Testosterone in women: Androgenic adverse events and lab monitoring

In this video, Sharon J. Parish, MD, IF, NCMP, notes that, according to Australian clinicians she spoke with at an International Menopause Society meeting, the package insert for the Australian cream allows levels up to 50% above the reference range when women have no adverse androgenic effects. A single variable reading, she adds, does not require stopping therapy.

She stresses that monitoring cannot rely on blood tests alone, and clinicians must ask every patient about adverse androgenic effects. Mild hirsutism occurs in about 15% of women, and a small amount of acne may also occur. These can be managed if levels are in range and hair growth is not male pattern. Hair loss is less clearly linked to physiologic dosing and should prompt evaluation for overdosing. Voice deepening, clitoral enlargement, male-pattern hair growth, or significant hair loss signal overdosing even when blood levels look acceptable, and some of these effects may not be reversible.

For testing, Parish recommends total testosterone from a standard laboratory, with liquid chromatography-mass spectrometry if results are unusual. Blood should be drawn in the morning, at least 12 hours after application and away from the application site. She describes a 3- to 6-month trial to assess response and reevaluation every 6 to 12 months, given limited long-term safety data.

Bruce Dorr, MD, FACOG, URPS, IFMCP, tells patients they often need more time rather than more testosterone. Parish agrees, returning to Helen Singer Kaplan's description of the fine line between benefit and adverse effects. Restoring desire, she explains, requires upregulating brain receptors and pathways, which takes time. The clinicians also discuss local androgen therapy for genitourinary symptoms of menopause, including compounded estrogen-testosterone cream in nonsystemic amounts and intravaginal prasterone, noting that tissue effects take months. Dorr closes by emphasizing that careful evidence and open-minded clinical inquiry both matter.