Testosterone Gel Dosing for Women
There is no FDA-approved testosterone gel dosing regimen for women, as testosterone gels are only approved for use in men with hypogonadism. While testosterone therapy may be used off-label in women, dosing must be significantly lower than for men due to physiological differences.
Physiological Considerations
- Women naturally have testosterone levels approximately 10-fold lower than men 1
- High testosterone doses in women inevitably cause virilization (unwanted masculine characteristics) 2
- The safety and efficacy of testosterone gel in women has not been established in large clinical trials
Off-Label Dosing Considerations
When testosterone gel is used off-label in women, the following approach is generally recommended:
Starting dose: Begin with approximately 1/10th of the male dose
Application site: Apply to skin of the upper arms, shoulders, or thighs
- Avoid application to breasts or genital areas
- Ensure thorough handwashing after application to prevent transfer
Monitoring: Check testosterone levels after 2-4 weeks of therapy
- Target testosterone levels should remain within the normal female range
- Monitor for signs of virilization (acne, hirsutism, voice deepening, clitoromegaly)
Important Cautions
- Risk of testosterone transfer to partners or children through skin-to-skin contact 2
- Potential side effects include lipid abnormalities, acne, and hair growth 2
- Long-term safety data in women is limited
Application Method
For optimal absorption:
- Apply to clean, dry skin
- Allow to dry completely before dressing (typically 5-10 minutes) 3
- Avoid washing the application site for at least 2 hours after application
Monitoring Parameters
- Serum testosterone levels (maintain within normal female range)
- Signs of virilization
- Lipid profile
- Complete blood count (to monitor for polycythemia)
Formulation Options
Available testosterone gel formulations (though all are FDA-approved only for men):
- AndroGel 1% (25 mg in 2.5-g packet)
- AndroGel 1.62% (20.25 mg in 1.25-g packet)
- Testim 1% gel (50 mg in 5-g packet)
- Fortesta 2% gel (10 mg per actuation via metered-dose pump) 2
Remember that testosterone gel use in women represents off-label prescribing and should be approached with caution, with careful consideration of potential risks and benefits.