What You Should Know About Androgel Side Effects

If your doctor has prescribed Androgel (Testosterone topical gel) for low testosterone, you're probably wondering what side effects to expect. Like all medications, Androgel comes with potential risks — some mild and manageable, others serious enough to need immediate medical attention.

This guide covers the most common side effects from FDA labeling, the serious ones to watch for, and practical advice for managing them. Knowing what's normal and what's not can help you stay safe while getting the benefits of testosterone replacement therapy.

What Is Androgel?

Androgel is a prescription testosterone gel made by AbbVie. It comes in two strengths — 1% and 1.62% — and is applied once daily to the skin of the shoulders, upper arms, or abdomen. It's used to treat hypogonadism (low testosterone) in adult men whose bodies don't produce enough testosterone on their own.

Androgel is a Schedule III controlled substance. For more details on how it works, see our guide: What Is Androgel?

Common Side Effects

These side effects are relatively common and usually mild. They may improve as your body adjusts to the medication:

• Skin irritation at the application site — Redness, itching, or a burning sensation where you apply the gel. This is the most frequently reported side effect.
• Acne — Increased oil production in the skin can cause breakouts, especially on the face, back, and shoulders.
• Headache — Some patients experience headaches, particularly in the first few weeks of treatment.
• Mood changes or strange dreams — You may notice shifts in mood, irritability, or vivid/unusual dreams.
• Increased blood pressure — Mild elevations in blood pressure are possible and should be monitored.
• Frequent or prolonged erections — While often seen as a benefit, erections lasting longer than normal may require medical attention.
• Nausea or vomiting — Some patients experience mild stomach discomfort.
• Swelling in lower legs (edema) — Fluid retention can cause noticeable swelling, particularly in the ankles and feet.

Most of these side effects are dose-dependent, meaning they're more likely at higher doses. If they bother you, your doctor may adjust your dose.

Serious Side Effects

These side effects are less common but require immediate medical attention:

Secondary Exposure (Boxed Warning)

This is Androgel's most important safety warning. Women and children can absorb testosterone through skin-to-skin contact with treated areas. In children, secondary exposure has caused premature puberty symptoms, including enlarged genitalia, early pubic hair growth, increased aggression, and advanced bone age.

To prevent this:

• Wash your hands thoroughly with soap and water after applying Androgel
• Cover the application site with clothing after the gel dries
• Wash the application area before any skin-to-skin contact with women or children
• If a woman or child makes contact with the treated skin, have them wash the area immediately with soap and water

Blood Clots

Testosterone therapy may increase the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Call your doctor immediately if you experience:

• Pain, swelling, warmth, or redness in a leg
• Sudden shortness of breath
• Chest pain
• Coughing up blood

Heart Attack or Stroke

Some studies have suggested an increased cardiovascular risk with testosterone therapy, particularly in older men or those with existing heart disease. Seek emergency care for:

• Chest pain or pressure
• Sudden weakness or numbness on one side of the body
• Difficulty speaking or sudden confusion
• Sudden severe headache

Increased Red Blood Cell Count (Polycythemia)

Testosterone stimulates red blood cell production. If levels get too high, your blood becomes thicker, increasing the risk of blood clots, stroke, and heart attack. Your doctor will monitor your hematocrit (red blood cell percentage) regularly through blood work.

Prostate Concerns

Androgel can increase prostate-specific antigen (PSA) levels and may cause prostate enlargement. It should never be used in men with known or suspected prostate cancer. Your doctor should check your PSA and perform a digital rectal exam before starting treatment and periodically during therapy.

Liver Problems

Though rare with topical testosterone (more common with oral forms), liver problems are possible. Watch for nausea, upper stomach pain, dark urine, or yellowing of the skin or eyes (jaundice).

Sleep Apnea

Testosterone can cause or worsen obstructive sleep apnea. If you start snoring heavily, stop breathing during sleep, or feel excessively tired during the day, let your doctor know.

Other Serious Effects

• Severe allergic reactions — Rash, hives, swelling of the face, lips, tongue, or throat, difficulty breathing
• Breast enlargement (gynecomastia) — Testosterone can convert to estrogen, causing breast tissue growth
• Decreased sperm count and infertility — Testosterone therapy suppresses natural sperm production. This is especially important for men who want to have children in the future

Specific Populations at Higher Risk

Men Over 65

Older men may have a higher risk of prostate problems and cardiovascular events while on testosterone therapy. Closer monitoring is recommended.

Men with Heart Disease, Diabetes, or Kidney Disease

These conditions can increase the risk of fluid retention and cardiovascular side effects. If you have diabetes, be aware that testosterone may lower your blood sugar — your doctor may need to adjust your insulin or diabetes medication doses.

Men with a History of Blood Clots

If you've had DVT or PE in the past, testosterone therapy may increase your risk of recurrence. Discuss the risks carefully with your doctor.

Women and Children

Androgel is not approved for use in women or children. Women who are or may become pregnant must avoid any contact with application sites due to the risk of fetal harm.

How to Manage Side Effects

Here are some practical tips for handling the most common issues:

• Skin irritation: Rotate application sites between shoulders, upper arms, and abdomen. Make sure skin is clean and dry before applying.
• Acne: Use a gentle cleanser and avoid heavy moisturizers on affected areas. If severe, your doctor may recommend a topical treatment.
• Edema: Reduce salt intake, elevate your legs, and stay active. If swelling is significant, contact your doctor.
• Mood changes: Track your mood over the first few weeks. If you experience severe irritability, depression, or anxiety, your dose may need adjustment.
• Blood pressure: Monitor at home and report any consistent elevations to your doctor.

Your doctor will schedule regular blood work — usually at 2–4 weeks after starting, then every 6–12 months — to check your testosterone levels, hematocrit, PSA, and liver function. Don't skip these appointments.

Final Thoughts

Most men tolerate Androgel well, and many side effects are mild and temporary. The key is knowing what to watch for and staying in touch with your doctor, especially during the first few months of treatment.

If you're concerned about side effects, talk to your doctor about alternatives — see our guide on Androgel alternatives. And if you're ready to fill your prescription, Medfinder can help you find a pharmacy with Androgel in stock near you.

For more on how Androgel interacts with other medications, check out our drug interactions guide.