Testosterone is widely believed to be available only in synthetic form. This is not true. A plain, "natural" bioidentical testosterone, USP, can be obtained by a compounding pharmacy to mix into various dose forms. A number of retail products also now use a human-identical formulation. Many pharmacies, even compounders, are not aware of this. You may have to shop around to find one familiar with the non-synthetic variation. There are various new testosterone hrts for women currently under development, but none of them have yet completed clinical trials and been approved for sale in the US. Currently-available testosterone patches are reservoir patches delivering male doses, which cannot be adjusted down to deliver a dose appropriate to a woman's needs.
Most of the commercial testosterones and most doctors' and pharmacists' familiarity with testosterone are focused on testosterone use in men. Some health care providers go so far as to state that women cannot use them for this reason, even though adjusting dose down to a woman's level is perfectly achievable with many formulations (although technically, yes, this constitutes an "off label" use). There is no difference between testosterone for men and testosterone for women other than the dose levels. It's very important, then, to double-check both the prescribed and filled doses we receive to be sure that they are correct for us, rather than a man, because of this one-sided familiarity. There are a number of testosterone formulations that cannot be adjusted for dose and are available only in male-sized increments; we have not listed all of these unsuitable brand names. If your testosterone isn't listed here, then, do be sure to carefully research the dose to make sure it's appropriate for a woman. And if you've found a new one that we can all use, do drop us an email with the name.
Use these links to go directly to a particular product, or peruse the entire list to look over the range available. This is not a definitive list, even for the US. New HRTs are being licensed all the time, and as older ones fall out of patent life, the generic versions come onto the market. We can't cover all of the generics, so you may need to figure out the proprietary form they are modeled on and work from that product information.
Note: Most pharmaceutical companies limit access to product websites according to the country a woman is browsing from. Because of this, it can be difficult to get information from the manufacturers about HRTs not specifically sold in our home countries. Many companies have dropped publication of their prescribing information brochures or have hidden them behind restricted professional access. We have linked to other sites that publish this where we can find them, and provided several references for most HRTs because so many links are lost over time. Some of the brand names in the discussion are direct links to pdf brochure downloads; you will need a program capable of reading a pdf file to open them. Where actual prescribing information is not available, we have linked to reputable sites providing their own discussion of the HRT. The information linked to and provided here may not contain everything a woman needs to know to use any particular HRT safely and effectively; please review use instructions and characteristics with your physician and pharmacist when beginning any new HRT.
Update note: The links here were checked and updated as of April, 2010, but they outdate rapidly and frequently. If you are having trouble opening an hrt link, try going to either drugstore.com or rxlist.com and doing a direct search there for either the brand or generic name. These sites generally publish the full FDA prescribing information accurately and fully.
Oral combo product with estrogen; synthetic:
- methyltestosterone in various forms
Transdermal bioidentical:AndroGel and Testim are both 1% bioidentical testosterone gels. Androgel's inert ingredients are listed as ethanol 67.0%, purified water, sodium hydroxide, carbomer 980 and isopropyl myristate. Testim also contains purified water, pentadecalactone, carbopol, acrylates, propylene glycol, glycerin, polyethylene glycol, ethanol (74%), and tromethamine. Being a 1% solution, that means that in 1 gm of gel there are 10mg of testosterone. Since women most typically use between 0.25-0.5mg per day (or even less), that means that to measure up a woman's dose you would need only a very tiny amount of the gel. This is why it's not convenient for women to use products blended for men, although with a syringe graduated in hundredths of a ml, it is doable with care. Don't try to do the math on this alone—have your pharmacist confirm any dose calculations to make sure that both of you are in agreement over where those slippery decimal points belong and exactly how much volume your dose should be measured out as. This is when a syringe rather than a measuring spoon is more or less obligatory. And your dose may not be precisely those numbers. According to the product sheets for both brands, "approximately 10% of the applied testosterone dose is absorbed across skin of average permeability during a 24-hour period." Do make sure, when you and your doctor are calculating your correct dose, then, that you take this into effect. The drug sheets also state that the gel may be applied to shoulders, upper arms and/or abdomen. The gel dries "quickly" after application and then is metered through the skin over the next 24 hours. A study on washing post-application showed that "the overall effect of washing was to lessen testosterone levels; however, when washing occurred two or more hours post drug application, serum testosterone levels remained within the normal range." In terms of person-to-person transfer, 15 minutes of skin contact from one to 12 hours after application led to a fourfold increase in baseline testosterone levels in the other party. This did not occur when clothing was applied 15 minutes after application and before skin contact. A generic manufactured by Watson Labs is also shown as available by the FDA. (more information)
Bioidentical testosterone can be made up in a variety of forms by a compounding pharmacy. While it can be made up in capsules, we are advised by pharmacists that you should specify a time-release formulation since oral testosterone is very easily eliminated by the liver. As with other human-identical formulations, testosterone can be converted into other hormones as the need arises. In fact, the sense of well-being and energy that many women report when beginning testosterone may be due to conversion of just enough into estrogen to top them off, and some women experience hot flashes or light sleep disturbances until they adjust to using it (it's a domino effect of hormonal adjustments and redirections). Since we normally produce about 0.3 mg a day, a dose of 0.25mg or 0.5mg per day is generally all we need. Many women take their testosterone only a few times a week and find adequate coverage that way while limiting their exposure to undesired effects. If you are prescribed your testosterone in a cream, be sure to discuss with your doctor exactly where it is to be applied. Some women apply it directly to the clitoris or vulva; others are told the inner thigh or, generally, anywhere the skin is thin and absorbent. There is some popular reporting that it can stimulate hair growth in the area where it is applied, although we have not seen scientific documentation of that yet. You might want to take this into account in your application choices, if it makes a difference to you. Because of the potential for conversion to estrogen, it is inadvisable to apply testosterone products on or near the breasts, and women who cannot or choose not to supplement their estrogen should for the same reasons not supplement their testosterone, since in a situation of estrogen deficiency, it is most likely to be utilized by the body as an estrogen source.
