The Labs, the Timing, and What “Normal” Actually Means
Monitoring usually starts with a total testosterone blood test before treatment, again 3–6 weeks after starting, and after any dose change. Once stable, US guidance says every 4–6 months. The Global Consensus says every 6 months. The British Menopause Society says 6–12 months. The test prevents too much exposure. It does not diagnose low desire or predict who will benefit.
You’re noticing voice changes, real hair loss, or genital changes right now.Some of those changes may not reverse. This page can wait. That can’t.
We’d rather lose you as a reader than have you finish an article while something that may not undo gets further along.
Testosterone monitoring at a glance
A comparison of published guidance, verified . Not a testing order for you.
When
What’s usually checked
Why
Before you start
Total testosterone. Several US protocols also add SHBG, liver function, and a lipid panel
Set a baseline and catch a high starting level
3–6 weeks after starting
Total testosterone + how you feel + side effects
Catch too much, early
After any dose change
Repeat total testosterone
The change reset the clock
Once steady
Every 4–6 months (US-oriented) or every 6–12 months (UK)
Confirm you’re still in the female range
Every visit
Benefit, distress, acne, hair, voice, skin transfer
A number alone can’t tell you it’s working
Around 6 months
The honest checkpoint
If it hasn’t meaningfully helped, guidance says stop or reconsider — not increase
About The HRT Index
The HRT Index is the independent decision resource for online menopause and HRT care—comparing telehealth providers on clinical legitimacy, care quality, medication fit, price transparency, and access, with every claim verified and dated. The right provider depends on your symptoms, uterus status, route preference, risk history, insurance situation, and state. Use Find My HRT Path to match your situation before your first consult.
Affiliate disclosure:The HRT Index may earn a commission if you start care through a labeled link on this page. It does not change the facts below or the standards we apply. You’ll see us name a partner we checked and then tell you not to use it for this. How we’re funded.
How does testosterone monitoring vary by guideline?
Answer:Five clinical or government guidance documents publish monitoring instructions, and they do not use one identical schedule. The first recheck clusters at 3–6 weeks. The ongoing interval ranges from every 4 months to every 12 months. They also disagree on whether liver and lipid tests are routine.
You’ve probably read three pages and gotten three answers. You assumed one of them was wrong. You didn’t. They’re all real. We read the source documents—not other people’s summaries of them—and put the monitoring instructions side by side.
The clinical and government guidance
Source
Baseline labs
First recheck
Once stable
Liver + lipids?
Global Consensus (2019)
Total testosterone
3–6 weeks
Every 6 months
Not specified
ISSWSH (2021)
Total T + SHBG
3–6 weeks; repeat within 6 wks of any dose increase
Every 4–6 months
Yes, at baseline
ACOG (2023)
Advises testing patients already using pellets or compounded testosterone
Not specified
Cites 20–80 ng/dL as the physiologic premenopausal range
Not specified
US Dept. of Veterans Affairs (Mar 2025)
Total T + SHBG + liver function + lipid panel
3–6 weeks, and after any dose change
Every 4–6 months
Yes, at baseline
British Menopause Society (May 2026)
Total testosterone
3–6 weeks (BMS calls this aspirational; most NHS clinics review at 2–3 months)
Every 6–12 months
No — says routine lipids or FBC not needed at female doses
Sources read directly and verified . ACOG’s 2023 consensus addresses compounded hormone therapy and does not publish a full timing schedule comparable to the other four.
Look at the spread.
Your ongoing check could be every 4 months or every 12. The VA—a US government body—says draw liver function and lipids at baseline, while the British Menopause Society, writing 14 months later, says routine safety bloods aren’t needed at these doses. Neither is careless. They were written for different health systems and weigh the same thin evidence differently.
So what should you use?
The three US-oriented documents share the same shape: baseline → 3–6 weeks → every few months.But even they aren’t identical. The Global Consensus says six months. ISSWSH and the VA say every 4–6. If your clinician follows a different schedule, that doesn’t make them wrong. It makes it a fair question. And now you know enough to ask it without sounding like you’re accusing anyone of anything.
Does your plan have a clear next check?
You now know what the published schedules say. The harder question is where your care sits against them. Free, no email, nothing stored—compares your dates to each published schedule and prints a question sheet you can hand to your clinician.
Answer: Testosterone levels are not used to diagnose HSDD and do not predict treatment efficacy. No cutoff level for any circulating androgen separates women with sexual dysfunction from women without it. The test exists to establish a baseline and to confirm treatment has not pushed levels above the normal premenopausal range.
HSDD(hypoactive sexual desire disorder) is the clinical term for low sexual desire that causes real personal distress—and it’s the only use of testosterone in women that the evidence supports. Major guidance treats it as a diagnosis made after a proper assessment has looked at your relationship, your mental health, your other medications, and your medical history first. Here’s what four separate bodies say about the blood test:
Source
Can it diagnose HSDD?
Does it predict benefit?
