AndroGel - A New Gel Formulation of Testosterone for Transdermal Application - Reviewed by The Medical Letter [Medical Letter 2000;42:49]: AndroGel is a gel formulation of testosterone that is rubbed on the skin for transdermal absorption in a fashion analogous to commercially available patches (Androderm, Testoderm, and Testoderm TTS). AndroGel is supplied in packets of 2.5 or 5 gm that are expected to deliver 25 or 50 mg of testosterone. The recommended starting dose is 5 gm daily, which can then be titrated according to serum testosterone levels. Pharmacokinetic studies show that doses of 10 gm in hypogonadal men reach normal levels in 30 minutes to 4 hours and are maintained in steady state for 1 - 3 days. Once-daily application maintained normal testosterone levels, which fell to pretreatment levels after 3 - 5 days. The main dose-related adverse effects have been acne in 12% and BPH in 19% who received 10 gm/day for up to one year. Alternative therapies include injectable testosterone, which causes wide variation in blood levels, the 17 alpha-substituted preparations (methyltestosterone and oxandrolone) that have been associated with liver disease and tumors, and the patches, which may be associated with local reactions or problems with falling off. AndroGel is applied by rubbing the gel on the shoulders, upper arms, and/or abdomen. The average wholesale price for 5 gm/daily for 1 month is $150 compared to $96 for the Testoderm 4 or 6 mg patch. posted 6/29/2000