Optimal Testosterone Levels for Females on HRT

Target Testosterone Range

The American College of Physicians recommends target testosterone levels in the typical physiological range for cisgender men: 300-1,000 ng/dL, with most clinicians aiming for mid-normal range (450-600 ng/dL) to optimize virilization while minimizing adverse effects 1
The Endocrine Society suggests that many experienced clinicians aim for the mid- to upper-normal range (450-600 ng/dL) to optimize therapeutic response while maintaining safety 2
This range promotes expected masculinizing effects including voice deepening, increased muscle mass and strength, body composition changes, and increased libido 1

The American Academy of Family Physicians recommends measuring testosterone levels 2-3 months after treatment initiation or after any dose adjustment 2
For injectable testosterone, the guideline is to measure levels midway between injections, targeting mid-normal values (500-600 ng/dL) 2
Once stable levels are achieved on a given dose, monitor every 6-12 months 2
Continue monitoring hematocrit/hemoglobin, lipid profiles, and blood pressure due to testosterone's effects on these parameters 1

The American Heart Association notes that testosterone may increase blood pressure, triglycerides, and LDL cholesterol while decreasing HDL 1
Despite these metabolic changes, current data show little to no significant impact on cardiovascular mortality outcomes in transgender men 1
The risk of erythrocytosis increases with testosterone therapy, particularly with injectable formulations 1, 3
To reduce erythrocytosis risk, advise smoking cessation, weight loss if BMI is elevated, and consider switching to transdermal administration 1

The World Health Organization notes that injectable testosterone (enanthate, cypionate) may cause greater fluctuations in levels, with peaks potentially reaching supraphysiological ranges 3
Transdermal preparations (gels, patches) provide more stable day-to-day testosterone levels and may have lower risk of erythrocytosis 3
Weekly injectable dosing (50-100 mg) provides more stable levels than biweekly dosing (100-200 mg) 3