Testosterone Gel UK: Testogel vs Tostran vs Testavan

  • By Amina Mughal

Published: Thursday, June 23, 2026

TL;DR — key facts

Three testosterone gels are MHRA-licensed for men in the UK: Testogel (16.2mg/g pump), Tostran (20mg/g pump), and Testavan (20mg/g applicator pump). All require a prescription. NHS eligibility typically requires total testosterone below 8 nmol/L with symptoms. Private clinics work to a broader threshold — around 15 nmol/L. Gel is not automatically the best option for everyone — injections and patches are alternatives. Women can also access testosterone gel off-label (or Tostran on-label at low dose) for menopausal symptoms including low libido.

3 gels

Currently MHRA-licensed for men in the UK

8 nmol/L

NHS total testosterone threshold for treatment

2–4 weeks

Typical private clinic access timeframe vs 12+ weeks NHS
Title

What is testosterone gel and what's it used for?

  1. Testosterone gel is a transdermal TRT — testosterone absorbed through skin daily, avoiding first-pass liver metabolism.
  2. Used for confirmed male hypogonadism — primary (testicular failure) or secondary (pituitary/hypothalamic dysfunction). 
  3. Increasingly used off-label for women with menopausal symptoms including low libido, brain fog, fatigue — note NICE guidance NG23 supports this.
  4. Not licensed for: performance enhancement, bodybuilding, age-related decline without confirmed pathological hypogonadism
  5. Gel sits alongside other TRT forms (injections, patches, pellets) — not always the default best choice
Title

The three MHRA-licensed testosterone gels in the UK: side by side

Treatment comparison
Testogel 16.2mg/g Tostran 20mg/g Testavan 20mg/g
Manufacturer Besins Healthcare ADVANZ Pharma Simple Pharma
Formulation Pump dispenser Canister pump Applicator pump
Application site Shoulders & upper arms only Abdomen or inner thighs Upper arm & shoulder (via applicator)
Starting dose 40.5mg (2 pumps) 60mg (3 pumps) 23mg (1 pump)
Max daily dose 81mg 80mg 69mg
Transfer risk
Moderate
Lower
Lowest
Suitable for women ✗ Too high concentration ✓ Yes — at low dose Not recommended
NHS availability ✓ Yes ✓ Yes ✓ Yes
Best for Most widely prescribed — familiar to GPs Active mornings; women at low dose; longer canister supply Men with children or partners — hands-free reduces transfer
Testogel 16.2mg/g Most prescribed
Manufacturer
Besins Healthcare
Apply to
Shoulders & upper arms only
Starting dose
40.5mg — 2 pumps daily
Max dose
81mg daily
Transfer risk
Moderate
Women
✗ Too high concentration
NHS
✓ Available
Tostran 20mg/g Women-suitable
Manufacturer
ADVANZ Pharma
Apply to
Abdomen or inner thighs
Starting dose
60mg — 3 pumps daily
Max dose
80mg daily
Transfer risk
Lower
Women
✓ Yes — low dose
NHS
✓ Available
Testavan 20mg/g Lowest transfer risk
Manufacturer
Simple Pharma
Apply to
Upper arm & shoulder via applicator
Starting dose
23mg — 1 pump daily
Max dose
69mg daily
Transfer risk
Lowest — hands-free
Women
Not recommended
NHS
✓ Available
Note: Testim (testosterone 1% gel) was discontinued in the UK in December 2023. AndroGel and Axiron are US products — they are not licensed or available in the UK. Always follow your prescriber's formulation-specific application instructions as sites and doses differ between products.
Sources: EMC Summaries of Product Characteristics — Testogel 16.2mg/g (Besins Healthcare, 2023); Tostran 20mg/g (ADVANZ Pharma, 2023); Testavan 20mg/g (Simple Pharma, 2022). NICE BNF testosterone prescribing guidance, accessed June 2026.

Testogel 16.2mg/g pump

  • Most widely prescribed in UK — familiar to most GPs and endocrinologists 
  • Applied to shoulders and upper arms only — not abdomen 
  • Note: Testogel 1% sachets were discontinued — many men still searching for these 
  • Hands-on application means transfer risk if not fully dried before contact

Tostran 20mg/g

  • Applied to abdomen or inner thighs — better for men who are active in the mornings 
  • The only gel currently recommended for women at low dose on NHS (Tostran 2% starting at 1 pump on alternate days per Scottish NHS guidance) 
  • Canister format lasts longer — practical for men on fixed doses

Testavan 20mg/g

  • Built-in applicator means testosterone goes from pump to skin without touching hands — lowest transfer risk of the three
  • Useful for men who live with women or young children
  • Slightly lower starting dose — may suit men with borderline levels or sensitivity concerns
  • Note: Testim (testosterone 1% gel) was discontinued December 2023 — flag for readers still searching for it
Title

Who qualifies for testosterone gel in the UK?

