Starting Dose of Testosterone Cream for Women
For women requiring testosterone therapy, the recommended initial dose of testosterone cream is 10 mg daily (2 cm of Andro-Feme cream). 1
Dosing Guidelines for Women
- Testosterone cream therapy for women should be started at significantly lower doses than those used for men, with 10 mg daily being an effective starting dose that has demonstrated improvement in sexual function parameters without side effects 1
- The typical application site for testosterone cream in women is the skin of the torso, though specific application instructions may vary by product 2
- Testosterone concentrations can vary substantially with gel/cream use, requiring monitoring to ensure appropriate levels 3
Monitoring and Dose Adjustment
- After initiating testosterone cream therapy, serum testosterone levels should be tested 2-3 months after treatment initiation and after any dose changes 3
- Once stable levels are confirmed, monitoring every 6-12 months is typically sufficient 3
- For women, the goal is to maintain testosterone levels within the physiological female range to avoid masculinizing side effects 2
Formulation Considerations
- Commercially manufactured testosterone products should be prescribed rather than compounded testosterone when possible, as compounded products may have considerable variation in potency and quality 3
- Transdermal testosterone preparations (including creams) offer the advantage of relatively stable day-to-day testosterone levels compared to injectable formulations 3
- Testosterone cream provides easy application with good skin tolerability 3
Safety Considerations and Side Effects
- The most frequently reported adverse event with topical testosterone in women is hypertrichosis (excessive hair growth), which is dose-related and mostly confined to the application site 4
- There is potential for transfer to partners or children through skin-to-skin contact, so proper application and hygiene measures should be followed 3
- Lower doses of testosterone (such as 10 mg) may help minimize side effects while still providing therapeutic benefit 1, 5
Special Populations
- For transgender and gender diverse individuals seeking masculinization, starting doses may be lower than those used for cisgender men with hypogonadism, with a median starting dose of 50 mg daily reported in one study 2
- For premenopausal women with reduced libido, even lower doses may be effective - one study found that a 90-μL spray (lower than 10 mg cream) improved sexual satisfaction compared to placebo 4
Clinical Pearls
- Testosterone cream application should be applied to dry, intact skin, typically of the torso, avoiding transfer to others 3
- Patients should be advised to wash hands thoroughly after application to prevent unintended transfer 3
- Scrotal delivery of testosterone cream results in significantly higher absorption rates and should be avoided in women 6
- Monitoring for signs of virilization (deepening voice, hirsutism, clitoromegaly) is essential during follow-up visits 4