Starting Testosterone Cypionate Dose for Women
For women seeking testosterone therapy, the appropriate starting dose depends critically on the indication: for gender-affirming masculinization in transgender men, begin with 125 mg intramuscularly every 2 weeks; for cisgender women with hypoactive sexual desire or androgen deficiency, use substantially lower doses such as 100 mg intramuscularly monthly, or preferably start with transdermal testosterone cream rather than cypionate injections.
Gender-Affirming Testosterone Therapy (Transgender Men/Transmasculine Individuals)
Standard Dosing Approach
- Standard masculinizing doses aim to achieve serum testosterone concentrations in the typical cisgender male reference range 1
- Research demonstrates that 125 mg intramuscularly every 2 weeks is an effective starting dose that achieves therapeutic effects within 6 months 2
- Alternative dosing includes 250 mg every 2-3 weeks, though lower doses (125 mg every 2 weeks) show equivalent long-term efficacy with potentially fewer early side effects 2
Dose-Response Considerations
- Higher initial doses (250 mg every 2 weeks) produce faster onset of masculinizing changes in the first month, but by 6 months all dosing regimens achieve similar therapeutic endpoints 2
- For individuals desiring gradual or partial masculinization, low-dose testosterone therapy can be used to achieve a more androgynous appearance 1
- Hemoglobin increases to male reference range within 3 months of standard-dose therapy 1
Route of Administration
- Subcutaneous administration of testosterone cypionate weekly produces stable therapeutic levels and is easier for self-administration than intramuscular injections 3
- Weekly subcutaneous dosing maintains mean total testosterone of 627 ± 206 ng/dL with stable levels between injections 3
Testosterone Therapy for Cisgender Women
Critical Distinction
Testosterone cypionate injections are NOT the preferred formulation for cisgender women with androgen deficiency or sexual dysfunction 4
Preferred Approach
- Transdermal testosterone cream should be prescribed rather than injectable testosterone cypionate for cisgender women 4
- Commercially manufactured testosterone products are preferred over compounded preparations due to quality and potency consistency 4
- Transdermal preparations provide stable day-to-day testosterone levels and easier dose titration 4
Injectable Dosing (If Cream Unavailable)
- Research in women with hypoactive sexual desire used 100 mg testosterone cypionate intramuscularly monthly for 3 months with therapeutic benefit 5
- This monthly dosing produces much lower testosterone levels than the every-2-week dosing used for masculinization 5
Monitoring Requirements
Initial Monitoring
- Measure serum testosterone 2-3 months after initiating therapy or after any dose adjustment to ensure appropriate therapeutic levels 4
- Once stable levels are confirmed, monitoring every 6-12 months is sufficient 4
Safety Monitoring
- Monitor for polycythemia, lipid changes (reduced HDL), androgenic alopecia, and acne in those receiving masculinizing doses 1
- Annual clinical review focusing on treatment adherence and safety is recommended 4
Critical Safety Considerations
Contraindications for Cisgender Women
- Do not prescribe testosterone to breast cancer survivors 4
- Limit duration to maximum 24 months for cisgender women due to limited long-term safety data 4
Common Pitfalls to Avoid
- Do not use masculinizing doses (125-250 mg every 2 weeks) in cisgender women seeking treatment for sexual dysfunction or androgen deficiency—these doses will cause virilization 2, 5
- Avoid co-prescribing anti-androgenic progestins in women with premature ovarian insufficiency, as this exacerbates hypo-androgenism 4
- With transdermal preparations, counsel patients on proper application technique and hand washing to prevent transfer to partners or children 4
Irreversible Changes
Voice deepening and body/facial hair growth are irreversible even if testosterone therapy is discontinued 1