The primary use Dr. Ty discusses
Testosterone is not FDA approved for women’s perimenopause and menopause treatment. However, major societies widely recommend it for its primary use: postmenopausal hypoactive sexual desire disorder. Basically, that means low libido or loss of sexual desire.
Placebo-controlled meta-analyses have shown significant improvement in sexual desire, arousal, the frequency and quality of orgasms, and reduction of sexually related distress. That is its main use and what the major organizations and societies recommend it for.
We are also seeing data on fatigue, sleep, muscle definition, and bone health. Testosterone has been the forgotten hormone for women for a long time, but it plays an important role.
Testosterone for women is dosed differently
The formulation of testosterone for women is going to be significantly lower than what men take. Getting it commercially at a normal pharmacy is tricky because it is difficult to dose correctly.
Insurance almost never approves testosterone for women. If we can get it approved or obtain it at a decent price from a local pharmacy, we have to significantly reduce the amount used. That is less precise, but it is doable.
The main way I prescribe topical testosterone is through compounding pharmacies that make it and gear it toward women.
Why Dr. Ty recommends topical testosterone
There are other forms of testosterone, including injections and pellets. The data leans toward topical testosterone and recommends the topical form.
Topical testosterone is better studied. It has longer-term data. It is also more consistent.
With injections and pellets, we tend to see very high levels followed by very low levels. Testosterone can rise far above what we would recommend for women, and then it drops.
The time delay creates another problem. If you have a pellet, you have to wait until that pellet runs out before inserting another one. A huge part of that interval can become a big dip.
I recommend topical testosterone. Leading societies and recent data recommend the topical form as well.
How Dr. Ty monitors testosterone
Testosterone is the one lab that we absolutely do need to monitor. I do not need to test testosterone levels before beginning treatment, although I can.
At six to eight weeks on a consistent dose, testosterone reaches its steady state in the blood. That is also when you should know whether the dose is working for you. That is when we get a level.
The main reason is to make sure we do not overshoot. If testosterone becomes too high in women, the risk is male-pattern symptoms: facial hair, hair in places you do not want it, and voice deepening. Those are things we want to avoid.
Side effects Dr. Ty watches
With topical testosterone, the biggest side effects occur at the application site. Some women experience irritation. Some develop temporary skin changes, including acne. That is not common, it usually goes away, and it is something we can address if it happens.
Some women experience temporary hair loss. That typically resolves, but it is also something we monitor closely. Otherwise, topical testosterone is pretty well tolerated.
Why application technique matters
Topical testosterone is very important in how you apply it.
Many things that we put on or inject into the body are absorbed subcutaneously, through fat, or through muscle. Testosterone is not absorbed that way. In the way it is formulated, it is absorbed in the top layer of the skin.
Surface area is important, and using the same kind of location is important. You need to keep things symmetrical.
If you apply testosterone to your upper buttocks or outer hip, and you use your right side, make sure you also use your left side. Do not use the right buttock one day and behind the knee the next. Keeping the areas symmetrical keeps the same kind of skin and supports consistent absorption throughout the day.
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