A Look At Intranasal Testosterone (Natesto)

Natesto: What It Is

Natesto is an intranasal testosterone product approved for treating men with confirmed low testosterone. Instead of injections or skin gels, you apply a metered dose inside each nostril three times per day. That schedule raises testosterone into the normal range for many men and then lets it fall predictably between doses. The short action is the main difference from long-acting injections.

How It’s Used (and how often)

The usual dose is one pump per nostril, three times daily—morning, mid-day, and evening, roughly 6–8 hours apart. Each application delivers 11 mg total (5.5 mg per nostril) for 33 mg per day. Hands are washed before and after; the applicator tip goes just inside the nostril, angled slightly out, and the gel is gently spread across the inside wall. If you use a nasal decongestant or have a cold, timing may need to be adjusted. Y

Pros

• Short-acting and flexible. Because levels rise and fall each day, adjustments are quick. If you have a side effect, stopping leads to a faster washout than with long-acting injections. Adherence can be checked against symptom patterns and blood tests drawn at consistent times.

• No needles and no skin transfer. There’s no risk of unintentionally transferring gel to a partner or child or pets, and no injection site issues.

• Fertility-friendly profile (relative to injections). Short-acting intranasal dosing raises testosterone while showing smaller average drops in LH and FSH than long-acting injectable regimens in several studies. That hormonal pattern aligns with better preservation of semen parameters for many men who want to maintain fertility. However with any testosterone product, there will always be a fertility risk. Natesto just provides a lower risk.

Cons

• Three-times-daily schedule. You need consistency across the day. Missed doses can mean symptom swings and other issues. Natesto use means strict compliance with the dosing regime.

•Nasal side effects. Congestion, drip, irritation, or nosebleeds can occur, especially during colds or allergy seasons. Men with chronic nasal issues may prefer another route.

• Cost and coverage. Depending on your plan, intranasal therapy may be more expensive than generics for injectables.

• Not a fit for everyone. Men with normal testosterone levels are not candidates, and standard TRT cautions still apply (you and your clinician will review risks, monitoring, and alternatives).

Fertility: Natesto versus Injectable TRT

Long-acting injectable regimens suppress the pituitary hormones (LH/FSH) that drive testicular testosterone and sperm production; fertility can fall during therapy and take time to recover afterward. Recovery is not predictable either.

Intranasal testosterone behaves differently. Because dosing is short-acting and given multiple times per day, studies report smaller reductions in LH/FSH and a higher chance of maintaining semen parameters in men who start with normal counts. That doesn’t make Natesto a guarantee of fertility by any means; but it’s a practical option for men who need symptomatic treatment and want to protect reproductive potential.

Who Might Consider Natesto

Men with confirmed low testosterone (symptoms plus low morning levels on two separate days) who want to avoid injections or skin transfer risk; men who value faster on/off control; and men who wish to preserve fertility while treating symptomatic hypogonadism. Men with significant chronic nasal disease or who cannot reliably dose three times daily may be better served by another route.

Monitoring and Follow-Up

Monitoring with Natesto looks like any responsible TRT program, with a few timing nuances.

Bottom Line

Natesto provides an alternative to injections and skin gels: short-acting, needle-free, and designed to raise testosterone while placing a lighter brake on LH/FSH in many men. The trade-offs are the three-times-daily routine and potential nasal side effects. For men who want a fertility-conscious approach—or who simply prefer quick on/off control—intranasal testosterone is a reasonable, evidence-based option when hypogonadism is properly diagnosed and monitoring is in place. Work with a clinician to confirm eligibility, choose a route that fits your day, and set a follow-up plan that keeps therapy safe and predictable.

At True North Metabolic men's health clinic, we use Natesto when appropriate for our patients.

Serving patients across Kitchener, Waterloo, Cambridge, Guelph, and surrounding communities including the Toronto/GTA corridor and London, Ontario.

References

1. Natesto (testosterone) Nasal Gel—Full Prescribing Information. natesto.com

2. Ramasamy R, et al. Effect of Natesto on reproductive hormones and semen parameters. AUA Journals, 2020. AUA Journals

3. Westfield G, et al. Short-acting testosterone: more physiologic? Endocr Pract/Review, 2020. PMC

4. Diaz P, et al. Randomized data comparing intranasal vs long-acting testosterone on endogenous hormones. World J Men’s Health, 2023. WJMH

5. Rogol AD, et al. Phase 1 PK and Phase 3 efficacy of testosterone nasal gel. Andrology, 2018.