Target Testosterone Levels for Females Receiving Testosterone Therapy
For female-to-male gender transition, target total testosterone levels of 450-600 ng/dL, with acceptable range extending to 300-800 ng/dL (the normal cisgender male reference range). 1
Standard Dosing Goals
The goal is to achieve serum testosterone concentrations in the typical cisgender male reference range. 2
- The American College of Physicians specifically recommends maintaining levels between 450-600 ng/dL for optimal masculinization 1
- The World Professional Association for Transgender Health emphasizes using minimal dosing necessary to maintain testosterone in the normal physiologic range of 450-600 ng/dL 1
- A patient with a level of 503 ng/dL is considered within the target range according to the Endocrine Society 1
Monitoring Strategy
Measure testosterone levels midway between injections for injectable formulations, targeting 500-600 ng/dL. 1
- For transdermal preparations, levels can be measured at any time, though peak values occur 6-8 hours after application 1
- Once stable levels are confirmed on a given dose, measure testosterone every 6-12 months per the American Association of Clinical Endocrinologists 1
- Patients typically require approximately 9 months to reach steady-state testosterone levels 3
- Subcutaneous testosterone administration maintains stable levels throughout the weekly dosing interval, with mean levels of 627 ± 206 ng/dL 3
Important Physiologic Changes
Hemoglobin will increase to the male reference range within 3 months of initiating therapy. 2
- The American Society of Hematology recommends measuring hemoglobin at baseline and during follow-up 1
- Physical changes include deeper voice, body and facial hair growth, menstrual suppression, increased libido, clitoral growth, and increased muscle mass with reduced fat mass 2
Critical Safety Monitoring
Screen for cardiovascular risk factors including dyslipidemia, hypertension, diabetes, and smoking status. 1
- Adverse effects include polycythemia, reduced HDL cholesterol, androgenic alopecia, acne, pelvic pain, genital dryness, and potentially increased myocardial infarction risk 2
- The European Society of Cardiology recommends counseling about cardiovascular symptoms (chest pain, shortness of breath, dizziness) and advising immediate reporting 1
- Counsel that fertility will be impaired while on testosterone therapy, as exogenous testosterone suppresses spermatogenesis 1
Common Pitfall to Avoid
Do not use commercial laboratory reference ranges for "normal female" testosterone levels (typically up to 95 ng/dL) when treating transgender patients, as these are irrelevant for masculinizing therapy. The target is explicitly the male reference range of 300-800 ng/dL, with optimal levels at 450-600 ng/dL. 1