What You Should Know About Androgel Side Effects Before Starting Treatment

Androgel (Testosterone topical gel) is one of the most commonly prescribed testosterone replacement therapies in the United States. For men with clinically low testosterone (hypogonadism), it can be life-changing — restoring energy, sex drive, muscle mass, and overall quality of life.

But like any medication, Androgel comes with potential side effects. Some are mild and temporary. Others are serious and require immediate medical attention. Knowing the difference helps you use Androgel safely and feel confident about your treatment.

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 shoulders, upper arms, or abdomen. It's classified as a Schedule III controlled substance and is used to treat men whose bodies don't produce enough testosterone on their own. For more background, see our full guide on what Androgel is and how it's used.

Common Side Effects of Androgel

Most side effects from Androgel are mild and tend to improve as your body adjusts to the medication. Based on FDA labeling, the most frequently reported side effects include:

• Skin irritation at the application site — redness, itching, or burning where you apply the gel. This is the most common complaint and usually fades within a few weeks.
• Acne — increased oil production can cause breakouts, particularly on the face, back, and shoulders.
• Headache — usually mild and resolves on its own.
• Mood changes — some men report irritability, anxiety, or vivid dreams, especially early in treatment.
• Increased blood pressure — your doctor will monitor this at follow-up visits.
• Frequent or prolonged erections — while sometimes welcomed, erections lasting more than 4 hours need medical attention.
• Nausea or vomiting — uncommon but possible, especially with higher doses.
• Swelling in lower legs (edema) — fluid retention can cause mild swelling in the ankles and feet.

Most of these side effects happen in the first few weeks of treatment and improve once your testosterone levels stabilize. If any side effect persists or gets worse, let your doctor know — a dose adjustment often helps.

Serious Side Effects: When to Call Your Doctor

Some side effects from Androgel are serious and need prompt medical attention. Contact your doctor right away or go to the emergency room if you experience:

Secondary Exposure (Boxed Warning)

Androgel carries an FDA boxed warning — the most serious type — about secondary exposure. If women or children come into skin-to-skin contact with areas where you've applied Androgel, they can absorb testosterone through their skin. In children, this has caused premature puberty, genital enlargement, and aggressive behavior. In women, it can cause voice deepening, body hair growth, and other masculinizing effects.

How to prevent it: Always wash your hands after applying the gel. Cover the application area with clothing. Wash the area thoroughly before skin contact with others. If a child or woman in your household shows unexpected signs of testosterone exposure, contact their doctor immediately.

Blood Clots

Testosterone therapy can increase the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Seek emergency care if you have leg swelling, pain, warmth, or redness (signs of DVT) or sudden shortness of breath, chest pain, or coughing up blood (signs of PE).

Heart Attack or Stroke

Studies have shown a potential increased risk of cardiovascular events with testosterone use. Warning signs include chest pain or pressure, pain radiating to the jaw or arm, difficulty breathing, sudden weakness on one side of the body, slurred speech, or sudden severe headache.

Increased Red Blood Cell Count (Polycythemia)

Androgel can increase your red blood cell production, making your blood thicker. This raises the risk of stroke and blood clots. Your doctor will check your hematocrit and hemoglobin levels regularly. If your hematocrit exceeds 54%, your dose may need to be reduced or treatment paused.

Prostate Issues

Testosterone therapy can raise PSA levels and potentially enlarge the prostate. Men with existing prostate issues should be monitored closely. Androgel is contraindicated in men with known or suspected prostate cancer or male breast cancer.

Liver Problems

Though rare with topical testosterone, watch for signs of liver trouble: yellowing of the skin or eyes (jaundice), dark-colored urine, severe nausea, or upper abdominal pain.

Sleep Apnea

Testosterone can cause or worsen obstructive sleep apnea. If you start snoring heavily, gasping during sleep, or feeling excessively tired during the day despite adequate sleep, tell your doctor.

Decreased Fertility

Androgel can significantly reduce sperm count and may cause infertility. If you're planning to have children, discuss this with your doctor before starting treatment — there may be better options for you.

Who's Most at Risk for Side Effects?

Certain groups should use Androgel with extra caution or avoid it altogether:

• Men over 65 — higher risk of prostate issues and cardiovascular events.
• Men with heart disease — testosterone may increase cardiovascular risk.
• Men with liver or kidney disease — impaired ability to metabolize and clear the medication.
• Men with diabetes — testosterone can lower blood sugar, potentially requiring adjustments to diabetes medications.
• Men with sleep apnea — TRT can make it worse.
• Men with a history of blood clots — increased clot risk with testosterone.
• Women and children — must not use Androgel or come into contact with treated skin areas.

How to Manage Androgel Side Effects

Here are practical steps to minimize side effects while on Androgel:

• Apply correctly: Follow the instructions exactly — apply to clean, dry skin on your shoulders, upper arms, or abdomen. Never apply to your genitals. Let it dry for at least 5 minutes before dressing.
• Rotate application sites: Moving where you apply the gel can reduce skin irritation.
• Keep follow-up appointments: Your doctor will monitor your blood work (testosterone levels, CBC, PSA, liver function) at 1 month, 3 months, and then every 6-12 months. Don't skip these.
• Stay hydrated: Helps manage headaches and supports kidney function.
• Prevent secondary exposure: Wash hands immediately after application. Cover the area. Shower before skin-to-skin contact with others.
• Report symptoms early: The sooner your doctor knows about side effects, the sooner they can adjust your dose or switch your treatment.

For many men, a simple dose adjustment resolves most side effects. Androgel comes in adjustable doses — your doctor can increase or decrease the amount to find the sweet spot where you get the benefits with minimal side effects.

Final Thoughts

Androgel is a well-established testosterone replacement therapy that helps thousands of men manage low testosterone. Most side effects are mild and manageable. The serious ones are uncommon but important to know about — especially the boxed warning about secondary exposure to women and children.

The key to safe Androgel use is working closely with your doctor, keeping up with blood work, and reporting any unusual symptoms. If you're currently taking Androgel and want to learn more, check out our guides on how Androgel works and how to save money on your prescription.

If you're having trouble finding Androgel at your pharmacy, Medfinder can help you check stock availability near you.