Injectable Testosterone Therapy for Women with Low Testosterone Levels
Injectable testosterone therapy is not indicated for women with low testosterone levels as there are no FDA-approved testosterone formulations specifically for women, and current guidelines do not support its use in this population.
Diagnostic Considerations for Female Hypogonadism
- Free testosterone is a better indicator of gonadal status than total testosterone in women and should be measured when possible 1
- Morning serum total testosterone measurements should be repeated to confirm low levels due to variability in assays 1
- A comprehensive evaluation should include assessment of sex hormone binding globulin (SHBG) levels to calculate the free testosterone index 1
- Symptoms of androgen insufficiency in women may include diminished sexual motivation/desire, persistent unexplainable fatigue, and lack of sense of well-being 2
Evidence on Testosterone Therapy in Women
- While some clinical trials suggest testosterone therapy may improve sexual function in postmenopausal women, these studies primarily used transdermal formulations, not injectable testosterone 3
- The North American Menopause Society states that testosterone therapy without concomitant estrogen therapy cannot be recommended due to lack of evidence 3
- There is insufficient evidence regarding the long-term safety of testosterone therapy in women, particularly concerning risks of breast cancer, cardiovascular disease, or thromboembolic events 3
- Most studies on testosterone therapy in women have been short-term (less than 6 months), limiting conclusions about long-term safety and efficacy 3
Current Guidelines on Testosterone Use
- Current guidelines focus on testosterone therapy for men with hypogonadism, with detailed protocols for diagnosis, administration, and monitoring 4
- The European Association of Urology (2025) specifically recommends against using testosterone therapy in eugonadal individuals 4
- Guidelines consistently recommend testosterone therapy only for men with confirmed low testosterone levels and corresponding symptoms 4
- Injectable testosterone is primarily discussed as a treatment option for male hypogonadism, with specific dosing and monitoring parameters 4
Potential Risks and Monitoring Considerations
- Testosterone therapy in women may cause hirsutism and acne, though the actual risks are not well defined 3
- There is insufficient data on whether testosterone therapy increases the risk of breast cancer, cardiovascular disease, or thromboembolic events in women 3
- Laboratory assays commonly used for testosterone measurement may not accurately detect testosterone concentrations at the values typically found in women 3
- No specific testosterone level has been clearly linked to a clinical syndrome of hypoandrogenism or testosterone insufficiency in women 3
Alternative Approaches
- For premenopausal women with hypogonadism, estrogen replacement with progesterone should be considered as first-line therapy 1
- Transdermal hormone replacement therapy may be appropriate for premenopausal or postmenopausal women with hormonal deficiencies 1
- Addressing other potential causes of symptoms similar to those attributed to low testosterone (such as fatigue, low libido) is recommended before considering testosterone therapy 1
- Adequate nutrition, calcium and vitamin D supplementation, regular weight-bearing exercise, and smoking cessation are important supportive measures for women with hormonal concerns 1
Common Pitfalls to Avoid
- Treating based on symptoms alone without laboratory confirmation of low testosterone levels is not recommended 1
- Using testosterone products formulated specifically for men carries a risk of excessive dosing in women 3
- Custom-compounded testosterone products should be used with caution due to potentially inconsistent dosing 3
- Failing to distinguish between primary and secondary hypogonadism, which require different management approaches 1