint. One man stopped TRT after 6 months of severe acne on 150 mg a day of scrotal cream; 6 months later new acne had mostly subsided but marks remained. [94], [95], [96]
• Blood pressure. A man on scrotal cream reported strong energy and sex drive within 12 days, then a large rise in blood pressure that made him stop. Another, 18 months into scrotal cream, reported severe headaches and a reading of 184/110; the cause was not established. [97], [98]
• Heart and sleep. A man who switched from AndroGel to cream reported a higher resting heart rate and poor sleep after 5 weeks, which he had not had on gel. Another reported chest pressure, anxiety and poor sleep in his first 3 days, with normal heart tests. [99], [100]
• Nipple sensitivity and testicular shrinkage. Both come up, as they do on other forms. [101], [102]
• Skin irritation. One man developed severe scrotal itching that worsened when his pharmacy changed the cream base, and eased when he spread the cream over a wider area. [52]
• Hematocrit. Cream is not always the fix men hope for: one man switched from injections to lower his hematocrit and still measured 54.8% with ferritin of 9 while on cream. Others describe drops, such as 60% on injections to 49% on cream. [103], [104]

What do people report about transfer?

Worry about partners and children is a reason several men give for choosing or switching to injections. One man using cream on his arms suspected it had transferred to his partner through contact, bedding or towels after her bloodwork changed; the cause was not established. Another, on scrotal cream, noticed possible new hair growth on his partner's neck. [105], [106], [107], [92]

What do people report about cost and access?

Prices vary widely: a thread comparing 10% and 20% compounded creams in Australia found substantially different prices and fees between providers. Supply is another theme: one man switched to injections when his cream supplier became unavailable. [108], [88]

How can you judge a cream story?

Ask: What strength was it, in mg/mL, and how many mg were applied, not just clicks? Where on the body, once or twice a day? When was blood drawn relative to the last application? Was it a compounded product or an approved cream, and did the batch change? What else changed at the same time, such as hCG, an aromatase inhibitor, weight loss or training? What happened a few months later?

These selected discussions show what people experience and the questions research should answer. They are not a survey of all users, a success rate or a substitute for the studies.

How does compounded testosterone cream compare with other testosterone forms?

These are the forms most often weighed against cream. Status was checked in September 2026.

No trial ranks these forms on long-term outcomes, and none has compared cream with injections. The practical differences are how often you dose, how much levels swing, how much hematocrit rises, whether someone else can be exposed, and whether the product's strength is checked. See testosterone gel for the closest approved alternative.

Common questions about compounded testosterone cream

Is compounded testosterone cream FDA approved?

No. No testosterone cream is FDA-approved; compounded creams are made by pharmacies for individual prescriptions, and FDA does not verify their safety, effectiveness or quality before they are used. The approved topical options in the US are gels and a solution. The only approved testosterone cream found anywhere is AndroForte 5 in Australia. [1], [2], [3] See legal status.

What is a normal starting dose of testosterone cream?

The only label, AndroForte 5, starts at 25 mg (0.5 mL of a 5% cream) once daily on the scrotum or 100 mg (2 mL) on the torso, with a maximum of 50 mg or 200 mg a day. No guideline gives a dose for compounded cream, so compounded prescriptions vary, and the right amount is found with follow-up blood tests at a consistent time after application. [3], [4] See typical protocols.

Is scrotal application safe?

It is the labeled site for AndroForte 5 and the preferred site in Australia's subsidy criteria, and it needs a much smaller dose. It raises DHT above the normal range. The label says there is no evidence this harms the prostate or heart, and a 7–10-year study of scrotal patches in 11 men found PSA stayed low. No study has measured hair loss. US gel labels forbid the genitals, and transfer during sex needs washing first. [3], [42], [50], [26] See scrotum or torso.

Is testosterone cream better than injections?

Neither has been shown better: no trial has compared cream with injections. Cream avoids needles and the peaks after each shot. In trials, gel raised hematocrit about 3.0 points and injections about 4.0, a difference that was not statistically significant; one clinic's records showed fewer high readings on gel. No trial measured cream. Injections have no transfer risk and, when approved, a checked strength. The AUA prefers commercially made products over compounded ones when possible. [3], [10], [55], [4] See how cream compares.

How do I know my compounded cream is the right strength?

You usually cannot tell without a blood test. In the Toronto study, half or fewer of the pharmacies made a product within 20% of the prescribed strength. Keep the pharmacy label, test at the same time after application each time, and ask the prescriber about retesting if a new batch behaves differently. [5], [4] See dose accuracy.

Can my partner or children be affected?

Yes. Testosterone on the skin can transfer through contact and has caused early puberty in young children. Wash your hands after applying, cover the area once dry, wash the site before skin contact, and keep pregnant women away from application sites. [3], [7] See transfer.

Does testosterone cream cause hair loss?

It can, like other forms: the AndroForte label lists hair loss. Scrotal application raises DHT, the hormone involved in male-pattern hair loss, but no study has measured whether scrotal cream causes more hair loss than other forms. [3], [6] See DHT.

How long does compounded testosterone cream last once opened?

The pharmacy sets a beyond-use date on each compounded product, and that is the limit to follow. The approved AndroForte 5 must be used within 125 days of opening and stored below 25 °C. [3], [53] See storage.

Glossary

Plain explanations of the medical, dosing and research terms used in this guide. Underlined terms in the text link here.

Adverse event

A harmful or unwanted medical event reported after someone used a treatment. A report alone does not prove the treatment caused it.

