Testosterone Dosing for Females

Introduction to Testosterone Therapy

The standard testosterone dosing for masculinizing gender-affirming hormone therapy in transgender men and non-binary individuals assigned female at birth targets serum testosterone concentrations in the typical cisgender male reference range (approximately 300-1000 ng/dL), with effects on hemoglobin, voice, body composition, and sexual characteristics occurring within 3-12 months 1, 2, 3, 4

Standard-dose testosterone therapy is administered to achieve male-range testosterone levels, with expected physiological changes including hemoglobin increase to male reference range within 3 months, voice deepening, facial/body hair growth, menstrual suppression, clitoral growth, and increased muscle mass with decreased fat mass 1, 2, 3, 4
Injectable formulations, such as testosterone enanthate or cypionate, are administered at 100-200 mg intramuscularly every 2 weeks, or 50 mg weekly, while testosterone undecanoate (long-acting) is administered at 750 mg initially, followed by 750 mg after 4 weeks, then 750 mg every 10 weeks 5, 6, 7
Low-dose testosterone may be used for non-binary individuals desiring gradual, partial masculinization, using reduced doses of the same formulations to achieve more androgynous effects 1, 2, 4

For masculinizing therapy, target testosterone levels in the cisgender male reference range (500-600 ng/dL mid-cycle for injections), and monitor hemoglobin/hematocrit, expecting an increase to male range within 3 months, as well as assessing for adverse effects such as polycythemia, reduced HDL cholesterol, acne, androgenic alopecia, pelvic pain, and potentially increased myocardial infarction risk 1, 2, 3, 4

High testosterone doses inevitably cause virilization in cisgender women seeking treatment for sexual dysfunction 8
Cardiovascular risk considerations include conflicting evidence regarding cardiovascular safety, with some studies suggesting increased myocardial infarction risk in transgender men, though data remain inconclusive 1, 2, 3, 4
The FDA required labeling changes in 2015 regarding potential cardiovascular risks, though this primarily addressed age-related hypogonadism treatment 5, 6, 7