What it’s for
Global Consensus (2019)
No
No
No androgen cutoff separates women with and without sexual dysfunction
ISSWSH (2021)
No
No
Baseline, then keep levels in the premenopausal range
VA (Mar 2025)
No — levels “are not used to diagnose HSDD and do not predict treatment efficacy”
No
Baseline; confirm you don’t exceed the physiologic premenopausal range
BMS (May 2026)
No
No
Establish a baseline; make sure levels aren’t already high before starting
Verified .
There is no number that means you need this.
So why draw blood at all? Two reasons, and only two:
To catch a high starting level.Under the VA’s protocol, a baseline in the mid-to-high range suggests your symptoms are unlikely to be about testosterone, and therapy shouldn’t be started.
To make sure your dose hasn’t overshot.That’s it.
Your clinical response—did it help, are you getting side effects—sits alongside the number. Neither one works alone.
Why “optimizing” your level isn’t the goal
If a clinic tells you they’ll get your testosterone to an optimal number, they’re describing something the evidence doesn’t support. ISSWSH cites evidence suggesting a bimodal effect: above the recommended physiologic range, sexual desire may actually decrease. “Higher is better” is not what the guideline says—and it may be backwards at the exact thing you came for.
While we’re being honest about what this does
A 2019 systematic review and meta-analysis pooled 36 randomized trials and 8,480 participants. The result for transdermal testosterone versus placebo: roughly one additional satisfying sexual event per month, along with reduced sexual distress and improvements in desire, arousal, orgasm, and self-image. One event a month. Statistically significant, and for a lot of women it genuinely matters. It’s also not what the internet promises.
And the energy, the brain fog, the muscle? The British Menopause Society (May 2026): randomized trials “have not demonstrated the beneficial effects of testosterone therapy for cognition, mood, energy and musculoskeletal health.” The VA says off-label use for bone density, mood, or cognition is not recommended due to lack of evidence of benefit.
BMS reported in May 2026 that a UK trial called ESTEEM—400 participants, funded by the National Institute for Health and Care Research—had recently commenced, looking at menopause quality of life as its main outcome. No results were available when we checked. We’d rather you hear that from us than find out in month six.
Which blood tests should be checked before testosterone therapy?
Answer: Baseline total testosterone is the strongest point of agreement across all five guidance documents. Several US-oriented protocols also include SHBG, liver function, and a lipid panel. The British Menopause Society does not treat routine safety bloods as necessary at female testosterone doses.
Test
Who asks for it
Why
Total testosterone
All five
The one thing everyone agrees on. Catches a high starting level and gives you something to compare to later.
SHBG
ISSWSH, VA (routine); BMS (in specific situations)
Helps explain a poor response or unexpected side effects
Liver function
ISSWSH, VA
Safety baseline. BMS says not needed routinely at these doses.
Lipid panel
ISSWSH, VA
Safety baseline. BMS says not needed routinely at these doses.
Verified .
If your clinic drew only total testosterone, that’s within one legitimate reading of the evidence. If they drew all four, that’s within another. What isn’t fine is nobody being able to tell you which one they follow, or why. That’s a real question you can ask, and the answer will tell you a lot.
What is a normal testosterone level for a woman?
Answer:There is no universal treatment target. ACOG cites 20–80 ng/dL as the physiologic premenopausal range for women on testosterone therapy. Quest Diagnostics reports 2–45 ng/dL as its adult-female reference interval for LC-MS/MS test 15983. Those figures answer different questions and are not interchangeable.
This is why “your levels are normal” landed with a thud. The sentence isn’t wrong. It’s incomplete.It’s missing its second half: normal by which range, on which test, for what purpose.
The ranges, side by side
Source
Population / context
Method
Reported interval
A treatment target?
ACOG (2023)
Women on menopausal testosterone therapy
Not specified
20–80 ng/dL
A physiologic premenopausal range to stay within—not a universal lab interval
Quest Diagnostics (test 15983)
Adult women, general
LC-MS/MS
2–45 ng/dL
No — a reference interval for that assay
Clinical Chemistry review (2023)
Adult women, general
LC-MS/MS
8.7–46 ng/dL (0.3–1.6 nmol/L)
No — a reference interval
Guay et al. (ISSWSH) — ages 20–29
Healthy premenopausal women, no sexual complaints
Historical cohort
45.5–57.5 ng/dL
No — historical cohort values
Guay et al. — ages 30–39
″
″
27.6–39.8 ng/dL
No
Guay et al. — ages 40–49
″
″
27.0–38.6 ng/dL
No
Assembled from the named primary sources and verified .
A real example. Say your result is 50 ng/dL.
ACOG:inside the 20–80 ng/dL physiologic premenopausal range.
Quest’s reference interval for test 15983: above range.
Both are correct. They’re answering different questions. If nobody named the range and the assay for you, you got a number, not an interpretation.
The correction almost nobody makes
You’ve read that women lose about half their testosterone by menopause. Testosterone concentrations dodecline across the reproductive years—but cross-sectional data hasn’t shown a discrete fall caused by natural menopause itself. The drop happens gradually, on the way there, not at the door.
The big exception: surgical menopause. ISSWSH cites data showing women who had both ovaries removed had substantially lower total and free testosterone than age-matched women who reached menopause naturally.
