As a principle gentlemen using testosterone in gel form, which is the majority nowadays, should use water and soap. The reason is obvious: It’s the pleasant part of the gel that the active ingredient absorbs into the skin. No unpleasant pricks necessary. But as always in life there are two sides to the coin. And the unpleasant one is that you are absorbing the hormone through the skin even if you don’t want to, especially if you get in closer contact with a man using the gel but neglecting the washing part.
US health authorities warn
A recent warning published by the US American health authorities Food and Drug Administration FDA shows that this is not only a theoretical problem but a very real one. Cause for this warning was the receipt of 20 warnings brought to the attention of the FDA over the past nine years regarding severe side effects of testosterone on children. The professional information points out to the user to wash hands after applying the gel and to cover treated skin areas. It also advises to be careful with skin contact to women and children. But obviously not every user takes that into consideration and handles things accordingly. As a result the FDA has requested two manufacturers now to add additional warnings to their testosterone products and to develop special measures to protect children in particular. And those measures taken by the FDA are definitely not exaggerated. The reported side effects on children the age between nine months and seven years are significant:
• Penis- or clitoris enlargement
• Premature pubic hair
• Accelerated aging of bones
• Increased propensity for self-stimulation
• Increased libido
• Frequent erections
• Aggressive behaviour
In more than half of the 20 children, increased testosterone values were found according to the FDA. After the children did not have any more contact with the gel, the hormone values decreased and also the side effects – but not completely. The genitals of some of those children only partly reduced in size. Two girls had their clitoris made smaller by surgery.
Testosterone back to normal, but…
Only one example case already shows that it is important to read the patient information leaflet and to take the warnings of the FDA serious. A little girl, three years and three months old, was taken to the physician for an endocrinological testing because of its pubic hair. During anamnesis it attracted attention that her dad was using testosterone gel since even before her birth. Instead of the recommended daily highest dose of 2 x 5 grams, the father decided to 5 grams three times a day on arms and shoulders – true to the motto “a lot must help a lot”. The examination of the girl showed a premature development of breasts, a pre-pubertal pubic hair growth, an enlarged clitoris and adhesions of the labiae. The testosterone value was increased significantly with 68 ng/dl (a normal value is below 5 ng/dl). The parents were requested to make sure that the girl does not get in touch with the hormone gel again. Three weeks later the value had dropped to 41 ng/dl, but one month later it was with 38 ng/dl still way too high. The father changed from gel to shots, the family threw all bed clothes and moved to a hotel for one month. During a later check-up, when the girl was five, she showed normal testosterone values, but her clitoris remained enlarged.
Narrow chest not an indication for testosterone
Although it is known that unsolicited contact with testosterone gel might lead to unwelcome side effects but the mechanism is not quite clear yet. About 10 percent of the hormones are absorbed through the skin into the blood circulation system. According to several studies, a large share of the hormones stays on the skin though for more than 8 hours if the user does not wash. However, there are clues that side-effects by testosterone were caused also via towels, wash clothes and bed linen.
Thus the US Health Authorities strongly recommend:
• Wash hands regularly with warm water and soap after each gel-application
• Cover the skin areas with cloths when the skin is dry
• Wash prior to any body contact
• Make sure that children do not get any opportunity to get in touch with testosterone gel
And another recommendation by the FDA should not be missing: No matter how tempting the offer also in the internet might be: The substitution of testosterone has more or less clear indications: It is the clinically symptomatic lack of testosterone and not a floppy biceps.