What is the off-label dosing of testosterone gel for addressing libido issues in menopausal women with no contraindications?

Off-Label Testosterone Gel Dosing for Menopausal Women with Libido Issues

For menopausal women with libido issues and no contraindications, the recommended off-label dosing of testosterone gel is 5-10 mg per day applied to the skin of the back, abdomen, upper thighs, or upper arms.

Dosing Recommendations

Testosterone gel can be used off-label for menopausal women with decreased libido using the following approach:

1. Starting dose: 5-10 mg daily of testosterone gel (1% concentration)

   • This can be achieved using approximately 1/10 of the standard male dose packet
   • For example, using AndroGel 1%, this would be approximately 0.5-1.0 g of gel daily

2. Application site: Apply to dry skin of the back, abdomen, upper thighs, or upper arms

   • Avoid application to genital areas
   • Allow to dry completely before dressing
   • Wash hands thoroughly after application

3. Monitoring protocol:

   • Check testosterone levels after 4-8 weeks of therapy
   • Target serum testosterone levels in the mid-normal female range
   • Do not exceed levels of 70 ng/dL (upper limit of normal female range)

Evidence and Rationale

The use of testosterone in women is supported by several studies showing efficacy for sexual dysfunction:

• Testosterone treatment has been shown to improve sexual function in postmenopausal women, particularly when using the 300 μg/day dosage via patch (equivalent to approximately 5-10 mg gel) 1

• The addition of low-dose testosterone gel to estrogen therapy significantly improved sexual function scores compared to estrogen alone 2

• Transdermal application is preferred due to:

  • More stable serum levels compared to injections 3
  • Lower risk of cardiovascular events compared to injections 3
  • Ease of application and good skin tolerability 3

Important Considerations and Cautions

1. Monitoring for adverse effects:

   • Check for androgenic side effects: acne, hirsutism, voice deepening
   • Monitor lipid profiles and liver function tests periodically
   • Discontinue if androgenic side effects become problematic

2. Contraindications:

   • History of hormone-sensitive cancers (breast, endometrial)
   • Severe liver disease
   • Untreated polycythemia
   • Pregnancy or planned pregnancy

3. Risk of transference:

   • Warn patients about potential transfer to partners or children through skin contact
   • Advise covering application site with clothing or washing area before close contact

Clinical Evaluation Before Initiation

Before starting testosterone therapy:

1. Laboratory assessment:

   • Baseline total testosterone level (ideally in the morning)
   • Complete blood count
   • Lipid profile
   • Liver function tests

2. Clinical assessment:

   • Rule out other causes of low libido (relationship issues, depression, medications)
   • Evaluate for other menopausal symptoms that may benefit from conventional hormone therapy

Duration of Treatment

• Evaluate response after 3 months of therapy
• If no improvement in sexual function is observed within 6 months, consider discontinuation
• For those who respond, periodic reassessment (every 6-12 months) is recommended to evaluate ongoing need and monitor for adverse effects

While testosterone therapy for female sexual dysfunction remains off-label, the evidence suggests that low-dose transdermal testosterone can provide meaningful improvements in sexual function for menopausal women with appropriate monitoring and follow-up.