Testosterone Side Effects
It is possible that some side effects of testosterone may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.
For the Consumer
Applies to testosterone: buccal patch extended release
If any of the following symptoms of overdose occur while taking testosterone, get emergency help immediately:
- Blurred vision
- sudden and severe inability to speak
- slurred speech
- temporary blindness
- weakness in arm and/or leg on one side of the body, sudden and severe
Some testosterone side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:More Common
- Gum or mouth irritation
- Abnormal liver function test
- abnormal renal function
- bad unusual or unpleasant (after) taste
- bleeding gums
- blemishes on the skin, pimples
- blurred vision
- breast enlargement
- breast pain
- buccal inflammation
- change in taste
- difficulty breathing
- dry mouth
- feeling sad or empty
- fever or chills
- gum blister
- gum pain
- itching skin
- loss of appetite
- loss of interest or pleasure
- lower back or side pain
- mental depression
- mouth ulcers
- noisy breathing
- painful or difficult urination
- passing of gas
- pounding in the ears
- quick to react or overreact emotionally
- rapidly changing moods
- redness and swelling of gums
- shortness of breath
- slow or fast heartbeat
- stomach cramps
- stomach pain, fullness or discomfort
- stinging of lips
- swelling of gums
- swelling or inflammation of the mouth
- swelling of the nose
- taste bitter
- tightness in chest
- trouble concentrating
- trouble sleeping
- unusual tiredness or weakness
For Healthcare Professionals
Applies to testosterone: buccal film extended release, compounding powder, intramuscular solution, subcutaneous implant, transdermal cream, transdermal film extended release, transdermal gel, transdermal ointment, transdermal solution
Cardiovascular side effects have included hypertension, and edema with and without congestive heart failure.
Endocrine side effects have included gynecomastia as a frequent and sometimes persistent side effect. Cautious use is recommended in patients with existing gynecomastia.
During exogenous administration of androgens, endogenous testosterone release is inhibited through feedback inhibition of pituitary luteinizing hormone (LH). Large doses of exogenous androgens may suppress spermatogenesis through inhibition of pituitary follicle stimulating hormone (FSH).
Androgens may decrease levels of thyroxin binding globulin resulting in decreased total T4 serum levels and increased resin uptake of T3 and T4. Free thyroid hormone levels remain unchanged and there is no clinical evidence of thyroid dysfunction.
Changes in insulin sensitivity or glycemic control may occur in patients treated with androgens. In diabetic patients, the metabolic effects of androgens may decrease blood glucose and, therefore, insulin requirements.
Virilization of children has been reported due to secondary exposure to testosterone. Signs and symptoms have included inappropriate enlargement of the penis or clitoris, premature development of pubic hair, increased erections and libido, aggressive behavior, and advanced bone age. In most cases, these signs and symptoms regressed with removal of the exposure to testosterone. In a few cases, however, enlarged genitalia did not fully return to age-appropriate normal size and bone age remained modestly greater than chronological age.
Renal side effects have included retention of nitrogen, sodium, potassium, chloride, water and phosphorus, and decreased urinary excretion of calcium.
Hepatic side effects have included life-threatening peliosis hepatitis and hepatic abnormalities including hepatic neoplasms and hepatocellular carcinomas following prolonged therapy with high doses of androgen. Tumor regression did not occur in all cases following medication withdrawal.
Cholestatic hepatitis, jaundice, and abnormal liver function tests have occurred during androgen therapy. Drug-induced jaundice is usually reversible following drug discontinuation.
Genitourinary side effects following chronic administration and/or large dosages of testosterone have included oligospermia and decreased ejaculatory volume. Elderly male patients have experienced prostatic enlargement resulting in urinary obstruction. Priapism and excessive stimulation has developed. Other urinary side effects have included nocturia, urinary hesitancy, urinary incontinence, urinary retention, urinary urgency, and weak urinary system.
In female patients the use of androgens has resulted in virilization including deepening voice, hirsutism, acne, clitomegaly (not reversible), and menstrual abnormalities. Discontinuation of testosterone at signs of mild virilization may prevent irreversible virilization.
Metabolic side effects have included osteolytic-induced hypercalcemia in immobilized patients or those with metastatic breast disease. Increased cholesterol levels and acute intermittent porphyria have been reported.
Other side effects have included virilization in female patients. Virilization included deepening voice, hirsutism, acne, clitomegaly (not reversible), and menstrual abnormalities.
Female sexual partners of men using topical testosterone (residual on skin) have reported virilization.
Dermatologic side effects have included hirsutism, acne, male-patterned baldness and seborrhea. Dermal reactions have been the most commonly reported side effects for transdermal testosterone and occur primarily at the site of application. Dermal effects have included 3 types: irritation including mild to moderate erythema (to 6%), induration (3%), itching (12%), and burning (3%); allergic contact dermatitis including pruritus (to 37%), vesicles (6%), and rash (2%); and burn-like blisters (12%).
Discontinuation rates for transdermal testosterone were as follows: due to chronic skin irritation (5%), allergic dermal reactions (4%), and burn-like, usually a single site (0%).
Triamcinolone 1% cream applied sparingly to skin under the reservoir reduced irritation and did not interfere with testosterone absorption. Ointment formulations reduce testosterone absorption.
Gastrointestinal side effects have included nausea and vomiting.
Testosterone is involved in termination of linear bone growth by closure of the epiphyseal growth centers. Appropriate monitoring of bone age is recommended during testosterone use in healthy males with delayed puberty.
Musculoskeletal side effects have included myalgia and pain.
Hematologic side effects have included alteration in clotting factors II, V, VII and X and polycythemia due to increased red cell production. Anemia has also been reported.
Hypersensitivity side effects have included rash and anaphylactoid reactions.
Local side effects have included inflammation and pain at injection or dermal application site.
Nervous system side effects have included altered libido (increased/decreased), headache (to 5%), anxiety, depression, generalized paresthesia, or sleep apnea syndrome.
Oncologic side effects have included carcinoma of the prostate, hepatic neoplasms, and hepatocellular carcinomas.
Respiratory side effects have included reports of potentiation of sleep apnea, particularly in obese patients or those with chronic lung disease. There have been rare postmarketing reports of transient reactions involving urge to cough, coughing fits, and respiratory distress immediately after the injection of testosterone enanthate, an oil-based depot preparation.
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