8 nmol/L

NHS total testosterone threshold — two fasting morning tests required

8–15 nmol/L

The "grey zone" — symptoms present but NHS often refuses treatment

2×

Blood tests needed before diagnosis — single low reading is not enough
NHS eligibility NHS criteria for testosterone gel — where do you sit?
Below
8 nmol/L
Eligible for NHS TRT
Qualifies for testosterone gel on the NHS with accompanying clinical symptoms. Two fasting morning tests required.
Below
10.4 nmol/L
Eligible with PDE5 inhibitors
If already taking sildenafil or tadalafil for erectile dysfunction, the NHS threshold is raised to 10.4 nmol/L.
8–15
nmol/L
The grey zone — often refused
Symptoms frequently present but GPs attribute them to lifestyle, sleep, or depression. Private clinics use broader criteria including free testosterone and SHBG.
Above
15 nmol/L
Not eligible for NHS TRT
Explore other causes of symptoms — thyroid, sleep disorders, metabolic dysfunction, or depression. Low testosterone is unlikely to be the primary cause.
What you need before NHS treatment begins
✓
Two fasting morning blood tests — taken between 7–11am on separate occasions. Testosterone fluctuates throughout the day and between days — a single low reading is not diagnostic.
✓
Clinical symptoms confirmed — biochemical deficiency alone is not enough. You must also have symptoms such as reduced libido, fatigue, erectile dysfunction, or loss of muscle mass.
✓
Other causes ruled out — GPs will first consider sleep problems, obesity, stress, alcohol, thyroid issues, and depression before referring for TRT.
✗
No prostate or breast cancer — absolute contraindication. Testosterone may stimulate the growth of hormone-sensitive tumours.
✗
Not trying to conceive — testosterone gel suppresses sperm production. Discuss alternatives with your prescriber if fertility is a consideration.
i
Free testosterone matters — the NHS typically measures total testosterone only. Low free testosterone with normal total testosterone (due to high SHBG) can still cause symptoms but is rarely tested in primary care.
If your GP refuses: Ask for the clinical reason in writing. Request a referral to endocrinology or urology — this is your right under the NHS Constitution. If your reading was borderline, ask to retest. If all NHS routes fail, a CQC-registered private clinic is a clinically reasonable next step.
NHS 2026 update: Recent NICE guidance (2024) and BSSM 2022 guidelines have streamlined access. The NHS now handles straightforward hypogonadism cases in primary care more frequently — waiting times are shorter than two years ago. If your total testosterone is clearly below 8 nmol/L with symptoms, the NHS route is viable and free.
Sources: BSSM Guidelines for Testosterone Deficiency (2022) · NICE BNF testosterone prescribing guidance (accessed June 2026) · EAU Guidelines on Sexual and Reproductive Health (2026) · Society for Endocrinology UK guidance on androgen replacement in males.
Title

NHS vs private: honest comparison for 2026

Go NHS if

Total testosterone clearly below 8 nmol/L with symptoms

Willing to wait 12+ weeks

Stable symptoms, no urgency

Go Private If

Testosterone grey zone (8–15 nmol/L)

Need treatment within 2–4 weeks

GP has refused despite clear symptoms
Cost guide 2026 private TRT cost breakdown — what to expect
Item Typical cost Frequency Notes
Initial consultation Private clinic — CQC registered £150–300 One-off Includes review of blood results and treatment plan
Testosterone gel Testogel, Tostran or Testavan £30–60 Monthly Medication cost — varies by formulation and dose
Ongoing monitoring Private clinic review £50–100 Every 3–6 months Prescription renewal + clinical review
Home blood test panel Testosterone, FBC, PSA, LFTs £40–80 Every 3–6 months Required for safe monitoring — some clinics include this
Estimated monthly total Ongoing after first 3 months £60–120 Per month Gel + amortised monitoring and blood test costs
NHS prescription If eligible via GP or specialist £9.90 Per item Standard NHS prescription charge — 2026 rate. Free if exempt.
Initial consultation One-off
Cost
£150–300
Notes
CQC-registered clinic — includes blood results review and treatment plan
Testosterone gel Monthly
Cost
£30–60 / month
Notes
Testogel, Tostran or Testavan — varies by formulation and dose
Ongoing monitoring Every 3–6 months
Cost
£50–100
Notes
Private clinic review — prescription renewal and clinical check
Home blood test panel Every 3–6 months
Cost
£40–80
Notes
Testosterone, FBC, PSA, LFTs — some clinics include this in their fee
Est. monthly total Ongoing
Cost
£60–120 / month
Notes
Gel + amortised monitoring and blood test costs after first 3 months
NHS prescription Per item
Cost
£9.90
Notes
Standard NHS prescription charge — 2026 rate. Free if exempt (under 16, over 60, certain conditions).
Prices are indicative based on mid-2026 UK private clinic market rates. Costs vary between providers — always confirm the full fee structure including monitoring and blood tests before committing to a clinic. Main CQC-registered UK private TRT providers include Optimale, Balance My Hormones, Fountain TRT, Leger Clinic, and Numan.
Sources: UK private TRT clinic published pricing, June 2026. NHS prescription charge rates — NHS England 2026. Costs are estimates and subject to change.
Title

