Typical Starting Dose for Intramuscular Testosterone in Women
For adult women initiating intramuscular testosterone therapy, start with 50 mg of testosterone enanthate or cypionate weekly, administered subcutaneously or intramuscularly. 1
Evidence-Based Dosing Recommendations
Initial Dose Range
- Begin with 50 mg weekly as the standard starting dose for most women 1
- The effective dose range spans 50–150 mg weekly, with most women achieving therapeutic testosterone levels at 50–100 mg 1
- This weekly dosing schedule provides more stable testosterone concentrations compared to biweekly administration 2
Route of Administration
- Subcutaneous injection is preferred over intramuscular due to ease of self-administration, less discomfort, and comparable efficacy 1
- All 63 female-to-male transgender patients in a 2017 study achieved normal male-range testosterone levels with subcutaneous doses of 50–150 mg weekly 1
- Among 22 patients who switched from intramuscular to subcutaneous administration, 20 had a marked preference for subcutaneous injection 1
Dose-Response Considerations
- Higher initial doses (100–200 mg every 2 weeks) accelerate onset of androgenic effects but do not improve long-term outcomes 3
- By 6 months, therapeutic responses are equivalent across different starting doses (125 mg every 2 weeks, 250 mg every 2–3 weeks) 3
- A dose-finding study demonstrated that 50 mg weekly subcutaneous testosterone enanthate achieved mean steady-state levels of 422 ng/dL, while 100 mg weekly reached 896 ng/dL 4
Target Testosterone Levels
- Aim for serum testosterone concentrations of 300–1,000 ng/dL, with mid-normal values of 450–600 ng/dL preferred 2
- For women undergoing masculinizing therapy, these levels correspond to the physiologic male range 2
Monitoring Protocol
Initial Monitoring
- Measure serum testosterone 2–3 months after starting therapy or after any dose adjustment 2, 5
- Check testosterone levels midway between injections to capture representative values 2
Ongoing Surveillance
- Once stable levels are achieved, monitor every 6–12 months 2, 5
- For women receiving testosterone for sexual dysfunction (not gender transition), limit therapy duration to 24 months maximum due to insufficient long-term safety data 5
Dose Titration
- Adjust dose based on serum levels and clinical response, typically within the 50–150 mg weekly range 1
- Therapy is effective across a wide body mass index range (19.0–49.9 kg/m²) 1
Alternative Formulations
Transdermal Options
- Testosterone cream or gel (1.62% formulation at approximately 40.5 mg daily) provides more stable day-to-day levels compared to injections 2, 5
- Transdermal preparations offer easy application with good skin tolerability but carry risk of transfer to partners or children 5
Safety Considerations
Contraindications
- Do not prescribe testosterone to breast cancer survivors, as hormone replacement is contraindicated 5
- Women with BRCA1/BRCA2 mutations who have undergone prophylactic bilateral salpingo-oophorectomy may be considered for therapy in the absence of personal breast cancer history 5
Common Pitfalls to Avoid
- Do not start with biweekly dosing (100–200 mg every 2 weeks) as the first-line approach, as weekly administration provides superior pharmacokinetic stability 2
- Avoid compounded testosterone products when commercially manufactured preparations are available, as compounded formulations have considerable variation in potency and quality 5
- Do not assume intramuscular injection is necessary—subcutaneous administration is equally effective and better tolerated 1