Comprehensive medication guide to Natesto including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
Commercially insured patients may pay as little as $0/month using the Natesto Savings Card (up to $3,500/year in savings); not covered by most Medicare Part D plans; prior authorization typically required at commercial plans; Tier 3 or higher at most formularies.
Estimated Cash Pricing
Retail price is approximately $1,047 for a 30-day supply (3 dispensers) without insurance; with a GoodRx coupon, as low as $165; through the Natesto Cash Option Program for uninsured patients, $140 per prescription for up to a 30-day supply.
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Natesto is the only FDA-approved intranasal testosterone replacement therapy in the United States. Approved in 2014 and manufactured by Acerus Pharmaceuticals Corporation, it is a metered-dose nasal gel that delivers testosterone directly through the nasal mucosa into the bloodstream.
Natesto is prescribed to adult males with hypogonadism — a medical condition in which the body fails to produce sufficient testosterone. This can result from problems with the testicles (primary hypogonadism) or with the brain's hormonal signaling (hypogonadotropic hypogonadism). Symptoms of low testosterone include fatigue, low libido, erectile dysfunction, reduced muscle mass, depression, and decreased bone density.
Unlike topical testosterone gels applied to the skin, Natesto carries no risk of accidental testosterone transfer to partners or children. It has a rapid onset of action — peak testosterone levels are reached in approximately 40 minutes — and its pulsatile pharmacokinetics may partially preserve natural testosterone production and fertility compared to other TRT formulations.
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Natesto delivers testosterone through transmucosal absorption across the nasal mucosa — the blood vessel-rich lining of the nasal cavity. When applied inside the nostril with the metered-dose pump, testosterone in the gel is absorbed directly into the bloodstream, bypassing the digestive system and liver.
Once in circulation, testosterone binds to androgen receptors throughout the body — in muscle tissue, bone, the brain, and other organs — triggering the downstream hormonal effects that maintain male sex characteristics, energy, libido, and overall wellbeing. Peak plasma testosterone concentrations are reached approximately 40 minutes after intranasal application.
Natesto's rapid rise-and-fall pharmacokinetic profile requires three-times-daily dosing to maintain testosterone in the normal range (300–1050 ng/dL) throughout the day. This pulsatile profile is also believed to explain why Natesto appears to suppress FSH and LH levels (the pituitary signals controlling sperm production) less completely than injectable testosterone formulations.
5.5 mg/actuation — nasal gel (metered-dose pump)
One actuation per nostril (2 total) = 11 mg per dose; three times daily for 33 mg/day total. Each dispenser contains 60 actuations (~10-day supply).
Natesto is not in an active FDA-declared shortage as of 2026, but it is not stocked at every pharmacy. Because it is a brand-name-only product with no generic equivalent, low relative prescription volume, and Schedule III controlled substance requirements, many standard retail pharmacies do not keep it on their shelves routinely.
Patients are most likely to find Natesto at specialty pharmacies, independent pharmacies with testosterone replacement therapy patient populations, and chain specialty pharmacy departments. Mail-order pharmacy services may also carry it. The average retail price of approximately $1,047 per month can also deter patients, though substantial discounts are available through the Natesto Savings Card, Cash Option Program, and GoodRx.
Rather than spending time calling pharmacies, use medfinder — a service that calls pharmacies in your area on your behalf and reports back which ones have Natesto in stock and can fill your prescription today. Results are sent directly to your phone.
Natesto is a Schedule III controlled substance, which means it must be prescribed by a licensed provider with DEA prescribing authority. Any qualified prescriber — whether a specialist or a primary care provider — can prescribe Natesto if they have Schedule III prescribing rights in their state.
Urologists — Most commonly prescribe Natesto; men's health and TRT are within the core scope of urology practice.
Endocrinologists — Preferred specialist for secondary (hypogonadotropic) hypogonadism or complex cases.
Primary care physicians — Many internists and family medicine physicians manage straightforward hypogonadism.
Nurse practitioners and physician assistants — Can prescribe Natesto in most states with DEA authority.
