Testosterone Therapy for Women: Which Delivery Method Is Right for You?

If you and your healthcare provider decide that testosterone therapy is appropriate for you, the next question may be:

How am I going to take it?

Testosterone can be administered in several different ways, and the method matters. Each has different advantages, disadvantages, dosing characteristics and levels of supporting evidence.

Here’s a look at some of the options you may hear about.

1. TRANSDERMAL TESTOSTERONE: CREAMS & GELS

Transdermal testosterone is applied to the skin, where the medication is absorbed into the bloodstream.

Pros

• No needles • Easy to use at home • Dose can generally be adjusted relatively easily • Treatment can be discontinued readily if necessary • Transdermal therapy currently has the strongest guideline support for women when testosterone therapy is appropriate

Cons

• Must be applied regularly • Absorption can vary between individuals • Testosterone can potentially transfer to another person through skin contact if appropriate precautions aren’t followed • Some patients simply don’t like using a cream or gel every day

For many women who are appropriate candidates for testosterone therapy, transdermal treatment is an important option to discuss with their provider.

2. SUBLINGUAL OR BUCCAL TESTOSTERONE

Sublingual preparations are designed to dissolve under the tongue, while buccal preparations dissolve in the mouth.

Pros

• No injections • Convenient • May appeal to patients who don’t want a topical medication

Cons

• Testosterone levels may fluctuate more than with some other delivery methods • Some of the medication may be swallowed rather than absorbed through the mouth • Troches and similar compounded preparations have less supporting evidence than transdermal testosterone for women • Compounded products may have greater variability than standardized, FDA-regulated products

For those reasons, “no needles” doesn’t necessarily mean “better.” Your provider should explain why a particular formulation is being recommended.

3. SUBCUTANEOUS (SUBQ) INJECTIONS

Subcutaneous injections place medication into the fatty tissue just beneath the skin.

Pros

• Uses a relatively small needle • May be easier for some patients to self-administer than an intramuscular injection • Doesn’t require applying medication to the skin every day • Dosing can be measured precisely

Cons

• Requires injections • Can cause irritation, bruising or discomfort at the injection site • Testosterone levels can fluctuate between doses depending upon the regimen • Injectable testosterone for women has less guideline support than physiologic transdermal therapy, and excessive dosing can produce testosterone levels that are too high

Careful dosing and blood-level monitoring are particularly important when injectable testosterone is used.

4. INTRAMUSCULAR (IM) TESTOSTERONE INJECTIONS

Intramuscular testosterone is injected into muscle tissue.

Pros

• Does not require daily application • Provides a measured dose • Familiar medication-delivery method

Cons

• Larger/deeper injection than SubQ administration • May be uncomfortable for some patients • Can potentially produce higher peaks and lower troughs in testosterone levels • Current expert guidelines generally do not recommend IM testosterone for treatment of HSDD in women because other approaches can more reliably maintain physiologic female testosterone levels

SO WHICH METHOD IS BEST?

There isn’t a universal answer.

The goal isn’t simply to find the easiest way to get testosterone into your body. The goal is to use an appropriate treatment—when indicated—at an appropriate dose while avoiding excessively high testosterone levels and monitoring both benefits and side effects.

Current international and women’s sexual-health guidelines give the strongest support to transdermal testosterone for appropriately selected women with hypoactive sexual desire disorder (HSDD). Other routes are sometimes used clinically, but the evidence and recommendations are not the same for every formulation.

That distinction is important when considering your options.

WHY BLOOD TESTING MATTERS

Testosterone therapy shouldn’t be “set it and forget it.”

Before beginning treatment, your provider may obtain baseline laboratory testing. Follow-up testosterone levels can then help ensure that treatment isn’t producing levels above the normal physiologic range for women.

Monitoring also gives your provider an opportunity to ask:

• Are your symptoms improving?

• Are you experiencing acne, increased facial hair, scalp hair changes or other unwanted effects?

• Does your dose need to change?

• Should treatment be continued?

Blood levels are only one part of the picture—the way you actually feel and respond to treatment matters too.

WE MAKE THE MONITORING PART EASIER

At our office, we have an advantage that makes ongoing hormone management especially convenient:

We can draw your blood right here.

That means your laboratory testing, follow-up and hormone management can all be coordinated through our office.

If you’re curious about testosterone therapy, the first step isn’t choosing between a cream and a needle.

The first step is determining whether testosterone is appropriate for you.

Schedule an appointment with Kim Lilly, NP. We’ll obtain the appropriate labs, review your medical history and symptoms, discuss the potential benefits and risks, and help you understand the options available to you.

Ready to learn more? Contact our office to schedule your labs and consultation with Kim Lilly, NP.

Educational information only. Testosterone therapy requires individualized medical assessment and monitoring. The FDA has not approved a testosterone formulation specifically for women in the United States. Current consensus guidelines identify hypoactive sexual desire disorder (HSDD) as the evidence-based indication for systemic testosterone therapy in appropriately selected women. Long-term safety data are limited.