Medical Editor: John P. Cunha, DO, FACOEP Last updated on RxList: 5/16/2022
Fortesta Side Effects Center

What Is Fortesta?

Fortesta (testosterone) gel is a male hormone (an androgen) indicated for replacement therapy in males for conditions associated with a deficiency or absence of endogenous testosterone, such as primary hypogonadism (congenital or acquired) or hypogonadotropic hypogonadism (congenital or acquired). Fortesta is available as a generic.

What Are Side Effects of Fortesta?

Side effects of Fortesta include:

  • skin reactions where the patch is worn (redness, itching, burning, or hardened skin),
  • increased acne or hair growth, headache,
  • depression,
  • changes in your sex drive,
  • urinary problems or accidents,
  • increased risk of prostate cancer,
  • lower sperm count,
  • swelling/enlarged/painful breasts,
  • blood clots in the legs, and
  • sleep apnea

Tell your doctor if you have serious side effects of Fortesta including burn-like blistering of the skin where the transdermal patch is worn; skin irritation with patch-wearing that does not get better with time; swelling of your ankles; frequent, prolonged, or bothersome erections; or nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Dosage for Fortesta

Fortesta is available in a gel at a concentration of 10 mg testosterone per pump. The starting dose of Fortesta is 40 mg (4 pumps) applied topically once daily in the morning. Fortesta can be dose adjusted between a minimum of 10 mg of testosterone (1 pump) and a maximum of 70 mg of testosterone (7 pumps) on the basis of total serum testosterone concentrations 2 hours post Fortesta application.

Fortesta During Pregnancy and Breastfeeding

In pregnant or breastfeeding women, Fortesta may cause fetal harm. Fortesta may cause serious adverse reactions in nursing infants. Pregnant women or those who may become pregnant need to be aware of the potential for transfer of testosterone from men treated with Fortesta. If a pregnant woman is exposed to Fortesta, she should be apprised of the potential hazard to the fetus. Fortesta may cause adverse reactions if accidently contacted by women or children; it can even be transferred to others topically by clothing. The safety and effectiveness of this drug in the pediatric population has not been studied; children and women should avoid topical contact on skin or clothing.

Additional Information

Our Fortesta Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


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Fortesta Consumer Information

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using testosterone topical and call your doctor at once if you have:

  • increased urination (many times per day), loss of bladder control;
  • painful or difficult urination;
  • breast pain or swelling;
  • painful or bothersome erections;
  • swelling, rapid weight gain, shortness of breath during sleep;
  • chest pain or pressure, pain spreading to your jaw or shoulder;
  • liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
  • signs of a blood clot in the lung--chest pain, sudden cough, wheezing, rapid breathing, coughing up blood; or
  • signs of a blood clot deep in the body--swelling, warmth, or redness in an arm or leg.

Topical testosterone is absorbed through the skin and can cause side effects or symptoms of male features in a child or woman who comes into contact with this medicine. Call your doctor if a person who has close contact with you develops enlarged genitals, premature pubic hair, increased libido, aggressive behavior, male-pattern baldness, excessive body hair growth, increased acne, irregular menstrual periods, or any signs of male characteristics.

Common side effects may include:

  • redness, itching, burning, hardened skin or other irritation where the medicine was applied or where the skin patch was worn;
  • increased red blood cells (may cause dizziness, itching, redness in your face, or muscle pain);
  • increased prostate-specific antigen;
  • increased blood pressure;
  • headache;
  • mood changes, strange dreams;
  • frequent or prolonged erections;
  • nausea, vomiting; or
  • swelling in your lower legs.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Fortesta (Testosterone Gel)


Erectile Dysfunction (ED) Causes and Treatment See Slideshow
Fortesta Professional Information


Clinical Trial Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

In a controlled multicenter, open-label, non-comparative 90-day clinical study, 149 hypogonadal patients were treated with FORTESTA [see Clinical Studies]. Adverse reactions occurred in 22.8% (34/149) of patients. The most common adverse reaction reported in this study was skin reactions associated with the site of application (16.1%; 24/149) of which 79% (19/24) were mild and the remainder were moderate (21%; 5/24) (Table 3).

Table 3: Adverse Reactions Reported in >1% of Patients in the US Phase 3 Clinical Trial of FORTESTA

Adverse ReactionNumber (%) of Patients
N = 149
Skin reaction24 (16.1%)
Prostatic specific antigen increased2 (1.3%)
Abnormal dreams2 (1.3%)

During the 90-day trial 5 patients (3.4%) discontinued treatment because of adverse reactions. These reactions were: 1 patient with contact dermatitis (considered probably related to FORTESTA application), 1 with application site reaction (considered probably related to FORTESTA application), 1 with gastrointestinal hypomotility (considered possibly related to FORTESTA application), 1 with severe dyspnea (considered not related to FORTESTA application), and 1 with moderate contusion (considered not related to FORTESTA application).

Postmarketing Experience

The following adverse reactions have been identified during post approval use of FORTESTA. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure (Table 4).

Table 4: Adverse Drug Reactions from Post Approval Experience of FORTESTA by System Organ

System Organ ClassAdverse Reaction
Blood and lymphatic system disordersPolycythemia
Eye disordersVitreous detachment
Gastrointestinal disordersAbdominal symptoms
General disorders and administrative site conditionsApplication site erythema, irritation, pruritus, and swelling; fatigue, influenza like illness, and malaise
InvestigationsDecreased serum testosterone, increased hematocrit and hemoglobin
Musculoskeletal and connective tissue disordersPain in extremity
Nervous system disordersDizziness, headache, and migraine
Reproductive system and breast disordersErectile dysfunction and priapism
Skin and subcutaneous tissue disordersAllergic dermatitis, erythema, rash, and papular rash
Vascular disordersVenous thromboembolism
Cardiovascular disordersMyocardial infarction and stroke

Secondary Exposure To Testosterone In Children

Cases of secondary exposure to testosterone resulting in virilization of children have been reported in postmarketing surveillance of testosterone gel products. Signs and symptoms of these reported cases have included enlargement of the clitoris (with surgical intervention) or the penis, development of pubic hair, increased erections and libido, aggressive behavior, and advanced bone age. In most cases with a reported outcome, these signs and symptoms were reported to have regressed with removal of the testosterone gel exposure. In a few cases, however, enlarged genitalia did not fully return to age appropriate normal size, and bone age remained modestly greater than chronological age. In some of the cases, direct contact with the sites of application on the skin of men using testosterone gel was reported. In at least 1 reported case, the reporter considered the possibility of secondary exposure from items such as the testosterone gel user's shirts and/or other fabric, such as towels and sheets [see WARNINGS AND PRECAUTIONS].

Read the entire FDA prescribing information for Fortesta (Testosterone Gel)

© Fortesta Patient Information is supplied by Cerner Multum, Inc. and Fortesta Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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