From the Guidelines
Testosterone cream for women undergoing hormone replacement therapy (HRT) should be started at a low dose of 0.5-2 mg daily, with the goal of using the lowest effective dose for the shortest possible time, as recommended by various expert groups 1.
Key Considerations
- The cream should be applied to clean, dry skin once daily, rotating application sites to prevent skin irritation, and allowing it to dry completely before dressing.
- Common formulations include AndroGel (1% or 1.62%), Testim (1%), or compounded testosterone creams (0.5-2%).
- Dosage adjustments are made based on symptom improvement and blood testosterone levels, which should be monitored every 3-6 months to maintain levels in the upper female physiologic range (typically 20-70 ng/dL) 1.
Benefits and Risks
- Testosterone supplementation in women aims to improve libido, energy, muscle mass, and cognitive function.
- Side effects may include acne, hair growth, voice deepening, and clitoral enlargement, which are usually dose-dependent and reversible with dosage reduction.
- The quality of evidence on the benefits and harms of HRT varies for different hormone regimens, and a cautious approach is recommended, avoiding routine use of HRT for preventing chronic disease in women 1.
Monitoring and Management
- It's essential to work with a healthcare provider experienced in women's hormone therapy, as testosterone for female HRT is often prescribed off-label in many countries and requires careful monitoring to balance benefits against potential side effects.
- Women should be informed about the risks and benefits of HRT, including the potential increased risk for venous thromboembolism, CHD, and stroke, as well as the potential increased risk for breast cancer with longer-term HRT 1.
From the Research
Testosterone Cream for Women in HRT
To administer testosterone cream for a woman as part of Hormone Replacement Therapy (HRT), consider the following points:
- The use of transdermal testosterone therapy has shown short-term efficacy in improving hypoactive sexual desire disorder in postmenopausal women, with few androgenic side effects 2.
- Testosterone cream should be dosed within premenopausal physiologic testosterone ranges, and can be used alone or with menopausal hormone therapy 2.
- Long-term data on cardiovascular, cancer, and cognitive safety of testosterone therapy in women is lacking, and no approved testosterone preparation is available for women 2.
- Compounded testosterone creams or reduced dosing of male-approved therapies represent off-label use, and injections or pellets are not recommended due to supraphysiological testosterone levels 2.
General HRT Considerations
When considering HRT for women, keep in mind:
- HRT can relieve symptoms of menopause and is well tolerated, with bioidentical hormone replacement therapy showing better symptom relief and fewer side effects compared to commercially available products 3.
- The benefits of HRT include reduction in cardiovascular disease, osteoporotic fractures, and overall mortality, particularly in symptomatic younger women (50-59 years) within 10 years since menopause 4.
- HRT may be considered for breast cancer survivors, with informed consent and shared-decision-making, as evidence does not conclusively render HRT as a contraindicated approach for these patients 5.
- Current recommendations for HRT use in menopausal women emphasize the benefits of HRT in improving menopausal symptoms, as well as its potential role in managing long-term sequelae 6.