Alternatives to Natesto If You Can't Fill Your Prescription

Natesto is the only FDA-approved intranasal testosterone gel — a unique delivery method that some patients prefer because it avoids skin transfer risk and has a rapid onset of action. But if you can't find it at a pharmacy near you, or if cost or coverage is an issue, you have several solid alternatives to consider. This guide covers the most common substitutes and how they compare.

Why Patients Switch Away From Natesto

The most common reasons patients look for Natesto alternatives include:

Pharmacy availability — Natesto has no generic and is not stocked at every pharmacy.

Cost — average retail price is approximately $1,047 per monthly supply without a savings program.

Insurance coverage — not covered by most Medicare plans; requires prior authorization at many commercial plans.

Nasal side effects — some patients experience persistent nosebleeds, nasal discomfort, or congestion.

Dosing frequency — three-times-daily dosing is inconvenient for some patients.

Alternative 1 — Testosterone Topical Gel (AndroGel, Generic)

Topical testosterone gels are the most widely prescribed testosterone replacement therapy in the United States. Products include AndroGel (1% and 1.62%), Testim, Fortesta, Vogelxo, and generic testosterone gel. They are applied once daily to the shoulders, upper arms, or abdomen.

Generic testosterone gel is widely available and can cost as little as $41–$80 per month with a GoodRx or SingleCare coupon. The main downside compared to Natesto is the skin transfer risk — testosterone can transfer from skin to partners or children. Covering the application site with clothing reduces this risk significantly.

Alternative 2 — Testosterone Cypionate Injection (Depo-Testosterone)

Injectable testosterone cypionate is the most cost-effective testosterone replacement option. The generic form is available at most pharmacies and can cost as little as $20–$60 per month. It is typically injected intramuscularly every 1 to 2 weeks, though some patients and providers prefer weekly injections for more stable testosterone levels.

The main downsides: injections require skill or a provider visit, testosterone peaks sharply after injection then declines ("peak and trough" effect), and injections suppress natural testosterone and sperm production more robustly than Natesto.

Alternative 3 — Testosterone Transdermal Patch (Androderm)

Androderm is a testosterone patch applied to the skin daily (typically at bedtime). It mimics the body's natural circadian rise in testosterone overnight. It has no skin transfer risk to others when covered. The main drawback is that it has one of the highest rates of skin irritation among testosterone products — up to 56% of patients report skin reactions at the application site.

Alternative 4 — Oral Testosterone (Jatenzo, Kyzatrex, Tlando)

Oral testosterone undecanoate products (Jatenzo, Kyzatrex, Tlando) are newer options that are absorbed through the intestinal lymphatic system, bypassing liver metabolism. They are taken with meals twice daily. These products carry a black box warning for blood pressure increases, so patients with hypertension require careful monitoring.

Alternative 5 — Clomiphene Citrate (Off-Label for Hypogonadism)

Clomiphene citrate (brand name Clomid) is used off-label in men with secondary (hypogonadotropic) hypogonadism. Unlike testosterone replacement therapies, clomiphene stimulates the body's own testosterone production by blocking estrogen receptors in the hypothalamus and pituitary. This preserves fertility and sperm production, making it a popular choice for younger men who still want to have children. Generic clomiphene costs approximately $10–$30 per month.

Comparing Natesto to Its Alternatives

Here is a side-by-side summary:

Natesto: Nasal, 3x/day, no skin transfer, may preserve fertility better, brand-only (~$165/month with GoodRx)

Generic testosterone gel: Topical, once daily, skin transfer risk, generic available (~$41–$80/month with coupons)

Testosterone cypionate injection: Injectable, every 1–2 weeks, most affordable (~$20–$60/month), widely available generic

Androderm patch: Daily patch, no transfer risk, high skin irritation rate

Oral testosterone (Jatenzo/Kyzatrex): Oral, twice daily with meals, newer option, BP monitoring required

Clomiphene citrate: Oral, off-label, preserves fertility, generic ~$10–$30/month, best for secondary hypogonadism

Talk to Your Doctor Before Switching

Every testosterone formulation delivers the same hormone, but the route of delivery affects pharmacokinetics, side effects, insurance coverage, and convenience. Your prescriber is best positioned to recommend the right switch based on your labs, lifestyle, fertility goals, and insurance plan.

Before switching, it's also worth trying to find Natesto at a pharmacy near you. Our guide on how to find Natesto in stock near you covers the best tools and tips for locating your prescription without hours of phone calls.