From the Research
For a 46-year-old perimenopausal woman, the lowest effective starting dose of testosterone is typically 2-4 mg per week via subcutaneous injection, as this approach allows for monitoring of effects while minimizing potential side effects. This dose is based on the goal of achieving target testosterone levels of 30-50 ng/dL, which is significantly lower than male ranges, as established by studies such as 1. The medication used is usually testosterone cypionate or enanthate at a concentration of 100-200 mg/mL. Injections are typically administered once weekly, though some protocols divide this into twice-weekly doses for more stable hormone levels.
Before starting testosterone, comprehensive bloodwork including baseline testosterone levels, complete blood count, liver function tests, and lipid panel should be obtained. Regular monitoring every 3-6 months is essential to check for side effects and adjust dosing as needed. Testosterone therapy in women aims to address symptoms like decreased libido, fatigue, and mood changes, but must be carefully balanced to avoid masculinizing effects like increased facial hair, voice deepening, or clitoral enlargement, which can occur at higher doses. It's also important to consider the potential effects of testosterone on liver health, as studies such as 2 and 3 have shown associations between testosterone levels and liver disease, although these studies were conducted in different populations and contexts.
Key considerations for testosterone therapy in perimenopausal women include:
- Starting with a low dose and gradually increasing as needed
- Monitoring for side effects and adjusting dosing accordingly
- Targeting testosterone levels of 30-50 ng/dL
- Considering the potential effects of testosterone on liver health and other metabolic parameters
- Regular monitoring of bloodwork and liver function tests to ensure safe and effective treatment, as supported by studies such as 3, which demonstrated improvements in liver parameters and steatosis in hypogonadal men receiving long-term testosterone therapy.