Short answer: The Natesto label gives 11 mg of testosterone (one pump in each nostril) three times daily, morning, afternoon and evening, 6 to 8 hours apart, for 33 mg a day. Total testosterone is checked periodically starting one month in. If it is consistently above 1050 ng/dL, Natesto is stopped; if consistently below 300 ng/dL, another treatment is considered.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What Natesto is approved for: Natesto is approved as replacement therapy in adult males with low or absent natural testosterone due to primary hypogonadism (testicular failure) or hypogonadotropic hypogonadism (a pituitary or hypothalamus cause). The label says safety and efficacy have not been established in men with "age-related hypogonadism" or in males under 18 (section 1).
Source
NATESTO (testosterone) nasal gel, CIII, prescribing information and Patient Information. Acerus Pharmaceuticals. DailyMed, version published July 29, 2026. DailyMed setid dea6bed1-eaca-11e3-ac10-0800200c9a66
Natesto is used in the nose only, three times daily, preferably at the same times each day. Each dose is one full pump in each nostril; one pump delivers 5.5 mg of testosterone (sections 2.2, 3).
Before a dose, the nose is blown. After applying the gel to the outer side wall of each nostril, the nostrils are pressed and lightly massaged, and the label says not to blow the nose or sniff for 1 hour (section 2.2).
A new pump is primed before first use by pressing it 10 times into a sink. The dispenser is replaced when the piston reaches the arrow on the inside label (section 2.2).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Item | What the label says |
|---|---|
| Dose | 11 mg of testosterone (2 pump actuations; 1 actuation per nostril) |
| How often | Three times daily: morning, afternoon and evening, 6 to 8 hours apart |
| Total daily dose | 33 mg |
| First testosterone check | As soon as one month after starting, then periodically |
| Total testosterone consistently above 1050 ng/dL | Discontinue Natesto |
| Total testosterone consistently below 300 ng/dL | Consider an alternative treatment |
Before starting, hypogonadism is confirmed by morning serum testosterone measured on at least two separate days, with both results below the normal range.
Natesto is not recommended with nasal drugs other than sympathomimetic decongestants such as oxymetazoline.
During an episode of severe rhinitis, Natesto is paused until it resolves. If severe rhinitis persists, another testosterone treatment is recommended.
Hematocrit is checked before starting, 3 to 6 months after, and then yearly.
Prostate cancer is checked for before starting and 3 to 6 months after, then by usual screening; PSA, hematocrit and lipids are monitored periodically.
No studies were done in people with kidney or liver impairment (sections 8.6, 8.7).
The Natesto label gives no missed-dose instruction. It describes three doses a day, 6 to 8 hours apart; ask your prescriber or pharmacist what to do if a dose is missed.
More on this: missed a dose of Natesto.
In Dose Track you set up Natesto as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.