What is the appropriate starting dose and administration instructions for AndroFeme 1 (testosterone cream) in an adult woman with diagnosed low testosterone?

AndroFeme 1 Dosing for Adult Women with Low Testosterone

Starting Dose and Administration

The recommended starting dose of AndroFeme 1 (testosterone cream 1%) for adult women with diagnosed low testosterone is 0.5 mL (5 mg testosterone) applied once daily to the upper outer arm or inner thigh. 1, 2

Application Instructions

• Apply once daily in the morning to clean, dry, intact skin 1
• Preferred application sites: upper outer arm or inner thigh (avoid breasts, genitals, and broken skin) 1
• Spread the cream over a palm-sized area using clean hands 1
• Wash hands thoroughly with soap and water immediately after application 1
• Allow the application site to dry completely before covering with clothing (approximately 5-10 minutes) 1
• Avoid swimming, showering, or washing the application site for at least 2 hours after application to ensure adequate absorption 1

Dose Titration Algorithm

Measure serum total testosterone 2-3 weeks after starting treatment to guide dose adjustment 3, 1:

• If testosterone remains low (<1.0 nmol/L or <30 ng/dL): Increase dose to 1.0 mL (10 mg) daily 2
• If testosterone is in mid-normal female range (1.0-2.0 nmol/L or 30-60 ng/dL): Continue current dose 2
• If testosterone exceeds upper limit of normal (>2.5 nmol/L or >70 ng/dL): Reduce dose to 0.25 mL (2.5 mg) daily or consider alternate-day dosing 2

Reassess testosterone levels and clinical response at 3 months, then every 6-12 months once stable 3, 1

Expected Clinical Outcomes

Testosterone therapy in women with documented low testosterone produces small but significant improvements in:

• Sexual function and libido (primary indication, with standardized mean difference of 0.35 in comparable studies) 2
• General well-being and mood (composite Psychological General Well-Being Index scores improve by approximately 13 points) 2
• Energy levels (though effect sizes are modest) 2

Minimal or no benefit should be expected for: physical strength, cognitive function, or body composition 4, 2

Critical Safety Precautions

Absolute Contraindications

Do not prescribe AndroFeme 1 in women with: 4

• Breast cancer (current or history)
• Pregnancy or breastfeeding
• Cardiovascular disease (active or recent)
• Liver disease (active)

Secondary Exposure Prevention

Children and partners must avoid contact with application sites 1:

• Cover the application site with clothing once dry 1
• Wash application site thoroughly before any skin-to-skin contact with children or partners 1
• Virilization has been reported in children secondarily exposed to testosterone products, including premature puberty and genital enlargement 1

Monitoring Requirements

Monitor at each follow-up visit for signs of androgen excess: 4

• Acne or oily skin
• Hirsutism (facial or body hair growth)
• Male-pattern hair loss (scalp)
• Voice deepening (irreversible if occurs)
• Clitoral enlargement

Laboratory monitoring: 3, 4

• Serum total testosterone at 2-3 weeks, 3 months, then every 6-12 months
• Lipid panel at baseline and annually (testosterone may worsen lipid profile)
• Liver function tests at baseline and if symptoms develop
• Hematocrit at baseline and annually (risk of polycythemia, though lower than in men)

Common Pitfalls to Avoid

Do not prescribe testosterone for cardiovascular health, weight loss, or general anti-aging purposes—there is no established benefit and potential cardiovascular risks exist 4

Do not diagnose low testosterone based on symptoms alone—always confirm with morning serum testosterone measurement on at least two separate occasions 3

Do not apply to the abdomen, breasts, genitals, or face—these sites have different absorption characteristics and higher risk of local side effects 1

Do not continue therapy beyond 6 months if no improvement in sexual function or well-being is documented—this indicates non-response and exposes the patient to unnecessary risks 4, 2

Do not use higher doses than 10 mg daily without specialist consultation—doses used in premenopausal women with low libido (10 mg/day) resulted in testosterone levels at the high end of normal female range, and higher doses risk virilization 2