Testosterone Therapy for Women — Clinician Prescribing Guide
A practical prescribing workflow for testosterone therapy in women including routes, dosing, product selection, and breast cancer scenarios
The vaginal estrogen guides have been downloaded and shared widely since release. Thank you. The most consistent follow-up question, from both clinicians and the patients who forwarded those guides to their prescribers, has been about testosterone.
That question deserves a real answer. So today I’m releasing the next CHOICES clinician resource: an 11-page prescribing guide for testosterone therapy in women, including cancer survivors on endocrine deprivation therapy.
Why this guide exists
There is no FDA-approved female-dose testosterone product in the United States. Every prescription is off-label. Five countries — Australia, New Zealand, the UK, South Africa, and Italy — have approved female-dose formulations. The US has not. That regulatory gap is real, and it creates predictable problems in practice:
• Clinicians conflate microgram-range local vaginal testosterone with milligram-range systemic testosterone — two different interventions, different evidence bases, different clinical indications
• Prescriptions get written without clear route, concentration, or base specifications, leading to pharmacy confusion and callbacks
• Pellets get offered as a starting option before adjustable-dose forms have established a preferred dose
• Cancer survivors are told testosterone is off-limits, without distinguishing local-only tissue therapy from systemic treatment, or ER/PR-positive from non-hormone-positive context
This guide is not a review article. It’s a clinical workflow: when to consider testosterone, which route and dose for which symptom target, how to write the prescription so it clears the pharmacy, and how to sequence decisions in the cancer survivorship setting.
What’s inside