Natesto is also available through telehealth platforms specializing in men's health, such as Hims, Roman (Ro), and Maximus Health. Blood work confirming hypogonadism is required before any prescriber — in-person or telehealth — can prescribe Natesto.
Yes. Natesto is a
Schedule III (CIII) controlled substance under the Controlled Substances Act. This designation applies because testosterone has accepted medical uses but also carries potential for misuse and dependence (particularly among athletes and bodybuilders who may use it at supratherapeutic doses).
As a Schedule III drug, Natesto requires a valid prescription from a DEA-licensed prescriber. In most states, testosterone prescriptions cannot be transferred between pharmacies, and the number of refills that can be authorized on a single prescription is limited. Early refills may be blocked by insurance and pharmacy systems. Never share Natesto with others — this is illegal and potentially harmful.
The Schedule III status also contributes to pharmacy stocking challenges, as some pharmacies prefer to minimize their controlled substance inventory for low-volume products.
The following side effects occurred in more than 3% of patients in clinical trials and are primarily related to nasal administration:
Increased PSA (prostate-specific antigen)
Headache
Rhinorrhea (runny nose)
Epistaxis (nosebleed)
Nasal discomfort and nasal scabbing
Nasopharyngitis (nasal and throat irritation)
Upper respiratory tract infection, bronchitis, sinusitis
Venous thromboembolism (deep vein thrombosis, pulmonary embolism)
Cardiovascular events (heart attack, stroke) — risk being evaluated in ongoing studies
Polycythemia / erythrocytosis (elevated red blood cell count)
Prostate cancer risk (monitoring required)
Hepatotoxicity (rare with intranasal route)
Sleep apnea exacerbation
Edema / fluid retention
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AndroGel (testosterone topical gel)
The most widely prescribed TRT; applied to skin once daily; generic available at $41–$80/month with coupons; skin transfer risk requires precautions.
Testosterone Cypionate (Depo-Testosterone)
Injectable testosterone; most cost-effective option at $20–$60/month; injected every 1–2 weeks; widely available as a generic.
Androderm (testosterone patch)
Daily patch applied to skin; no transfer risk; mimics circadian T pattern; higher skin irritation rate than gels.
Jatenzo / Kyzatrex (oral testosterone undecanoate)
Oral testosterone capsules taken with meals twice daily; newer option; black box warning for blood pressure increase; no liver metabolism concerns.
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Warfarin / oral anticoagulants
moderateAndrogens may alter anticoagulant activity. Monitor INR and prothrombin time more frequently when starting, stopping, or changing Natesto dose.
Insulin and diabetes medications
moderateAndrogens may decrease blood glucose, increasing hypoglycemia risk in diabetic patients on insulin or oral hypoglycemics. Monitor blood glucose closely.
Corticosteroids
moderateConcomitant use may increase risk of edema, particularly in patients with cardiac, renal, or hepatic disease. Use with caution.
Other nasal medications
moderateNatesto is not recommended for use with other nasally administered drugs (except oxymetazoline decongestants). Interaction potential is unstudied.
Oxymetazoline (Afrin)
minorMinimal interaction; oxymetazoline administered 30 minutes before Natesto reduces absorption by only 2.6–3.6% in allergic rhinitis patients. No clinically significant effect.
Natesto fills a unique niche in the testosterone replacement therapy landscape. As the only intranasal testosterone product in the United States, it offers several advantages: no skin transfer risk, rapid onset, three-times-daily dosing that mimics natural T production rhythms, and evidence of partial HPG axis preservation that may benefit men who wish to maintain fertility.
The challenges are real: no generic equivalent, high retail price without savings programs, limited pharmacy stocking, and three-times-daily dosing that some patients find inconvenient. But for the right patient — particularly one with skin conditions, concerns about transfer exposure, or fertility goals — Natesto can be an excellent choice.
If you've been prescribed Natesto and are struggling to locate it at a pharmacy, medfinder can help. Simply enter your medication and ZIP code, and medfinder will call pharmacies in your area to find which ones have it in stock — sending results directly to your phone.
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