Compounded Testosterone Options for Women: What Patients and Providers Should Know

By: Alana Leavell, APRN; FNP-C

Compounded Testosterone Options for Women: What Patients and Providers Should Know

Testosterone is not often the first hormone that comes to mind in women’s health, but for many women, it should be part of the conversation.  While estrogen and progesterone tend to dominate discussions around hormonal balance, testosterone plays a meaningful physiologic role in women throughout their lives, with published data examining its relationship to energy, mood, libido, muscle maintenance, and cognitive function. ¹

Unlike men, who experience a gradual decline in testosterone over decades, women can begin to see measurable declines in androgen levels before age 40; often well before any formal menopause diagnosis.²  Despite this, there is currently no FDA-approved testosterone product indicated specifically for women in the United States. In situations like this, compounded formulations are a key tool for individualized care.

Why Delivery Route Matters More Than You Might Think

When testosterone is prescribed for women, it is used off-label, and the formulation a provider selects can meaningfully influence how the hormone behaves in the body.  Currently, compounded testosterone for women is available in several forms including topical creams, subcutaneous pellets, injectable preparations, and sublingual troches.³ Each has distinct pharmacokinetic profiles, dosing considerations, and patient experience factors.

Topical creams allow for dose flexibility and can be adjusted easily.  However, this requires daily application, and the medication can be transferred to partners or children if skin-to-skin contact occurs.⁴

Pellets are another option. These small, rice-sized implants are placed just under the skin and release testosterone steadily into the bloodstream over three to six months after a minor in-office procedure. Many patients value the consistent dosing, but pellets are more expensive, require a procedure with brief activity restrictions, and cannot be removed or adjusted once inserted.³

Injectables provide reliable systemic delivery and allow for dose precision.  Fear of self-injection remains a significant barrier for many women, both practically and psychologically.³

Sublingual troches dissolve under the tongue, offering an alternative for patients who prefer to avoid topical or injectable administration, though absorption patterns can vary between individuals.³

Understanding DHT: Why the Delivery Route Conversation Goes Deeper

One aspect of testosterone therapy that is increasingly relevant, but often overlooked in clinical practice, is the relationship between delivery route and dihydrotestosterone (DHT) conversion.  DHT is a potent androgen metabolite formed when the enzyme 5-alpha reductase converts testosterone.  The reason this matters is that the skin itself is rich in 5-alpha reductase activity.    When testosterone is applied topically, a portion of it is converted to DHT locally at the skin level before ever reaching systemic circulation.  Testosterone injections, pellets and troches by contrast, bypasses this dermal conversion pathway entirely, resulting in a different DHT-to-testosterone ratio in the bloodstream.⁵

For patients and providers, this distinction has practical relevance. Androgenic side effects sometimes associated with testosterone therapy like acne and hair thinning, are largely mediated by DHT activity at the level of the skin and hair follicle.^6,7  Understanding that topical routes may generate relatively higher local DHT exposure compared to other routes can help guide delivery method conversations, particularly for women who report these side effects or who have a personal or family history of androgenic sensitivity.

This is not a basis for categorically preferring one route over another, but it is a layer of clinical nuance worth factoring into individualized prescribing decisions.

Individualized Care Is the Standard — The FDA Agrees

In November 2025, the FDA initiated the removal of boxed warnings from menopausal hormone therapy products. Revised labeling, approved in February 2026, removed risk language related to cardiovascular disease, breast cancer, and probable dementia, based on evidence the agency determined was no longer consistent with those warnings.  Labeling now explicitly frames treatment initiation and duration as individualized decisions made between the prescriber and patient.⁸

While this action focused on commercial estrogen-containing products, and no FDA-approved testosterone formulation for women currently exists, the underlying principle extends to testosterone therapy.³ Hormone therapy decisions should consider each patient’s symptoms, timing, personal risk factors, and treatment goals. Shared decision-making between the patient and provider, grounded in physiologic dosing and appropriate monitoring, remains the standard of care.

A Note on Benefits, Risks, and Monitoring

Published data examining testosterone therapy in women have explored associations with improvements in sexual function and quality of life, particularly in the context of hypoactive sexual desire disorder.¹  Research into broader effects on energy, mood, and body composition continues to evolve.  It is equally important, however, that patients and providers understand the known risks, which can include acne, unwanted hair growth, voice changes, and effects on lipid profiles with prolonged use.¹

Compounding offers the ability to tailor dose, delivery method, and formulation to the individual’s medical needs.  For women navigating hormonal changes at any stage of life, that flexibility can make a meaningful difference in whether they stay on therapy and feel well doing it.