Natesto, (testosterone) nasal gel

The following drug information is obtained from various newswires, published medical journal articles, and medical conference presentations.

Approval Status:

Approved May 2014

Specific Treatments:

deficiency or absence of endogenous testosterone

Therapeutic Areas

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General Information

Natesto is a nasal gel formulation of testosterone). Endogenous androgens, including testosterone and dihydrotestosterone (DHT), are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics.

Natesto is specifically indicated for replacement therapy in males for conditions associated with a deficiency or absence of endogenous testosterone: Primary hypogonadism (congenital or acquired) and Hypogonadotropic hypogonadism (congenital or acquired).

Natesto is supplied as a gel for intranasal administration. The recommended dose of Natesto is 11 mg of testosterone (2 pump actuations; 1 actuation per nostril) administered intranasally three times daily for a total daily dose of 33 mg. Natesto should be administered once in the morning, once in the afternoon and once in the evening (6 to 8 hours apart), preferably at the same time each day. Serum total testosterone concentrations should be checked periodically, starting as soon as one month after initiating treatment with Natesto. When the total testosterone concentration consistently exceeds 1050 ng/dL, therapy with Natesto should be discontinued.

Clinical Results

FDA ApprovalThe FDA approval of Natesto was based on in a 90-day, open-label, multicenter study of 306 hypogonadal men. Eligible patients were 18 years of age and older (mean age 54 years) and had morning serum total testosterone concentrations less than 300 ng/dL. Subjects were instructed to self-administer Natesto (11 mg of testosterone) intranasally either two or three times daily. The primary endpoint was the percentage of patients with an average serum total testosterone concentration (Cavg) within the normal range (300 to 1050 ng/dL) on Day 90. A total of 78 hypogonadal men received Natesto (11 mg of testosterone) three times daily (33 mg of testosterone daily). Of these, a total of 73 hypogonadal men were included in the statistical evaluation of efficacy (total testosterone pharmacokinetics) on Day 90 based on the intent-to­treat (ITT) population with last observation carried forward (LOCF). Ninety percent (90%) of these 73 patients had a Cavg within the normal range (300 to 1050 ng/dL) on Day 90. The percentages of patients with Cavg below the normal range (less than 300 ng/dL) and above the normal range (greater than 1050 ng/dL) on Day 90 were 10% and 0%, respectively.

Side Effects

Adverse effects associated with the use of Natesto may include, but are not limited to, the following:

  • PSA increased
  • headache
  • rhinorrhea
  • epistaxis
  • nasal discomfort
  • nasopharyngitis
  • bronchitis
  • upper respiratory tract infection
  • sinusitis
  • nasal scab

Mechanism of Action

Natesto is a nasal gel formulation of testosterone). Endogenous androgens, including testosterone and dihydrotestosterone (DHT), are responsible for the normal growth and development of the male sex organs and for maintenance of secondary sex characteristics. These effects include the growth and maturation of the prostate, seminal vesicles, penis, and scrotum; the development of male hair distribution, such as facial, pubic, chest, and axillary hair; laryngeal enlargement, vocal cord thickening, alterations in body musculature, and fat distribution. Testosterone and DHT are necessary for the normal development of secondary sex characteristics. Male hypogonadism, a clinical syndrome resulting from insufficient secretion of testosterone.

Additional Information

For additional information regarding Natesto or testosterone deficiency, please visit the Trimel Pharmaceuticals web page.