Should I continue testosterone cream therapy with a testosterone level of 112 ng/dL, Sex Hormone Binding Globulin (SHBG) of 152 nmol/L, and Free Testosterone of 6.5 pg/mL?

Testosterone Therapy Management for Females with Elevated Testosterone Levels

Based on your laboratory values, you should discontinue testosterone cream therapy as your total testosterone level of 112 ng/dL is significantly elevated above the normal female range, indicating potential overdosage.

Assessment of Current Laboratory Values

Your current laboratory results show:

• Total testosterone: 112 ng/dL (significantly elevated for females)
• Sex hormone binding globulin (SHBG): 152 nmol/L (elevated)
• Free testosterone: 6.5 pg/mL (elevated)

These values indicate supraphysiologic testosterone levels that exceed what would be considered therapeutic for females on testosterone supplementation 1. Normal testosterone levels in females are typically much lower, and your current levels suggest potential overdosage.

Risks of Continued Therapy at Current Levels

Continuing testosterone therapy at these elevated levels poses several risks:

• Virilization: Development of male secondary sexual characteristics including:

  • Increased facial/body hair growth
  • Deepening of voice
  • Clitoral enlargement
  • Male-pattern baldness
  • Acne
  • Changes in body composition 2

• Metabolic effects:

  • Potential adverse lipid profile changes
  • Increased risk of cardiovascular complications 3

• Other concerns:

  • Risk of secondary exposure to family members, particularly children who may develop precocious puberty through skin contact 4
  • Potential hepatotoxicity with long-term elevated levels 2

Recommended Course of Action

1. Immediate action: Discontinue testosterone cream therapy temporarily to allow levels to normalize 1

2. Follow-up testing: Repeat testosterone levels in 4-6 weeks after discontinuation to assess return to baseline

3. Reassessment: Once levels normalize, if testosterone therapy is still indicated:

   • Consider lower dosing
   • Use the minimal effective dose to achieve therapeutic benefits while maintaining total testosterone in the normal female range
   • Target levels should be significantly lower than current values 1

4. Application technique review:

   • If therapy is resumed, ensure proper application technique
   • Apply to clean, dry skin
   • Wash hands thoroughly after application
   • Avoid skin-to-skin contact with others, especially children and pregnant women 5

Monitoring Recommendations if Therapy is Resumed

If testosterone therapy is resumed at a lower dose after normalization:

• Measure testosterone levels 4-8 weeks after initiating therapy
• Target total testosterone levels appropriate for females (typically 20-50 ng/dL)
• Monitor for signs of virilization at each follow-up visit
• Evaluate for clinical response to therapy
• Continue regular monitoring every 3-6 months initially, then annually once stable 1

Important Considerations

• The elevated SHBG (152 nmol/L) may be binding much of the testosterone, but your free testosterone is still elevated at 6.5 pg/mL 6
• Transdermal formulations like creams have variable absorption and can lead to inconsistent hormone levels
• The risk of secondary exposure to others through skin contact is significant with topical formulations 4

Conclusion

Your current testosterone levels are significantly elevated above the therapeutic range for females. The safest approach is to discontinue therapy temporarily, allow levels to normalize, and then reassess whether continued therapy at a much lower dose is appropriate based on your symptoms and treatment goals.