What is the target testosterone level for postmenopausal women using testosterone cream?

Target Testosterone Levels for Postmenopausal Women Using Testosterone Cream

For postmenopausal women using testosterone cream, the target serum total testosterone level should be maintained within the normal premenopausal range of 0.4-0.7 ng/mL, with free testosterone levels between 4-7 pg/mL.

Understanding Testosterone Therapy in Postmenopausal Women

Testosterone therapy in postmenopausal women is primarily indicated for hypoactive sexual desire disorder (HSDD), not for general hormone replacement. The evidence supports using testosterone specifically for addressing sexual dysfunction rather than for other health outcomes.

Appropriate Testosterone Levels

Based on pharmacokinetic studies of transdermal testosterone cream in postmenopausal women:

• Total testosterone (TT) target: 0.4-0.7 ng/mL

  • A 5 mg daily dose typically achieves a median TT concentration of 0.54 ng/mL 1
  • This restores levels to the reference range for premenopausal women

• Free testosterone (fT) target: 4-7 pg/mL

  • A 5 mg daily dose typically achieves a median fT concentration of 4.14 pg/mL 1

Dosing Considerations

• Start with the lowest effective dose (typically 5 mg daily) 1, 2
• Apply to the upper arm for consistent absorption 1
• Doubling the dose (10 mg) only increases testosterone levels by approximately 30%, suggesting non-linear absorption 1
• Avoid supraphysiologic levels which may increase risk of adverse effects

Monitoring Recommendations

Laboratory Monitoring

• Baseline testosterone levels before initiating therapy
• Follow-up testosterone levels after 3-6 weeks of treatment to ensure target range is achieved
• Monitor for supraphysiologic levels rather than to diagnose testosterone insufficiency 2
• Standard laboratory assays may not accurately detect testosterone at the low concentrations found in women 2

Clinical Monitoring

• Assess improvement in sexual function parameters (desire, arousal, satisfaction)
• Monitor for adverse effects:
  • Hirsutism
  • Acne
  • Voice changes
  • Clitoromegaly
  • Lipid profile changes

Important Caveats and Considerations

• Testosterone therapy should only be used for hypoactive sexual desire disorder in postmenopausal women, not for other indications 3
• Testosterone cream is not FDA-approved specifically for women; it is used off-label 2
• The safety of testosterone therapy beyond 6 months has not been well established 2
• Transdermal formulations (creams, gels, patches) are preferred over oral formulations due to first-pass hepatic effects 2
• Custom-compounded products may have inconsistent dosing compared to government-approved products 2

Contraindications

Testosterone therapy is contraindicated in women with:

• Breast or uterine cancer
• Cardiovascular disease
• Liver disease 2

Clinical Application

For a postmenopausal woman with HSDD starting testosterone cream:

1. Obtain baseline total and free testosterone levels
2. Start with 5 mg daily application to upper arm
3. Assess response after 3 months (the minimum time needed to evaluate efficacy) 4
4. Adjust dose if needed based on clinical response and testosterone levels
5. Continue to monitor for adverse effects at regular intervals
6. Use for the shortest duration necessary to meet treatment goals 2

Remember that testosterone therapy should be part of a comprehensive approach to sexual dysfunction, addressing psychological, relationship, and other physiological factors that may contribute to the condition.