Hypogonadism
Initiated on specialist advice. Hypogonadism in men over 18years, 1g every 10-14 weeks, if necessary, second dose may be given after 6 weeks to achieve rapid steady plasma testosterone levels and then every 10-14 weeks.
There is currently a supply shortage with Tostran 2% gel, see prescribing notes.
2% gel 60g (after pump priming, 1 pump depression delivers 0.5g of gel, containing 10mg of testosterone). Initiated on specialist advice. Hypogonadism due to testosterone deficiency in men >18yrs by transdermal application, apply 60mg once daily, subsequent application adjusted according to response; maximum 80mg per day.
By transdermal application. Apply 40.5mg once daily; increased in steps of 20.25mg, adjusted according to response; maximum 81mg per day.
Prescribing Notes:
- Intramuscular depot injection of testosterone is usually preferred for replacement therapy. Gel may be preferred if the patient finds the injection painful or prefers to self-administer therapy.
- Where Nebido is the preferred option for replacement therapy, Sustanon 250 injection or testosterone gel may be used prior to initiating Nebido if there are concerns as to how an individual may tolerate testosterone treatment.
- Testosterone undecanoate oily injection (Nebido) is more expensive than alternative intramuscular formulations but offers the advantage of reduced frequency of dosing with less inter-dose fluctuation of testosterone levels.
- There is currently a supply shortage of Tostran 2% gel, the alternative option during this supply shortage is Testogel – refer to the relevant Medicine Supply Alert Notice (MSAN) on the NHS Scotland Publications website for guidance (if MSAN not yet available, refer to the Medicines Supply tool on the SPS website – login required).
History Notes
09/10/2023
Addition of Testogel and signpost to shortage information, ERWG Sept 23.
16/02/2022
East Region Formulary content agreed.
To be initiated and adjusted under the advice and ongoing supervision of a paediatric endocrinologist. Matrix patches are recommended so that they can be cut in order to deliver lower doses (see prescribing notes).
For dose, follow specialist advice.
To be initiated and adjusted under the advice and ongoing supervision of a paediatric endocrinologist.
For dose, refer to BNF for Children and follow specialist advice.
To be initiated and adjusted under the advice and ongoing supervision of a paediatric endocrinologist.
For dose, follow specialist advice.
For dose, follow specialist advice.
To be initiated and adjusted under the advice and ongoing supervision of a paediatric endocrinologist.
For dose, refer to BNF for Children and follow specialist advice.
As per specialist, refer to BSPED guidelines for additional information.
As per specialist, refer to BSPED guidelines for additional information.
As per specialist, refer to BSPED guidelines for additional information.
Prescribing Notes:
- For guidance on treatment options and dosing see the recommendations in the guidelines page of the British Society for Paediatric Endocrinology and Diabetes (BSPED): Hormone supplementation for pubertal induction in girls.
- Transdermal estradiol matrix patches (e.g.Evorel 25) are considered first line for induction of puberty by local paediatric endocrinologists. Evidence to support the use of transdermal estradiol patches off-label for this indication is limited.
- When indicated progestogen can also be administered by the transdermal route. The transdermal route may be preferable for women or girls who have used estradiol patches for pubertal induction. It is available in combined patches with estradiol, e.g.EvorelSequi & Evorel Conti. Evidence to support the use of transdermal progestogen off-label for this indication is limited.
History Notes
29/02/2024
East Region Formulary content agreed.
If moving between Testosterone products, please ensure clear dose guidance is provided due to the differences in strengths.
12-17 years, 25-50 mg/m2 every month, increase dose every 6-12 months according to response.
There is currently a supply shortage with Tostran 2% gel, see prescribing notes.
Dose on specialist advice.
Dose on specialist advice.
Dose on the specialist advice of paediatric endocrinology, see prescribing notes.
Prescribing Notes:
- There is a risk of hepatotoxicity with testosterone products.
- Evidence to support the use of transdermal testosterone gel off-label for this indication is limited. For guidance on dosing see the recommendations in the guidelines page of the British Society for Paediatric Endocrinology and Diabetes (BSPED): Testosterone Replacement Guidelines.
- Sustanon contains a mixture of testosterone esters (testosterone propionate 30mg, testosterone phenylpropionate 60mg, testosterone isocaproate 60mg and testosterone decanoate 100mg/mL) and should be prescribed by brand name.
- There is currently a supply shortage of Tostran 2% gel, the alternative option during this supply shortage is Testogel – refer to the relevant Medicine Supply Alert Notice (MSAN) on the NHS Scotland Publications website for guidance (if MSAN not yet available, refer to the Medicines Supply tool on the SPS website – login required).
History Notes
29/02/2024
East Region Formulary content agreed.
If moving between Testosterone products, please ensure clear dose guidance is provided due to the differences in strengths.
Dose on specialist advice of paediatric endocrinology.
There is currently a supply shortage with Tostran 2% gel, see prescribing notes.
Dose on specialist advice of paediatric endocrinology.
Dose on specialist advice of paediatric endocrinology.
Dose on the specialist advice of paediatric endocrinology, see prescribing notes.
Prescribing Notes:
- There is a risk of hepatotoxicity with testosterone products.
- Evidence to support the use of transdermal testosterone gel off-label for this indication is limited. For guidance on dosing see the recommendations in the guidelines page of the British Society for Paediatric Endocrinology and Diabetes (BSPED): Testosterone Replacement Guidelines.
- Sustanon contains a mixture of testosterone esters (testosterone propionate 30mg, testosterone phenylpropionate 60mg, testosterone isocaproate 60mg and testosterone decanoate 100mg/mL) and should be prescribed by brand name.
- There is currently a supply shortage of Tostran 2% gel, the alternative option during this supply shortage is Testogel – refer to the relevant Medicine Supply Alert Notice (MSAN) on the NHS Scotland Publications website for guidance (if MSAN not yet available, refer to the Medicines Supply tool on the SPS website – login required).
History Notes
29/02/2024
East Region Formulary content agreed.