Short answer: Natesto is testosterone gel pumped into the nose three times a day, 11 mg per dose.1 Testim is a gel rubbed on the shoulders and upper arms once each morning, 50 mg or 100 mg.2 Testim carries a boxed warning about testosterone passing to children through skin contact; Natesto has no boxed warning. Natesto is not recommended with a history of nasal problems. Neither label compares the two.
| Natesto | Testim | |
|---|---|---|
| How used | One pump in each nostril, three times daily, 6 to 8 hours apart1 | One or two tubes on the shoulders and upper arms once daily, preferably in the morning2 |
| Daily dose | 33 mg (11 mg three times)1 | 50 mg to start; may go to 100 mg2 |
| Level checks | From one month in; stop if consistently above 1050 ng/dL1 | Morning, before the dose, about 14 days in; raise to 100 mg if below 300 ng/dL2 |
| Common side effects | PSA increased 5.1%; runny nose, nosebleed and nasal discomfort 3.8% each1 | Application site reactions 2% on 50 mg and 4% on 100 mg vs 3% on placebo2 |
| Label notes | Not recommended with nasal disorders, nasal or sinus surgery, a recent nasal fracture or sinus disease1 | Dose and site not interchangeable with other skin testosterone products2 |
| Missed dose | No rule in the label1 | No rule in the label2 |
| Boxed warning | None1 | WARNING: SECONDARY EXPOSURE TO TESTOSTERONE2 |
Testim's boxed warning is about children: male-type changes have been reported in children exposed to testosterone gel through someone else. After a 100 mg dose and skin-to-skin rubbing, women's testosterone rose about 4 times; a T-shirt over the site prevented it.2 Natesto's own warnings are nasal: runny nose, nosebleeds and scabs, limited long-term nasal safety data, and a pause during severe rhinitis.1
The rest is the shared testosterone set: high red blood cells, blood clots, prostate checks, higher blood pressure, abuse, lower sperm counts and sleep apnea.12 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Natesto side effects, Testim side effects, the Natesto and Testim dosing schedules, the Natesto missed-dose page, the nasal testosterone and testosterone gel guides, and Natesto vs AndroGel: how do nasal and skin testosterone gel compare?.