Natesto is a nasal testosterone product used to treat men with low testosterone levels (hypogonadism). It may also be used off-label in gender-affirming hormone therapy for transgender men and some nonbinary individuals, as well as in select cases for women. Unlike gels or injectable products, Natesto is administered inside the nose, where testosterone is absorbed through the nasal lining into the bloodstream. Natesto is currently the only commercially available nasal testosterone therapy in the world.
In Canada, Natesto is supplied as a metered-dose nasal gel and is typically administered two or three times daily. Its short-acting profile differs from once-daily gels or longer-acting injections, which may affect convenience and adherence.
Because it is applied inside the nose, Natesto avoids the risk of unintentional transfer associated with topical testosterone. However, its dosing frequency and method of use may be less convenient for some patients.
Like other testosterone products, Natesto is used on an ongoing basis. If shortages occur, switching to another product may be necessary. Because it is the only nasal testosterone product available in Canada, shortages usually require switching to a different type of testosterone, such as topical gels and injections. Monitoring is usually needed when transitioning between products.
Public Coverage
Natesto is generally not included in provincial and territorial public drug benefit plans in Canada. As a result, access is often limited to private payment or private insurance coverage where available.
Clinical Evidence for Natesto
Gronski MA, Grober ED, Gottesman IS, Ormsby RW, Bryson N. Efficacy of Nasal Testosterone Gel (Natesto®) Stratified by Baseline Endogenous Testosterone Levels. J Endocr Soc. 2019 Jun 26;3(9):1652-1662.
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