Aromatase inhibitor

A medicine, such as anastrozole, that blocks the enzyme that turns testosterone into estradiol.

Beyond-use date

The date after which a compounded medicine should not be used, set by the pharmacy that made it. It plays the role an expiry date plays on an approved product.

Bioidentical

A hormone with the same chemical structure as the one the body makes. The word describes the molecule; it says nothing about whether a product is approved, tested or accurately dosed.

CGMP (current good manufacturing practice)

Federal quality rules for how medicines are made and tested in the US. Pharmacies compounding for individual prescriptions are exempt; outsourcing facilities are not.

Compounding

When a pharmacy prepares a medicine to order from individual ingredients, instead of dispensing a factory-made product. Compounded drugs are not FDA-approved.

Controlled substance

A medicine whose prescribing and possession are restricted by law because it can be misused. Testosterone is Schedule III in the US, Schedule IV in Canada and Class C in the UK.

Controlled trial

A study that compares people who receive a treatment with a similar group who do not, often receiving a placebo instead. Randomly assigning people to each group makes the comparison fairer.

DHT (dihydrotestosterone)

A stronger androgen made from testosterone by the enzyme 5-alpha reductase, which is active in scrotal skin. It is involved in body hair, male-pattern hair loss and prostate growth.

Dose (amount each time)

The amount given on one occasion. A protocol lists both the dose and how often it is given.

Ester

A chemical tail joined to testosterone so it dissolves in oil and releases slowly after injection. Testosterone cream uses plain testosterone with no ester.

Estradiol

The main form of estrogen. In men it is made mostly from testosterone, so it can rise when testosterone rises.

FSH (follicle-stimulating hormone)

A pituitary hormone that acts on the cells supporting sperm production. Testosterone therapy lowers it.

Gynecomastia

Growth of breast tissue in men, often tender at first. It is linked to a higher estrogen-to-testosterone balance.

Hematocrit

The share of the blood made up of red blood cells. Testosterone raises it, and most guidelines act when it goes above about 54%.

Hypogonadism

Low testosterone caused by a problem in the testicles or in the brain and pituitary signals that control them, confirmed with symptoms and repeated morning blood tests.

LH (luteinizing hormone)

A pituitary hormone that tells the testicles to make testosterone. Testosterone therapy switches it off.

Outsourcing facility (503B)

A larger US compounder registered under section 503B of federal drug law. It must follow CGMP and is inspected by FDA, unlike a pharmacy compounding under section 503A.

Peak level

The highest level of a medicine in the blood after a dose. For scrotal cream it comes a few hours after application.

Pharmacokinetics

How the body absorbs, moves, breaks down and removes a substance.

Placebo

A dummy treatment with no active ingredient, used as a comparison in studies.

Polycythemia (erythrocytosis)

Too many red blood cells, shown by a high hematocrit. Testosterone therapy is a common cause.

PSA (prostate-specific antigen)

A blood test for a protein made by the prostate. It rises slightly on testosterone and is used to decide whether prostate checks are needed.

Scrotal application

Rubbing a testosterone cream or gel into the skin of the scrotum. The thin skin absorbs far more than other sites, so the labeled dose is much smaller.

Secondary exposure (transfer)

When testosterone on one person's skin passes to someone else through contact. It can cause masculine changes in women and early puberty in children.

Special (UK)

An unlicensed medicine made or imported in the UK for an individual patient after a doctor orders it.

Titration

Adjusting a dose in steps, usually based on blood tests and symptoms.

Transdermal

Absorbed through the skin, as with testosterone creams, gels and patches.

Trough level

The lowest level of a medicine in the blood, just before the next dose. For daily cream it is measured about 24 hours after the last application.

TRT (testosterone replacement therapy)

Prescribed testosterone, by cream, gel, injection or other forms, for men with low testosterone. It switches off the brain's LH and FSH signals.

WADA

The World Anti-Doping Agency, which publishes the list of substances banned in sport. Testosterone is banned at all times.

Weekly total

All the amounts given in one week, added together. For example, 25 mg a day is a 175 mg weekly total. For creams it is the applied amount, not the amount absorbed.

How this guide was researched

This guide is built from a thorough review of the sources cited throughout it: the Australian label for the only approved testosterone cream, US gel labels, clinical guidelines from the United States, Canada, the United Kingdom and Europe, published studies of testosterone cream and scrotal testosterone, product-testing studies, and regulatory documents from FDA, Health Canada, the UK and Australia. We also reviewed public online forums where men describe their own experiences with testosterone cream.

The guide cites 111 sources, including 9 product labels, 10 guidelines and position statements, and 26 original studies in people, plus 36 public community threads. Each type of source answers a different question. Labels, guidelines and trials show what was approved and measured. Product-testing studies and regulatory records show how compounded creams are made and checked. Personal accounts show what individual people experienced. Every numbered citation links to its entry below, labeled by source type.

How this guide was made

Research and drafting were AI-assisted. Every cited source was checked against the original, and the guide was reviewed and edited by Doserly before publication. It has not had an independent clinical review, and Doserly does not currently have medical reviewers. Doserly makes a medication and health-tracking app and runs Doserly Academy, both of which are promoted in this guide. Read our editorial policy for how guides are researched, updated and corrected.

This guide is for educational purposes. It summarizes what the reviewed sources report so the research is easier to understand; it is not medical advice. For a deeper dive, or to check any point for yourself, go straight to the cited sources.

Explore the sources