What is the recommended dosing for transdermal testosterone (TT) for Hypoactive Sexual Desire Disorder (HSDD) in postmenopausal women?

Transdermal Testosterone Dosing for HSDD in Postmenopausal Women

For postmenopausal women with hypoactive sexual desire disorder (HSDD), the recommended dosing for transdermal testosterone is 300 μg/day, which has been shown to be effective and safe in clinical trials. 1, 2

Appropriate Formulations and Application

Recommended Dosing:

• Dose: 300 μg/day transdermal testosterone 2, 3
• Application sites: Back, abdomen, upper thighs, or upper arms 4
• Frequency: Typically applied as patches that are changed twice weekly or weekly depending on the specific product 4

Available Formulations:

• Testosterone patches:

  • Androderm (2 mg/24-h patch) - typically 2-6 mg/day for men, but must be adjusted to 300 μg/day for women 4
  • Note: Most testosterone products are formulated for men and must be carefully dosed for women

• Testosterone gels:

  • Can be used with careful measurement to achieve the 300 μg/day dose
  • Examples include AndroGel, Testim, and Testogel 4
  • Caution: Risk of transfer to partners or children through skin contact

Monitoring and Safety

Pre-treatment Assessment:

• Baseline total testosterone level (not for diagnosis but for monitoring) 1
• Comprehensive assessment to rule out other causes of decreased libido (relationship issues, medications, mental health conditions) 1

Monitoring During Treatment:

• Total testosterone levels should be maintained in the physiologic premenopausal range 1
• Monitor after 2-3 months of treatment initiation and every 6-12 months thereafter 4
• Assess for signs of androgen excess (acne, unwanted hair growth) 1, 5

Safety Considerations:

• Short-term safety data (up to 4 years) shows minimal side effects 5
• Most common adverse events are application site reactions and mild unwanted hair growth 6, 5
• No significant changes in lipid profiles, carbohydrate metabolism, or liver function have been observed 5
• Long-term safety beyond 4 years has not been firmly established 1

Important Clinical Considerations

Efficacy:

• Transdermal testosterone at 300 μg/day has demonstrated significant improvements in:
  • Number of satisfying sexual episodes 3
  • Sexual desire 3
  • Reduction in personal distress 3

Regulatory Status:

• Testosterone therapy for HSDD in women is currently off-label in most countries 1
• Requires informed consent and shared decision-making regarding benefits and risks 1

Cautions:

1. Avoid compounded testosterone products due to lack of standardized efficacy and safety data 1
2. Use cautiously in women with a history of estrogen-dependent cancers
3. Testosterone patches may cause skin irritation in some women 4
4. Monitor for cardiovascular effects, though short-term data suggests minimal risk 6

Treatment Algorithm

1. Confirm diagnosis of HSDD not primarily related to modifiable factors
2. Obtain baseline testosterone level
3. Initiate transdermal testosterone at 300 μg/day
4. Monitor at 2-3 months for efficacy, side effects, and testosterone levels
5. Continue monitoring every 6-12 months if treatment is effective and well-tolerated
6. Discontinue if:
   • No improvement in symptoms after 6 months
   • Development of significant side effects
   • Testosterone levels exceed premenopausal range

This approach provides a structured method for safely implementing testosterone therapy for postmenopausal women with HSDD while optimizing outcomes related to sexual function and quality of life.