1% Testosterone Cream Dosing for Women
For postmenopausal women using 1% testosterone cream, start with 5 mg (0.5 mL) applied daily to the upper arm or thigh, which restores testosterone levels to the premenopausal range without requiring dose escalation in most cases.
Starting Dose and Application
- Begin with 5 mg daily (0.5 mL of 1% cream) applied to dry, intact skin of the upper arm, thigh, abdomen, or torso 1, 2.
- This 5 mg dose achieves mean total testosterone levels of approximately 0.54 ng/mL and free testosterone of 4.14 pg/mL, restoring levels to within or above the premenopausal reference range 1.
- Apply the cream in a thin layer over approximately 15 cm² of skin area 3.
- Patients must wash hands thoroughly after application to prevent unintended transfer to partners or children 2.
Titration Schedule
- Do not routinely escalate the dose - doubling from 5 mg to 10 mg only increases testosterone levels by approximately 30%, with diminishing returns at higher doses 1.
- If using 10 mg daily, research shows adequate serum levels are achieved, though 20-30 mg doses provide minimal additional benefit 3.
- Check serum testosterone levels 2-3 months after initiating therapy and after any dose adjustments 2.
- Once stable therapeutic levels are confirmed, monitor every 6-12 months 2.
Monitoring and Duration
- Evaluate treatment effect after 3-6 months of therapy to assess symptom improvement 4.
- Limit total treatment duration to 24 months maximum due to limited long-term safety data 2.
- Conduct annual clinical reviews focusing on compliance and side effects 2.
- Morning serum samples should be obtained when monitoring testosterone levels due to diurnal variation 4.
- Free testosterone is a better index of gonadal status than total testosterone 4.
Important Safety Considerations
- Avoid in breast cancer survivors - testosterone therapy is contraindicated in women with a personal history of breast cancer 2.
- Avoid progestins with anti-androgenic activity (if co-prescribing hormone therapy), as these worsen hypoandrogenism and sexual dysfunction 2, 5.
- The most common side effect is hypertrichosis, typically dose-related and confined to the application site 6.
- Prescribe commercially manufactured products rather than compounded formulations when possible, as compounded products have considerable variation in potency and quality 2.
Clinical Context
The evidence base for testosterone cream in women comes primarily from studies in postmenopausal women with low libido and low testosterone levels. Steady-state pharmacokinetics are achieved within 3-5 days of daily application 1, 3. The transdermal route avoids first-pass hepatic metabolism, providing more stable hormone levels compared to oral administration 4.