Micronized Progesterone and Testosterone Dosing
For micronized progesterone in menopausal hormone therapy, use 100 mg daily for continuous regimens or 200 mg daily for 10-14 days per month for sequential regimens 1. For testosterone replacement in hypogonadal men, use 75-100 mg testosterone enanthate or cypionate intramuscularly weekly, or 150-200 mg every 2 weeks 2.
Micronized Progesterone Dosing
For Endometrial Protection in Menopausal Women
The evidence from multiple guidelines consistently supports specific dosing regimens:
Sequential (Cyclic) Regimens:
- 200 mg daily for 10-14 days per month when combined with continuous estrogen 1
- This provides adequate endometrial protection for up to 5 years 3
- Administered orally at bedtime to minimize drowsiness 4
Continuous Combined Regimens:
- 100 mg daily when given continuously (25 days per month or daily) 1
- This dose efficiently protects the endometrium by fully inhibiting mitoses 5
- Induces amenorrhea in over 90% of women, improving compliance 5
Alternative Routes:
- Vaginal administration: 200 mg daily for 12-14 days per month provides endometrial protection 4
- Vaginal route may have fewer systemic side effects while maintaining endometrial safety 1
Important Caveats
The choice between sequential and continuous regimens depends on whether withdrawal bleeding is desired. Sequential regimens induce monthly bleeding, while continuous regimens typically result in amenorrhea after 3-6 months 5. Micronized progesterone is preferred over synthetic progestins due to better cardiovascular and breast cancer safety profiles 4, 6, 7.
Testosterone Dosing
For Male Hypogonadism
The Endocrine Society guidelines 2 provide clear dosing recommendations:
Intramuscular Injections (Preferred for stable levels):
- 75-100 mg testosterone enanthate or cypionate weekly, OR
- 150-200 mg every 2 weeks
- Smaller, more frequent doses maintain testosterone levels in the normal range better than traditional 200-300 mg every 2-3 weeks 8
- Measure testosterone levels midway between injections; adjust if levels are >700 ng/dL or <350 ng/dL 2
Alternative Formulations:
- Transdermal patches: 5-10 mg daily (one or two 5-mg patches) 2
- Testosterone gel: 5-10 g daily (50-100 mg) applied to non-genital skin 2
- Buccal tablets: 30 mg every 12 hours 2
Monitoring Requirements
Critical monitoring parameters 2:
- Assess at 3 months, then annually for symptom response and adverse effects
- Check testosterone levels at 3 months after initiation
- Monitor hematocrit at baseline, 3 months, then annually
- Stop therapy if hematocrit exceeds 54% until it decreases to safe levels
- Perform digital rectal exam and PSA before treatment, at 3 months, then per guidelines
For Women with HSDD
The global consensus statement 9 emphasizes that testosterone therapy in women should:
- Maintain testosterone concentrations in the physiologic premenopausal range
- Avoid supraphysiologic concentrations (pellets and injections are not recommended)
- Monitor total testosterone at baseline, 3-6 weeks after initiation, then every 6 months
- Discontinue if no benefit after 6 months
Key Clinical Pitfalls
Do not use transdermal micronized progesterone for endometrial protection - it does not provide adequate protection 3
Avoid traditional high-dose, infrequent testosterone injections (200-300 mg every 2-3 weeks) as they cause supraphysiologic peaks and subtherapeutic troughs 8, 2, 8
Micronized progesterone doses below 100 mg daily (continuous) or 200 mg daily (sequential) may not provide adequate endometrial protection 1, 3
Compounded "bioidentical" testosterone cannot be recommended due to lack of standardization and safety data 9
For testosterone therapy, hematocrit >54% is an absolute indication to stop treatment temporarily 2