What is the appropriate testosterone (hormone replacement therapy) dosing for women with hypogonadism?

From the Guidelines

Testosterone dosing for women should be initiated at a low dose, typically ranging from 2-10 mg per day, with adjustments based on symptoms and blood levels, aiming for the upper female reference range of 30-70 ng/dL 1. When considering testosterone replacement therapy for women, it's crucial to select a formulation that balances efficacy with the risk of side effects and convenience of use.

• Topical applications, such as transdermal gels or patches, are often preferred due to their ease of use and flexibility in dosing, with typical doses ranging from 2-10 mg daily applied to the skin.
• Subcutaneous injections, like testosterone enanthate or cypionate, might be considered for women who require higher doses or have difficulty with topical formulations, starting at 10-20 mg weekly.
• The goal of treatment is to alleviate symptoms such as hypoactive sexual desire disorder, while monitoring for potential side effects like acne, hair growth, and voice changes. Key considerations in testosterone dosing for women include:
• Starting with low doses and titrating based on clinical response and testosterone levels.
• Regular monitoring of blood tests every 3-6 months to assess testosterone levels, lipids, and hematocrit.
• Individualizing treatment to address specific symptoms and conditions, such as surgical menopause or age-related hormone decline.
• Being aware of the potential risks and benefits associated with different formulations, including the risk of transference with topical gels and the convenience of extra-long-acting injections like testosterone undecanoate 1.

From the Research

Testosterone Dosing for Women

• The International Society for the Study of Women's Sexual Health recommends systemic transdermal testosterone for women with hypoactive sexual desire disorder (HSDD) not primarily related to modifiable factors or comorbidities 2.
• Government-approved transdermal male formulations can be used cautiously with dosing appropriate for women, and patients should be assessed for signs of androgen excess and total testosterone levels monitored to maintain concentrations in the physiologic premenopausal range 2.
• A review of testosterone therapy in women found that most clinical trials in postmenopausal women with loss of libido demonstrated that the addition of testosterone to estrogen significantly improved multiple facets of sexual functioning, including libido and sexual desire, arousal, frequency, and satisfaction 3.
• A systematic review and meta-analysis of randomized controlled trial data found that testosterone significantly increased sexual function, including satisfactory sexual event frequency, sexual desire, pleasure, arousal, orgasm, responsiveness, and self-image, and reduced sexual concerns and distress in postmenopausal women 4.
• The National Institute for Health and Care Excellence guideline on the diagnosis and management of menopause recommends considering testosterone supplementation for women with low sexual desire if hormone replacement therapy (HRT) alone has been ineffective 5.
• While there is evidence to support the use of testosterone therapy in women, it is essential to note that testosterone products are not licensed for use in women in many countries, including the UK 5.
• A study on transmen found that testosterone undecanoate and testosterone enanthate injections were both effective and safe over 5 years of administration, but the results may not be directly applicable to cisgender women 6.