From the Guidelines
Testosterone cypionate at 100mg monthly is not a suitable dose for female patients due to the high risk of adverse effects, and a much lower dose, typically ranging from 2-10mg per week or 10-40mg monthly, is recommended. For women requiring testosterone therapy, the appropriate dose depends on the specific indication, such as hypoactive sexual desire disorder, transgender hormone therapy, or treatment of certain hormonal deficiencies 1. Starting doses should be even lower, with gradual titration based on clinical response and serum testosterone levels. Using 100mg monthly would likely cause significant masculinizing side effects including deepening voice, increased facial/body hair, clitoral enlargement, acne, and mood changes, as reported in studies on masculinizing hormone therapy 1. These effects may become permanent even after discontinuation.
Some of the key considerations for testosterone therapy in female patients include:
- The risk of polycythaemia, reduced high density lipoprotein cholesterol (HDL-c), androgenic alopecia, acne, gynaecological effects, and potentially increased risk of myocardial infarction 1
- The importance of regular monitoring of testosterone levels, targeting the upper range of normal female values
- The need for treatment to be supervised by a healthcare provider experienced in hormone therapy who can adjust dosing based on individual response and minimize adverse effects
- The potential for significant side effects, including virilization, hirsutism, hoarseness or deepening of the voice, weight gain, menstrual irregularities, and breast hypotrophy, as reported in studies on anabolic-androgenic steroids 1
If testosterone therapy is indicated for a female patient, it should be initiated at a lower dose, with careful consideration of the potential risks and benefits, and regular monitoring to minimize adverse effects. The most recent and highest quality study on masculinizing hormone therapy 1 provides guidance on the use of testosterone therapy in female patients, and should be consulted when making treatment decisions.
From the FDA Drug Label
Pregnancy: Teratogenic Effects. Pregnancy Category X. (See CONTRAINDICATIONS.) Nursing mothers: Testosterone cypionate is not recommended for use in nursing mothers.
The use of testosterone cypionate 100mg monthly in females is contraindicated due to the potential for teratogenic effects and the lack of established safety and effectiveness in this population 2. Females of childbearing potential should not receive testosterone cypionate, and nursing mothers should not use this medication.
- Key points:
- Teratogenic effects
- Contraindicated in pregnancy
- Not recommended for nursing mothers
- Lack of established safety and effectiveness in females 2
From the Research
Testosterone Cypionate in Females
- There is limited research on the use of testosterone cypionate 100mg monthly in females, as most studies focus on male hypogonadism treatment 3, 4, 5.
- However, a study on transgender and gender-diverse adults on gender-affirming hormone therapy found that testosterone use was associated with an increase in triglycerides and a decrease in HDL-cholesterol in transmasculine individuals 6.
- Another study reviewed the relationship between endogenous testosterone and lipids, as well as testosterone replacement therapy and lipids, and found that exogenous testosterone administration was associated with decreased high-density lipoprotein coupled with beneficial decreases in low-density lipoprotein and total cholesterol 7.
- The effects of testosterone cypionate on females are not well-studied, and more research is needed to determine its safety and efficacy in this population.
- It is essential to monitor lipid profiles and other health markers in individuals using testosterone cypionate, especially in those with a history of cardiovascular disease or other health conditions 6, 7.