The My-T study: Patient satisfaction and preference comparing topical and nasal testosterone therapies

  • Jay Lee Department of Surgery, Division of Urology, University of Calgary, Calgary, AB.
  • Gerald Brock Department of Surgery, Division of Urology, St. Joseph's Health Care, London, ON
  • Jack Barkin Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, ON
  • Nathan Bryson Acerus Pharmaceuticals Corporation
  • Matthew A. Gronski Acerus Pharmaceuticals Corporation
  • Ross Ormsby Acerus Pharmaceuticals Corporation
Keywords: Hypogonadisim, testosterone, testosterone nasal gel, titration, symptoms, patient preference, patient satisfaction, convenience


Introduction: Natesto®, testosterone nasal gel (TNG) is an intranasal testosterone therapy (TTh) used to restore testosterone levels and improve symptoms of hypogonadism. Treatment requires application two (bid) or three (tid) times daily. The Treatment Satisfaction Questionnaire for Medication (TSQM) and a Patient Preference and Use (PPU) questionnaire were used to obtain patient feedback on the use of TNG and compare it to experience with topical TTh.

Methods: The study enrolled 24 TTh-naive (TThN) and 93 TThexperienced (TThE) hypogonadal men. Treatment lasted up to 120 days, with titration at day 90 to determine the most appropriate dose for restoration of testosterone levels (11 mg bid or tid). Patient satisfaction and symptom changes were measured at days 0, 30, 60, 90, and 120. The PPU questionnaire was performed at study entry and study completion.

Results: Symptoms improved from baseline (30.6) to day 90 (35.1) (p<0.0001; +15%), consistent with testosterone replacement. TNG increased scores for effectiveness (+20%), convenience (+30%), and global satisfaction (+3%) as compared to their previous topical TTh. TThE patients reported ease of use, convenience, efficacy/ effectiveness, and travel friendliness as “likes” of TNG therapy. Overall, 67.2% of patients agreed or strongly agreed that they preferred TNG over topical TTh and 59% sought a prescription to continue treatment with TNG.

Conclusions: Patients switching from topical TTh to TNG reported significant improvements in symptoms and patient satisfaction compared to their previous topical TTh. Patients also reported a significant improvement in convenience with TNG despite two to three times daily application. Preference, satisfaction, and convenience may translate to better treatment compliance.


Men’s Health Review Panel. Men’s Health Guidelines for Family Medicine. 1st ed. MUMS Guideline Clearinghouse; 2017.

Wang C, Cunningham G, Dobs A, et al. Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab 2004 May;89(5):2085-98.

Dean JD, Carnegie C, Rodzvilla J, et al. Long-term effects of testim(r) 1% testosterone gel in hypogonadal men. Rev Urol 2005 Spring;7(2):87-94.

Pastuszak A, Gomez L, Scovell J, et al. Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate-Specific Antigen. Sex Med 2015 Sep;3(3):165-73.

Zhang GY, Gu YQ, Wang XH, et al. A pharmacokinetic study of injectable testosterone undecanoate in hypogonadal men. J Androl 1998 Nov-Dec;19(6):761-8.

Hajjar RR, Kaiser FE, Morley JE. Outcomes of long-term testosterone replacement in older hypogonadal males: a retrospective analysis. J Clin Endocrinol Metab 1997 Nov;82(11):3793-6.

Malkin CJ, Pugh PJ, West JN, et al. Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial. Eur Heart J 2006 Jan;27(1):57-64.

Kühnert B, Byrne M, Simoni M, et al. Testosterone substitution with a new transdermal, hydroalcoholic gel applied to scrotal or non-scrotal skin: a multicentre trial. Eur J Endocrinol. 2005 Aug;153(2):317-26.

NATESTO® (Testosterone Nasal Gel 4.5%) Product Monograph, Acerus Biopharma Inc. November 27, 2017.

Ohdo S. Chronopharmacology focused on biological clock. Drug Metab Pharmacokin 2007; 22(1):3-14.

Kriegsfeld LJ, Silver R. The regulation of neuroendocrine function: timing is everything. Horm Behav 2006;49(5):557-74.

Lincoln GA, Andersson H, Loudon A. Clock genes in calendar cells as the basis of annual timekeeping in mammals- a unifying hypothesis. J Endocrinol 2003;179(1):1-13.

Rogol AD, Tkachenko N and Bryson N. Natesto®, a novel testosterone nasal gel, normalizes androgen levels in hypogonadal men. Andrology 2016 Jan;4(1):46-54.

Ramasamy, R. Effects of NATESTO® on Reproductive Hormones and Semen Parameters: A Prospective Clinical Trial. Paper presented at: American Society for Reproductive Medicine (ASRM); Oct 2018; Denver, CO, USA.

Mohamed O, Freundlich RE, Dakik HK, et al. The quantitative ADAM questionnaire: a new tool in quantifying the severity of hypogonadism. International Journal of Impotence Research 2010;22(1):20-4.

Bharmal M, Payne K, Atkinson MJ, et al. Validation of an abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9) among patients on antihypertensive medications. HRQOL 2009 27;7:36.

Kovac JR, Rajanahally S, Smith RP, et al. Patient satisfaction with testosterone replacement therapies: the reasons behind the choices. J Sex Med 2014 Feb;11(2):553-62.

Baillargeon J, Urban RJ, Ottenbacher KJ, et al. Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Intern Med 2013;173:1465–6.

Snyder CF, Aaronson NK, Choucair AK, et al. Implementing patient-reported outcomes assessment in clinical practice: a review of the options and considerations. Qual Life Res 2012; 21:1305-14.

Selby JV, Beal AC, Frank L. The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda. JAMA 2012;307:1583-84.

Valderas JM, Kotzeva A, Espallargues M, et al. The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res 2008; 17:179-93.

Gelhorn HL, Bodhani AR, Wahala LS, et al. Development of the Hypogonadism Impact of Symptoms Questionnaire Short Form: Qualitative Research. J Sex Med 2016 Nov;13(11):1729-36.

Cobden DS, Niessen LW, Barr CE, Rutten FF, Redekop WK (2010) Relationships among self-management, patient perceptions of care, and health economic outcomes for decision-making and clinical practice in type 2 diabetes. Value Health 13: 138–47.

Pollack MF, Purayidathil FW, Bolge SC, Williams SA (2010) Patient-reported tolerability issues with oral antidiabetic agents: Associations with adherence; treatment satisfaction and health-related quality of life. Diabetes Res Clin Pract 87: 204–10.

Biderman A, Noff E, Harris SB, Friedman N, Levy A (2009) Treatment satisfaction of diabetic patients: what are the contributing factors? Fam Pract 26:102–8.

ANDROGEL (testosterone gel) Product Monograph. BGP Pharma ULC. Canada. January 8, 2016.

TESTIM (testosterone gel) Product Monograph. Paladin Labs, Inc. Canada. February 3, 2017.

How to Cite
Lee, J., Brock, G., Barkin, J., Bryson, N., Gronski, M. A., & Ormsby, R. (2019). The My-T study: Patient satisfaction and preference comparing topical and nasal testosterone therapies. Canadian Urological Association Journal, 13(12), 384-9.
Original Research