Testosterone Cream Therapy for Postmenopausal Women with Hypoactive Sexual Desire Disorder (HSDD)

Indication & Patient Selection

Off‑label use of male testosterone cream is considered reasonable for postmenopausal women with HSDD confirmed by a formal biopsychosocial assessment that excludes relationship problems, mental‑health disorders, and other modifiable factors【1】.
The only evidence‑based indication for testosterone therapy in women is postmenopausal HSDD after such assessment【1】.

Women with high cardiometabolic risk were excluded from the randomized trials; therefore safety in this group is unknown【1】.
The majority of trial participants were concurrently receiving estrogen therapy, limiting the applicability of results to estrogen‑naïve patients【1】.

When FDA‑approved female testosterone products are unavailable, off‑label prescribing of male testosterone cream is acceptable provided the resulting serum concentrations remain within the physiologic female range【1】.
Compounded “bioidentical” testosterone is not recommended because of insufficient efficacy and safety data; if unavoidable, the compounding pharmacy must adhere to Good Manufacturing Practice standards for purity and quality【1】.
Testosterone pellets and injectable formulations should be avoided because they produce supraphysiologic serum levels【1】.

Obtain a baseline total testosterone level before initiating therapy to serve as a reference for subsequent monitoring【1】.

Re‑measure total testosterone 3–6 weeks after starting treatment to verify that levels are within the physiologic premenopausal range (≈ 20–70 ng/dL total testosterone)【1】.
Adjust the daily dose if the level is supraphysiologic or remains below target【1】.

Assess clinical response and screen for signs of androgen excess (acne, hirsutism, voice deepening, clitoromegaly, male‑pattern hair loss)【1】.
Measure serum total testosterone at each 6‑month visit to detect over‑use【1】.
Discontinue therapy if the patient experiences no benefit after 6 months of treatment【1】.

Safety data for physiologic‑dose testosterone in women are limited to 24 months of use; longer‑term cardiovascular, metabolic, and oncologic safety remain unknown【1】.