Therapeutic Testosterone Range for Females
For females taking testosterone supplementation, target testosterone levels should be maintained within the physiologic premenopausal range, which is approximately 15-70 ng/dL for total testosterone, with monitoring to prevent supraphysiologic levels and androgen excess symptoms. 1
Clinical Context and Indications
The primary indication for testosterone therapy in women is hypoactive sexual desire disorder (HSDD) in postmenopausal women, with limited data supporting use in late reproductive age premenopausal women. 1 Testosterone therapy should only be prescribed after a comprehensive biopsychosocial assessment confirms that sexual dysfunction is not primarily related to modifiable factors such as relationship problems, mental health conditions, or other treatable comorbidities. 1
Target Therapeutic Range
Total testosterone should be maintained within the physiologic premenopausal range during treatment, which typically ranges from 15-70 ng/dL, though specific upper limits vary by laboratory reference ranges. 1
Baseline total testosterone measurement is required before initiating therapy, not for diagnosis of HSDD, but specifically to establish a reference point for monitoring and preventing supraphysiologic levels. 1
The goal is physiologic replacement, not supraphysiologic dosing, as excessive testosterone levels increase the risk of virilization and other androgen excess symptoms. 1
Monitoring Protocol
Assess total testosterone levels during treatment to ensure concentrations remain within the physiologic premenopausal range and do not exceed normal female levels. 1
Monitor for clinical signs of androgen excess including hirsutism, acne, voice deepening, clitoral enlargement, and male-pattern hair loss at each follow-up visit. 1
Frequency of monitoring should be individualized based on the formulation used and patient response, though specific intervals are not definitively established in guidelines. 1
Formulation and Dosing Considerations
Systemic transdermal testosterone is the recommended route of administration for women with HSDD. 1 Government-approved transdermal male formulations can be used cautiously with dosing adjusted appropriately for women, as female-specific formulations are not widely available in most countries. 1
Compounded testosterone products cannot be recommended due to lack of efficacy and safety data, inconsistent dosing, and potential contamination risks. 1
Critical Pitfalls to Avoid
Never use testosterone levels alone to diagnose HSDD - the diagnosis is clinical, based on symptoms and distress, not laboratory values. 1
Never prescribe testosterone without informed consent discussing off-label use (in most jurisdictions), potential benefits, risks, and the lack of long-term safety data beyond 1-2 years. 1
Never ignore signs of virilization - if androgen excess symptoms develop, testosterone should be dose-reduced or discontinued immediately. 1
Do not measure testosterone levels in women for routine screening outside of monitoring established therapy, as there are no validated reference ranges for "optimal" testosterone in women and measurement lacks clinical utility for diagnosis. 2
Safety and Efficacy Data
Current research demonstrates moderate therapeutic benefit for sexual function with physiologic testosterone use in women with HSDD. 1 Safety data show no serious adverse events with physiologic testosterone replacement, though long-term safety beyond 1-2 years has not been established. 1
The therapeutic approach requires shared decision-making with patients, acknowledging that testosterone therapy for women remains off-label in most regulatory jurisdictions despite substantial evidence supporting its use. 1