What is the recommended dose of testosterone for postmenopausal women?

From the Guidelines

The recommended dose of testosterone for postmenopausal women is typically in the range of 0.5 to 1.5 mg per day, delivered through a transdermal preparation such as a cream or gel, with treatment starting at the lowest effective dose and adjusted based on symptom response and serum testosterone levels 1.

Key Considerations

• Treatment should be considered for postmenopausal women experiencing hypoactive sexual desire disorder (HSDD) that causes personal distress, particularly after estrogen therapy has been optimized.
• Baseline testosterone levels should be measured, and regular monitoring should occur at 3-6 month intervals to ensure levels remain within the normal female physiologic range (typically below 70 ng/dL).
• Side effects to watch for include acne, hirsutism, voice deepening, and potential lipid changes.
• Testosterone therapy works by improving sexual desire and arousal through direct effects on brain receptors and by increasing genital blood flow and sensitivity.

Important Notes

• Testosterone products for women are not FDA-approved in the United States, so treatment typically involves compounded formulations or off-label use of products designed for men at significantly reduced doses.
• The use of hormone therapy should be based on the intersection of a woman's clinical situation, preferences, and values to maximize benefits over harms 1.
• Other effective interventions for treating women with low bone density include weight-bearing exercise, bisphosphonates, and calcitonin 1.

From the Research

Postmenopausal Testosterone Dosage

The recommended dose of testosterone for postmenopausal women is not explicitly stated in the provided studies. However, the following points can be considered:

• Testosterone therapy should be administered at the lowest dose for the shortest time that meets treatment goals 2.
• Transdermal patches and topical gels or creams are preferred over oral products because of first-pass hepatic effects documented with oral formulations 2.
• Custom-compounded products should be used with caution because the dosing may be more inconsistent than it is with government-approved products 2.
• Testosterone products formulated specifically for men have a risk of excessive dosing, although some clinicians use lower doses of these products in women 2.

Key Considerations

When evaluating a woman for testosterone therapy, the following considerations should be taken into account:

• Rule out causes not related to testosterone levels (e.g., physical and psychosocial factors, medications) 2.
• Ensure that there is a physiologic cause for reduced testosterone levels (e.g., bilateral oophorectomy) 2.
• Laboratory testing of testosterone levels should be used only to monitor for supraphysiologic levels before and during therapy, not to diagnose testosterone insufficiency 2.
• Monitoring should also include subjective assessments of sexual response, desire, and satisfaction as well as evaluation for potential adverse effects 2.

Safety and Efficacy

The safety and efficacy of testosterone therapy in postmenopausal women have been studied in several trials:

• Testosterone therapy has been shown to improve sexual function, including desire, arousal, and orgasmic response, in postmenopausal women 2, 3, 4.
• The use of testosterone therapy is associated with a significantly greater likelihood of reporting acne and hair growth, but no serious adverse events have been recorded 4.
• The effects of testosterone on individual wellbeing and musculoskeletal and cognitive health, as well as long-term safety, warrant further investigation 4.