Testosterone Injections Should NOT Be Used for Acute Menstrual Bleeding
Testosterone is not indicated for the treatment of acute menstrual bleeding and should not be given for this purpose. The evidence provided addresses testosterone use in completely different clinical contexts (male hypogonadism, transgender hormone therapy) and does not support its use for managing acute uterine bleeding in cisgender women.
Why Testosterone Is Inappropriate for Acute Menstrual Bleeding
Wrong Mechanism of Action
- Testosterone does not acutely stop menstrual bleeding. While testosterone can eventually induce amenorrhea in transgender individuals over months (mean time 2.9 months), this is through chronic suppression of the hypothalamic-pituitary-ovarian axis, not acute hemostatic control 1.
- In transgender patients on long-term testosterone, breakthrough bleeding actually occurs in 25-34% of cases despite therapeutic testosterone levels, demonstrating that testosterone does not reliably control uterine bleeding even in chronic use 2, 3.
Appropriate Acute Management Options
For acute menstrual bleeding requiring urgent intervention, the evidence supports:
- High-dose progestin therapy (oral or injectable) is recommended for hemodynamically unstable women with acute heavy bleeding as a short-term intervention 4.
- Progestin-eluting intrauterine devices (levonorgestrel 20 μg/d) are the most effective medical approach for controlling heavy menstrual bleeding, reducing blood loss by 71-95% 4.
- Cyclic oral progestin reduces bleeding by 87% and is appropriate for ongoing management 4.
Clinical Context Matters
- The evidence discussing testosterone relates exclusively to: (1) replacement therapy in hypogonadal men 4, (2) gender-affirming hormone therapy in transgender individuals 5, 6, 2, 1, 3, and (3) managing bleeding complications in specific cardiovascular conditions 4.
- None of these contexts involve using testosterone to treat acute menstrual bleeding in cisgender women.
Critical Pitfalls to Avoid
Do not confuse testosterone's ability to eventually cause amenorrhea in transgender patients with acute hemostatic control. The time course is completely different—breakthrough bleeding in transgender patients on testosterone takes a median of 22 months to occur after initial amenorrhea, and when it does occur, no management approach (including dose adjustment) has proven superior to observation 6, 3.
Recognize that even when testosterone successfully induces amenorrhea, this takes months, not hours or days. In transgender youth, 85% achieved menstrual cessation by 6 months, with an average time of 2.9 months 1. This timeline is incompatible with managing acute bleeding.