Estratest contains 1.25 mg of esterified estrogens and 2.5 mg of methyltestosterone; a half strength version called Estratest HS contains 0.625 mg and 1.25 mg respectively. We still occasionally hear of the misconception that this drug contains Premarin, which is partially explained by listings online that group this with Premarin but mostly because some years ago, there was a combined product marketed. But Estratest (and its generics, such as Syntest) does indeed contain only esterified estrogens, not conjugated equine estrogens as in Premarin. Esterified estrogens are synthesized from wild yams and soy, and deliver primarily (synthetic) estrone, the weaker estrogen found at highest levels after natural menopause. Methyltestosterone is a synthetic testosterone that is also available alone. As with any combination product, it is impossible to adjust the dose of one hormone relative to the other—your only adjustment option is to halve or double the dose of both. Nonetheless, this is the most heavily-promoted brand name testosterone, so women who ask for testosterone may be offered this as their only option. Because methytestosterone is very strong and the dose is relatively high, even in the HS version, women who have trouble with it often complain of developing symptoms of testosterone excess while suffering from estrogen deficit due to the weak estrogen. It's important, when taking any testosterone, to be familiar with the signs of excess and be prepared to adjust your dose to avoid masculinizing effects and health risks that may be irreversible. Note that the manufacturer of the brand name product, Estratest, has discontinued producing it. This same product remains available as the generic EEMT, however, and is often referred to by the brand name. (more information) is hard to track down in references, but its ingredients are listed as being the same as Estratest and Estratest HS.
Methyltestosterone is a synthetic testosterone that is not readily metabolized by the liver and hence is more effective for oral use than bioidentical testosterone. It comes in 10mg and 25mg tablets, doses suitable for men, under the brand name Android; it is available in capsules at that dose (even more difficult to adjust for female needs) under the brand names Virilon and Testred as well as an unnamed generic from Impax Labs. There have also been sublingual forms marketed at times by various companies. As of April 2010, the FDA has no prescribing information available through their website for any of these. There is a known linkage to liver cancer with high use—primarily use by transsexuals at over 30 times the dose in Estratest, which is approved for women. There is no intermediate measurement of whether or not it is doing other, more subtle liver damage other than the standard liver function profile. Because it is synthetic, it doesn't act quite the same way testosterone itself does. It has a strong affinity for androgen receptors, so it causes testosterone effects, but it also is fully capable of undergoing the process of "aromatization," which means a certain percentage of it converts to estradiol. Because of this, it is every bit as able to alter overall hormone balance as the bioidentical testosterones and it poses the same risks as taking estradiol itself. It's important, when taking any testosterone, to be familiar with the signs of excess and be prepared to adjust your dose to avoid masculinizing effects and health risks that may be irreversible. According to the American Association of Clinical Endocrinologists,
This weak androgen cross-reacts with the measurement of serum testosterone in most laboratory kits. Consequently, one might see a considerable elevation of the serum testosterone level that is a result of cross-reactivity of this weak androgen. In fact, when testosterone levels are measured after chromatographic separation from methyltestosterone, the administration of methyl-testosterone results in a reduction in the serum testosterone concentration.In other words, lab tests to measure efficacy of this hrt may give falsely high results.
Transdermal methyltestosterone can be made up in any dose. It carries the same profile as when taken orally, but the dose is more adjustable.