Testosterone Dosing for Postmenopausal Women: IM Administration
Testosterone replacement therapy is not routinely recommended for postmenopausal women, and there are no established FDA-approved intramuscular testosterone dosing regimens specifically for this population. The available evidence focuses primarily on estrogen-progestin hormone replacement therapy for postmenopausal women, not testosterone therapy 1.
Critical Evidence Gap
The guideline evidence provided addresses postmenopausal hormone replacement therapy with estrogen and progestin, not testosterone 1. The USPSTF recommends against routine use of combined estrogen and progestin for primary prevention of chronic conditions in postmenopausal women due to increased risks of coronary heart disease, stroke, pulmonary emboli, and breast cancer 1.
Testosterone Dosing Information (Not Specific to Postmenopausal Women)
While the question asks about postmenopausal women, the only available testosterone dosing guidance comes from male hypogonadism and transgender medicine literature:
Standard IM Testosterone Dosing (Male Populations)
- Testosterone enanthate or cypionate: 100-200 mg every 2 weeks or 50-100 mg weekly via intramuscular injection 2
- Weekly dosing of 50-100 mg provides more stable testosterone levels compared to biweekly administration 2
- Testosterone undecanoate: 750 mg initially, followed by 750 mg at 4 weeks, then 750 mg every 10 weeks via gluteal intramuscular injection only 2
Monitoring Requirements
- Testosterone levels should be measured 2-3 months after treatment initiation or any dose change 2
- For injectable formulations, levels should be measured midway between injections, targeting mid-normal values of 450-600 ng/dL 2
- Once stable levels are achieved, monitoring should occur every 6-12 months 2
Critical Safety Concerns
Injectable testosterone carries greater cardiovascular risk compared to transdermal preparations, possibly due to fluctuating testosterone levels 2. Erythrocytosis occurs more frequently with injectable formulations, with 43.8% of patients receiving intramuscular injections developing this complication versus only 15.4% with transdermal patches 2.
Clinical Recommendation
For postmenopausal women specifically seeking hormone replacement, the evidence supports estrogen-based therapy (with or without progestin depending on hysterectomy status) rather than testosterone 1. If testosterone therapy is being considered for postmenopausal women for specific indications (such as hypoactive sexual desire disorder), this represents off-label use requiring specialist consultation, as no standard IM dosing protocols exist for this population in the provided guidelines.
The dosing information provided (100-200 mg every 2 weeks or 50-100 mg weekly) is derived from male hypogonadism treatment and would likely result in supraphysiological levels in women 2. Women typically require substantially lower doses than men, but specific IM dosing recommendations for postmenopausal women are not established in the available guideline evidence.