How to use testosterone gel correctly

Apply once daily in the morning to clean, dry skin. Application site rules differ by formulation — Testogel goes on shoulders and upper arms only, Tostran on abdomen or inner thighs, Testavan via its built-in applicator to upper arm and shoulder. Getting the site wrong reduces absorption significantly. 

 

Let the gel dry for at least 3–5 minutes before dressing. Cover with clothing and avoid skin contact with others until the site has been washed. Always wash hands thoroughly after application (not required for Testavan applicator). Do not shower for at least 2 hours — 6 hours is safest. The gel is alcohol-based and flammable until dry.

The absorption problem nobody talks about 

Some men absorb testosterone gel poorly due to skin thickness, excessive body hair, or heavy sweating. Signs: testosterone levels not rising after 4–6 weeks of consistent use. Solution: switch application site, try a different gel formulation, or discuss with prescriber whether injections would give more reliable results. This affects a meaningful subset of patients and is a common reason treatment appears to "not work."
Side effects and monitoring
Skin reactions Common
Redness, dryness or irritation at the application site — most cases are mild and settle within a few weeks.
Rotate sites to reduce irritation. If persistent, switch formulation or discuss with prescriber.
Polycythaemia Monitor closely
Raised red blood cell count — haematocrit must stay below 54%. Affects 5–10% of patients significantly.
Symptoms are usually absent until severe. Dose reduction or temporary cessation required if exceeded. Increases blood clot risk.
Transfer risk Prevention key
Testosterone can transfer to partners, women and children through skin contact before the gel dries.
Causes virilisation in women (facial hair, deepened voice) and premature puberty in children. Always cover site with clothing. Testavan has lowest transfer risk.
Fertility Important
Exogenous testosterone suppresses LH and FSH, reducing natural production and sperm count.
Not suitable for men actively trying to conceive. Recovery after stopping can take months. Discuss alternatives with your prescriber before starting.
Sleep apnoea Caution
Can worsen existing sleep-disordered breathing or trigger new onset in susceptible patients.
Report any new or worsening snoring, morning headaches, or daytime sleepiness to your prescriber.
Cardiovascular Ongoing debate
Recent data is reassuring for men with confirmed hypogonadism — the TRAVERSE trial showed no increased cardiovascular risk vs placebo.
Risk is higher with polycythaemia. Men with existing cardiovascular disease should be monitored closely. Discuss your individual risk profile with your prescriber.
Skin reactions Common
Redness or dryness at application site — usually mild, settles within weeks. Rotate sites to reduce irritation.If persistent, try a different formulation or application site.
Polycythaemia Monitor closely
Raised red blood cell count — haematocrit must stay below 54%. Affects 5–10% significantly.Dose reduction or cessation required if exceeded. Increases clot risk.
Transfer risk Prevention key
Can transfer to partners and children before gel dries — causes virilisation in women, premature puberty in children.Always cover site with clothing. Testavan has lowest risk — hands-free applicator.
Fertility Important
Suppresses sperm production — not suitable for men trying to conceive.Recovery after stopping can take months. Discuss before starting.
Sleep apnoea Caution
Can worsen existing sleep-disordered breathing or trigger new onset.Report worsening snoring or daytime sleepiness to your prescriber.
Cardiovascular Ongoing debate
TRAVERSE trial data reassuring for confirmed hypogonadism — no increased cardiovascular risk vs placebo.Risk higher with polycythaemia. Discuss individual risk with prescriber.
Monitoring schedule
Baseline Before starting — testosterone, FBC, haematocrit, PSA (men over 40), LFTs, lipids
3 months First check — testosterone levels and haematocrit. Morning test, before day's application.
6 months Full panel — testosterone, FBC, PSA, LFTs, cardiovascular risk assessment
Annually Ongoing — full panel repeated every 12 months for the duration of treatment
Always test in the morning before that day's gel application. A blood test taken after applying the gel will show artificially elevated levels and give a misleading result.
Testosterone gel vs other TRT options — which is right for you?
Type Frequency Hormone peaks Transfer risk NHS Private
Gel Testogel, Tostran, Testavan Daily Low — steady Yes — cover site ✓ Yes ✓ Yes
Injection Nebido, Sustanon, Testosterone E Every 1–14 weeks High (short ester) / Low (Nebido) ✓ None ✓ Yes ✓ Yes
Patch Androderm Daily Low — steady ✓ Minimal Limited ✓ Yes
Pellet implant Testopel Every 3–6 months Very low — sustained ✓ None ✗ Rare ✓ Yes
GelRecommended start
Frequency
Daily application
Peaks
Low — steady levels
Transfer risk
Yes — cover site
NHS
✓ Available
InjectionEvery 1–14 weeks
Frequency
Every 1–14 weeks depending on ester
Peaks
High (short) / Low (Nebido)
Transfer risk
✓ None
NHS
✓ Available
PatchDaily
Frequency
Once daily — changed each day
Peaks
Low — steady levels
Transfer risk
✓ Minimal
NHS
Limited availability
Pellet implantEvery 3–6 months
Frequency
Minor procedure every 3–6 months
Peaks
Very low — sustained
Transfer risk
✓ None
NHS
✗ Rarely available
Gel suits you if...
You prefer daily routine control over your dose
You're new to TRT and want easy dose adjustment
You're sensitive to hormone peaks and troughs
You want to avoid needles entirely
Consider alternatives if...
Your gel absorption is poor after 6 weeks
You have skin conditions at application sites
You find daily application impractical long-term
You live with young children (or try Testavan)
Gel is not automatically the best option for everyone — the right formulation depends on your lifestyle, living situation, skin type, and whether you absorb transdermally well. Your prescriber should discuss all options before defaulting to gel.
Sources: BSSM Guidelines for Testosterone Deficiency (2022) · NICE BNF testosterone prescribing (accessed June 2026) · EAU Guidelines on Sexual and Reproductive Health (2026) · TRAVERSE trial cardiovascular outcomes data (2023).

