When to Check Testosterone After Starting Testosterone Injections in Women
Testosterone levels should be checked 2-3 months after initiating testosterone injections in women, with the blood draw timed midway between injections to accurately assess therapeutic response. 1, 2
Initial Monitoring Timeline
The first follow-up visit should occur at 1-2 months after starting therapy to assess clinical efficacy and tolerability, though formal testosterone level measurement is typically performed at 2-3 months 1, 2
Measure testosterone levels 2-3 months after treatment initiation or after any dose change to ensure target levels have been achieved 1, 2
Once stable therapeutic levels are confirmed on a given dose, subsequent monitoring should occur every 6-12 months 3, 1
Critical Timing Considerations for Blood Draw
For testosterone cypionate or enanthate injections, blood should be drawn midway between injections (typically day 5-7 for weekly injections, or day 7-10 for biweekly injections) to obtain the most accurate assessment 1, 2. This is essential because:
Peak serum testosterone occurs 2-5 days post-injection, with return to baseline by 10-14 days 1, 2
Injectable testosterone creates significant fluctuations with peaks and valleys between doses 1, 2
Target levels should be in the mid-normal range when measured at this midpoint 1
Dose Adjustment Strategy
If clinical response is inadequate and testosterone levels are in the low-normal range at the midpoint measurement, increase the testosterone dosage 1, 2
If levels are supraphysiological or adverse effects occur (particularly elevated hematocrit), reduce the dose or temporarily discontinue therapy 1, 2
Essential Safety Monitoring
Beyond testosterone levels, the following must be monitored:
Hemoglobin/hematocrit at baseline and follow-up visits - if hematocrit exceeds 50% at baseline, investigate before starting therapy; if it rises above 54% on treatment, reduce dose or temporarily discontinue 3, 1
Assess symptomatic response, including virilization effects and desired therapeutic outcomes 2
Common Pitfall to Avoid
The most critical error is drawing testosterone levels at random times relative to injection timing. A level drawn shortly after injection will be falsely elevated, while one drawn just before the next dose will be falsely low, leading to inappropriate dose adjustments 1, 2. Always standardize the timing to midway between injections for consistent, interpretable results.