What is the recommended dosage and administration of testosterone gel (transdermal testosterone) for individuals undergoing gender transition?

Testosterone Gel Dosage for Gender Transition

For individuals undergoing gender transition, the recommended starting dose of testosterone gel is 50 mg daily (5g of 1% gel), with adjustments based on serum testosterone levels targeting the middle tertile of the normal male reference range (450-600 ng/dL). 1

Dosage and Administration Guidelines

Initial Dosing

• Start with 50 mg daily (5g of 1% gel) applied to the skin of the upper arms, shoulders, or abdomen 1
• Apply once daily, preferably in the morning, to clean, dry skin
• Allow gel to dry completely (approximately 5 minutes) before covering with clothing 2

Dose Adjustments

• Check testosterone levels after 2-3 months of therapy 1
• Target testosterone levels in the middle tertile of the normal male reference range (450-600 ng/dL) 1
• Adjust dosage as needed:
  • If levels are below target: increase to 75-100 mg daily
  • If levels are above target: decrease to 25-40 mg daily

Application Sites

• Most effective application sites (in order of effectiveness) 3:
  1. Arms/shoulders (highest absorption)
  2. Chest/abdomen (moderate absorption)
  3. Thighs (lower absorption)
• Rotate application sites to prevent skin irritation
• Avoid washing the application site for at least 2 hours after application

Expected Effects and Timeline

Physical Changes

• Early changes (1-6 months):
  • Increased libido
  • Cessation of menses
  • Increased muscle mass and decreased fat mass
  • Clitoral growth
  • Voice deepening begins
  • Increased body hair growth 1

Long-term changes (6+ months):

• Continued voice deepening
• Continued body and facial hair growth
• Further muscle development
• Body fat redistribution 1

Monitoring Parameters

Regular Monitoring

• Testosterone levels: Every 3 months initially, then every 6-12 months once stable 1
• Hemoglobin/hematocrit: Every 3-6 months (risk of polycythemia) 1
• Lipid profile: Annually (may see reduced HDL cholesterol) 1
• Liver function tests: Not routinely required with gel formulations 1

Safety Considerations

• Monitor for polycythemia (increased risk with testosterone therapy) 1
• Watch for acne, androgenic alopecia, and mood changes
• Consider cardiovascular risk factors, especially in those with pre-existing conditions 1

Important Precautions

Skin Transfer Prevention

• Wash hands thoroughly after application
• Cover application site with clothing once dry
• Avoid skin-to-skin contact with others, especially women and children, at the application site 1
• Wait at least 2 hours before swimming or showering

Contraindications

• Active attempts to conceive (testosterone suppresses spermatogenesis) 1
• Recent cardiovascular events (within 3-6 months) 1
• Known hypersensitivity to testosterone or gel components

Practical Considerations

• Commercially manufactured testosterone products are preferred over compounded formulations due to consistent potency and quality 1
• Gel formulations have fewer skin reactions (5%) compared to patches (up to 66%) 1
• Gel formulations provide more stable serum testosterone levels compared to injectable forms 4
• Non-binary individuals may desire lower doses (25-30 mg daily) for more gradual or partial masculinization effects 1

Remember that some changes from testosterone therapy (voice deepening, hair growth) are irreversible even if treatment is discontinued 1. Consistent daily application is essential for maintaining stable hormone levels and achieving desired masculinizing effects.