Frequently asked questions

What testosterone gels are available in the UK?

Three gels are currently MHRA-licensed for men: Testogel 16.2mg/g, Tostran 20mg/g, and Testavan 20mg/g. Testim (1% gel) was discontinued in December 2023. AndroGel and Axiron are US products — not licensed or available in the UK.

What testosterone level do I need for NHS gel?

Typically below 8 nmol/L on two fasting morning blood tests with accompanying symptoms. Men between 8–15 nmol/L (the grey zone) with clear symptoms often need to pursue a private route as NHS GPs frequently attribute symptoms to lifestyle rather than hypogonadism.

Can women use testosterone gel in the UK?

Yes — off-label via Tostran 2% at low dose on the NHS, or via private prescription. Testogel 16.2mg/g is not suitable for women as the concentration is too high to dose accurately. AndroFeme cream became the first MHRA-licensed testosterone product specifically for women in 2026 and is now available to private prescribers.

What's the difference between Testogel and Tostran?

The main differences are application site (Testogel goes on shoulders and upper arms only; Tostran on abdomen or inner thighs), concentration (16.2mg/g vs 20mg/g), and suitability for women (Tostran is the only one suitable at low dose). Both are available on the NHS.

Why isn't my testosterone gel working?

Poor skin absorption is a common and underreported issue — especially in men with thick skin, heavy body hair, or who sweat heavily. If your testosterone levels aren't rising after 6 weeks of consistent use, check application technique first, then discuss switching formulation or moving to injections with your prescriber.

How much does testosterone gel cost privately in the UK?

Initial private consultation: £150–300. Ongoing monthly cost including medication: £40–100. NHS prescription charge: £9.90 per item (2026 rate). Home blood test panels required for monitoring: £40–80 every 3–6 months.

Can testosterone gel transfer to my partner?

Yes, before it fully dries. Testavan has the lowest transfer risk as its built-in applicator means no hand contact. Always cover the site with clothing once dry, and wash the site with soap and water before anticipated skin-to-skin contact with others — particularly women and children.

How long before testosterone gel starts working?

Blood testosterone levels begin rising within hours of the first application. Symptomatic improvements follow a longer timeline: mood and energy typically improve within 2–4 weeks, sexual function over 3–6 months, and full effects on body composition and bone density develop over 6–12 months of consistent treatment.

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