First-Line Testosterone Dosing for Women with Undetectable Testosterone Levels

For women with undetectable testosterone levels, the first-line dosing is a transdermal patch releasing 50-100 μg of testosterone daily. 1

Dosing Recommendations

Transdermal testosterone patches should be applied to dry, intact skin of the back, abdomen, upper thighs, or upper arms 1
Peak testosterone levels occur 6-8 hours after patch application 1
For women with premature ovarian insufficiency (POI), transdermal patches releasing 50-100 μg of testosterone daily are often combined with estradiol therapy 1
Transdermal delivery is preferred as it avoids first-pass hepatic metabolism, providing more stable hormone levels compared to oral administration 1

Transdermal testosterone therapy, dosed within premenopausal physiologic testosterone ranges, has shown short-term efficacy for hypoactive sexual desire disorder in postmenopausal women 2
Clinical improvements include an additional satisfying sexual episode per month, improved desire, arousal, orgasm, pleasure, and responsiveness, and reduced distress 2
A daily 90-μL dose of transdermal testosterone has been shown to improve self-reported sexual satisfaction for premenopausal women with reduced libido and low serum-free testosterone levels 3

Evaluate treatment effect after 3-6 months of therapy 1
Annual clinical reviews are recommended, with particular attention to compliance and side effects 1
No routine laboratory monitoring is required, but testing may be prompted by specific symptoms or concerns 1
Testosterone therapy should possibly be limited to 24 months due to limited long-term safety data 1

Short-term studies (up to 2 years) have shown that testosterone levels at the upper portion or slightly above the reference range for reproductive-aged women do not increase the risk of hepatotoxicity or endometrial hyperplasia 4
Side effects may include mild and reversible acne and hirsutism 4
Transdermal testosterone does not appear to cause adverse changes to the lipid profile, unlike oral testosterone 4
The most frequently reported adverse event with transdermal testosterone is hypertrichosis (excessive hair growth), which is dose-related and mostly confined to the application site 3

No approved testosterone preparation is specifically available for women in many countries 2
Compounded testosterone creams or reduced dosing of male-approved therapies represent off-label use 2
Injections or pellets cause supraphysiological testosterone levels and are not recommended for women 2
Long-term data on cardiovascular, cancer, and cognitive safety are lacking 2

For women with hypogonadism, transdermal testosterone can be given after discussion of theoretical risks 5
When monitoring testosterone levels in women, morning serum samples should be taken due to significant diurnal variation in levels 5
Free testosterone is a better index of gonadal status than total testosterone, though not all laboratories can measure it 5