Testosterone online prescribing beyond physiologic female levels
November 26, 2025
Testosterone online prescribing beyond physiologic female levels
Another potential hormone overdose-online health clinics doctors prescribing large doses of Testosterone and achieving “young man” blood serum levels
Women need one-tenth to one-twentieth of a male dose.
Men 18–25 years of age make about 4–8 mg of testosterone per day.
Women make about 0.25–0.5 mg per day of testosterone by comparison.
A troubling trend has developed over the last 3 years-online “health” clinics are popping up all over and women are receiving supraphysiologic doses of Testosterone to achieve energy, regain lost sex drive, and get their mojo back.
Further underscoring this growing problem, New York Times journalist Susan Dominus recently reported multiple cases of women being prescribed testosterone doses far beyond physiologic female levels — in some cases approaching the levels seen in young men. In her interviews, women described dramatic side effects, including chunks of hair falling out, deepening of the voice, facial hair growth, irritability or rage, and dangerously elevated blood viscosity*. As Dominus emphasized, these high doses are often promoted by cash-pay online clinics operating outside FDA-approved indications, with no standardized monitoring and no long-term safety data.
Her reporting reinforces what I see in practice: women are being harmed not by hormone therapy itself, but by inappropriate, excessive, and unmonitored testosterone prescribing.
Dr David Zava founder and chief scientist at ZRT lab states: “The BIG problem with Testosterone is that serum testing is used to measure and assess tissue levels, which is the wrong body fluid. It underestimates by 5-10 fold the amount of Testosterone available to tissues, and so reflexively results in dose escalation and side effects. It’s really only when dosing is excessive, and in the absence of physiological estradiol and progesterone. Estradiol and progesterone both counter each other and Testosterone (e.g. estradiol down-regulates cellular Androgen receptors and increases SHBG-sex hormone binding globulin-which lowers bioavailable Testosterone; progesterone competitively inhibits 5-alpha reductase which diminishes Testosterone metabolism to DHT, the more active androgen)”.
The consequences of excess dosing of Testosterone to women can be permanent and include:
- Irreversible voice deepening
- Irreversible clitoromegaly
- Facial hair
- Cystic acne
- Scalp hair loss
- Aggression, rage, mood instability
- Insulin resistance
- Elevated LDL
- Liver strain
- *Increased blood thickness and potential risk of blood clots, heart attack, and stroke
*High testosterone levels in women can affect blood thickness (viscosity) by increasing red blood cell production, a condition known at polycythemia or erythrocytosis that can lead to a higher hematocrit (the percentage of blood volume occupied by RBC) and blood viscosity. This makes the blood thicker and can increase the risk of blood clots, heart attack, and stroke. Medical professionals must manage this risk through regular monitoring of hematocrit levels and can adjust treatment or recommend blood donation to reduce thickness.
This happens because serum does not reflect topical testosterone, levels appear falsely low, and doses are escalated repeatedly. Women overdosed on testosterone “look normal” in serum.
Saliva and capillary blood reflect true tissue levels and bioavailable hormone
If you test the wrong bodily fluid → you get the dose wrong → and the wrong outcome.
Hormones are lipophilic. (Fat loving)
Serum is hydrophilic. (Water loving)
Estradiol, progesterone, and testosterone move into the fatty tissues, cell membranes, salivary glands, capillary beds, and red blood cell membranes.
They do not accumulate meaningfully in watery venous serum unless they are bound to binding proteins-in the case of Testosterone this is SHBG-Sex Hormone Binding Globulin-the same binding protein that binds Estradiol. The hormone must shed its binding protein before it can be in its bioavailable form.
Expert commentary relying solely on serum labs (including recent podcasts, articles, and online clinical programs) continues to misinterpret real-world pharmacology/biochemistry of bioidentical hormones.
Over my 25 year hormone practice, all too often I have seen doctors prescribe male testosterone hormone products to women (There is no FDA-approved testosterone product specifically for women in the United States).
Susan Davis, MD from Australia advocates using a Testosterone patch. (https://pubmed.ncbi.nlm.nih.gov/16735935/- In this study, transdermal testosterone therapy via a skin patch improved sexual desire and other sexual function domains.)
In low dose topical physiologic dosing* Testosterone is applied topically and bypasses the liver. AndroFeme 1 is a testosterone cream approved for use in Australia to treat hypoactive sexual desire dysfunction (HSDD) in postmenopausal women.
*Recent literature supports the concept of physiologic testosterone dosing in women when appropriately prescribed. A 2019 Global Consensus Statement endorsed doses that approximate premenopausal female testosterone concentrations as beneficial for symptoms such as hypoactive sexual desire disorder. Moreover, Donovitz (2022) highlights that physiologic dosing has the potential for benefits beyond libido — including bone health, brain protection and metabolic wellness. Smaller clinical reviews have also demonstrated improvements in mood and cognitive function with transdermal testosterone in postmenopausal women.
So where are the FDA approved testosterone products for women?
Fortunately, practitioners who understand hormone physiology are now prescribing low-dose, topical testosterone in true female physiologic ranges, with compounding pharmacies preparing individualized formulations. Although I no longer compound these therapies myself, I collaborate closely with compounding pharmacies to consult with their patients and ensure proper follow-up using salivary or capillary blood spot testing.
Of note in this discussion is the women’s RX libido drug Addyi, which treats the condition known as “hypoactive sexual desire disorder”, or H.S.D.D., in premenopausal women. Sometimes erroneously referred to as “female Viagra” — Addyi targets neurotransmitters, not blood flow — its proper name is flibanserin, which works by balancing the brain chemicals that influence sexual desire, a process that involves both increasing dopamine and norepinephrine while decreasing serotonin, to improve a woman's "pro-desire" mindset rather than working on hormones. Common side effects include dizziness, somnolence, fatigue, and nausea, and alcohol must be avoided due to a risk of severe hypotension and syncope.
30 tablets of Addyi cost $299, and that’s Good Rx-most pharmacies will charge over $1000 for 30!! Insurance does not cover it. Hmmmm…Viagra and Cialis are covered on insurance!!
These findings make one thing unmistakably clear: when testosterone — or any human-identical hormone — is prescribed physiologically, balanced appropriately, and monitored correctly, hormone therapy becomes a safe, transformative, and profoundly effective tool for women’s health.
Stay tuned for my upcoming podcast on Women Talking Frankly in February 2026 (TBD)
Want to learn more about hormone therapy? Click here. Interested in at-home hormone testing? Click here!
References
Dominus S. “Testosterone for Women: What You Need to Know.” The New York Times. (2025). Also discussed in: Dominus S. Interview on Vox Podcast — “Testosterone for women, aging, menopause, libido, muscle health, energy.” November 10, 2025.
Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660-4666
Donovitz GS. A Personal Perspective on Testosterone Therapy in Women: A Focus on Physiological Dosing. Post Reprod Health. 2022;28(1):65-76.
Davis SR. Review: Testosterone in Women — The Clinical Significance. Women’s Health (Lond Engl). 2015;11(5):571-581.
Glynne S, et al. Effect of Transdermal Testosterone Therapy on Mood and Cognitive Function in Post-Menopausal Women. PMC. 2024.