Short answer: Natesto is testosterone gel pumped into the nose: 11 mg (one pump per nostril) three times a day, 6 to 8 hours apart.1 AndroGel 1.62% is rubbed onto the shoulders and upper arms once each morning, starting at 40.5 mg.2 AndroGel carries a boxed warning about transfer to children through skin contact; Natesto does not, but it can cause nasal side effects.
| Natesto (nasal gel) | AndroGel 1.62% (skin gel) | |
|---|---|---|
| Where it goes | Inside the nose, one pump per nostril1 | Shoulders and upper arms only, within a short-sleeve T-shirt area2 |
| Label dose | 11 mg three times daily (33 mg a day), 6 to 8 hours apart1 | 40.5 mg once daily in the morning; adjusted between 20.25 and 81 mg2 |
| Per pump | 5.5 mg1 | 20.25 mg2 |
| How levels behave | Peak about 40 minutes after a dose1 | Continuous delivery over 24 hours; back to about baseline 48 to 72 hours after stopping2 |
| Dose checks | From about 1 month; stop if consistently above 1,050 ng/dL, consider another option if below 3001 | Morning pre-dose level at about 14 and 28 days, then periodically2 |
| In the label trial | 90% of 73 men had average testosterone of 300 to 1,050 ng/dL at day 901 | 81.6% of 179 men had average testosterone of 300 to 1,000 ng/dL at day 1122 |
| Boxed warning | None | Secondary exposure: virilization in children after contact2 |
| Notable precautions | Not recommended with nasal disorders, nasal or sinus surgery, recent nasal fracture or sinus disease; pause during severe rhinitis1 | No swimming or showering for 2 hours after applying; cover the site with clothing2 |
| Common side effects | PSA increase, headache, runny nose, nosebleed, nasal discomfort1 | PSA increase (11.1% in the double-blind period)2 |
AndroGel's boxed warning describes virilization in children who touched unwashed or uncovered application sites.2 Natesto is applied inside the nose and has no such boxed warning. Its label does advise washing your hands if gel gets on them while priming the pump.1
Each label reports its own single-arm trial with a slightly different normal range and length: 90% of Natesto users were in range at day 90, and 81.6% of AndroGel 1.62% users at day 112.12 These were not head-to-head trials.
Natesto's peak comes about 40 minutes after each dose, which is why it is taken three times a day.1 AndroGel absorbs through the skin over the full day.2
More detail: Natesto side effects, AndroGel side effects, and the Natesto and AndroGel dosing schedules.
That is for you and your prescriber. Three daily doses vs one, nasal history, and who you share close contact with are the practical differences on the labels. For gels vs injections, see Testosterone cypionate injection vs testosterone gel: what is different?.