If levels don’t fall at menopause, and no level diagnoses anything, then testing was never about finding a deficiency. It’s a safety check on your dose. A clinic using one low number to diagnose a testosterone deficiency is using the test for a purpose the major guidance doesn’t support.
Which testosterone test should you ask for?
Answer:Ask whether your total testosterone will be measured by LC-MS/MS. Quest test 15983 and LabCorp test 070001 are current examples built for the lower concentrations typical in women. Quest’s own clinical guidance states that immunoassay is highly unreliable at the low total testosterone concentrations present in women and should not be used.
Here’s the most useful thing on this page. Screenshot it.
Lab
✅ Built for female levels
❌ Not this
Quest Diagnostics
Test code 15983— Testosterone, Total, LC/MS/MS (CPT 84403)
Standard testosterone immunoassay
LabCorp
Test 070001— Testosterone, Total, Women, Children, and Hypogonadal Males, LC/MS-MS
Test 004226— Testosterone, Total (immunoassay)
Pulled from each laboratory’s own test directory, .
📋 What to look for on your lab report
•The words “LC/MS” or “LC/MS-MS” near the test name
•The test code
•The units—US labs use ng/dL; UK labs use nmol/L (1 nmol/L ≈ 28.8 ng/dL)
If the method isn’t printed on the report, ask the lab or your clinician which assay was used. Don’t guess it from the reference range.
Why the routine test fails women
LC-MS/MS(liquid chromatography–tandem mass spectrometry) is sensitive enough to measure the very low testosterone levels women actually have—roughly one-tenth of a man’s. The routine test, an immunoassay, performs poorly at those concentrations.
⚠️Quest, on its own clinical education page: immunoassay “is highly unreliable with the low TT concentrations present in women and should not be used.”
⚠️LabCorp, on its own page for test 004226 (the routine one): for females, use 070001 instead.
✔️LabCorp states that 070001 has been certified by the CDC’s Hormone Standardization Program—an outside quality check most tests don’t carry.
A peer-reviewed Clinical Chemistry review explains the mechanism: DHEAS—another hormone circulating at far higher concentrations—looks similar enough that the antibodies grab it too, producing a falsely high result. High SHBG can make some immunoassays read falsely low.
What it costs
Quest listed its direct-purchase testosterone test at $69 plus a $6 physician service fee when we checked on . Eligibility, state restrictions, and insurance coverage vary. Coverage for compounded testosterone, visits, and lab work depends on the product, provider, pharmacy, and plan—confirm each one separately before you pay.Midi’s own patient materials say most insurance plans don’t cover compounded medications.
Can testosterone gel make your blood test read falsely high?
Answer: Yes. Applying testosterone gel at or near the site where blood is drawn can contaminate the sample and produce a markedly elevated result. Record where and when you last applied, and avoid applying near the arm used for the draw.
A Clinical Chemistry review notes a case where a lab technician’s own gel use contaminated quality-control samples—the ones the lab runs to check that the machine is working. Because the gel is enormously more concentrated than blood, even a trace near the draw site can produce a markedly increased result.
What a contaminated result looks like in practice:
Your result comes back high. Your clinician does the responsible thing and cuts your dose. You feel worse. Nobody knows why. The gel was on your arm.
The blood-draw log — write these six things down
Record
Why it matters
Product name
Compounded and manufactured products behave differently
Application site
The single biggest contamination variable
Date and time of last application
Levels depend heavily on time since application
Which arm they drew from
So you can rule contamination in or out
Assay used
LC/MS-MS or immunoassay changes what the number means
Units and reference range
A number without these is not a result
Should you skip your dose that morning?Don’t invent a rule. UK guidance from NHS Highland advises women to omit the testosterone dose before a blood test because it can give a falsely high result. But absorption differs by product, and your prescriber’s protocol may differ. Ask your prescriber and follow their instruction—not a rule from the internet, including ours.
What is SHBG, and why does it change the picture?
Answer:SHBG—sex hormone-binding globulin—is a protein that binds much of the testosterone circulating in your blood and changes how a total testosterone result should be read. US-oriented guidance generally includes SHBG at baseline. The British Menopause Society treats it as supportive information in specific situations rather than a routine test.
Question
VA (Mar 2025) / ISSWSH (2021)
BMS (May 2026)
Routine SHBG at baseline?
Yes
Not routine — useful in specific situations
High SHBG means?
Associated with a lower likelihood of response
May explain a poor response despite a normal total
Low SHBG means?
—
May explain androgenic side effects despite a normal total
Oral estrogen consideration?
Named as a cause of raised SHBG
Consider switching oral → transdermal estrogen
Raise dose above physiologic range to overcome high SHBG?
No
No
Verified .
High SHBG
Elevated baseline SHBG is associated with a lower likelihood of respondingto testosterone. It’s raised by oral estrogen (especially conjugated estrogens), thyroid replacement, and untreated overactive thyroid. The BMS suggests considering a switch from oral estrogen to transdermal estrogen when oral estrogen is driving SHBG up—that can lower SHBG and change how much testosterone is available, without adding any testosterone at all.
Low SHBG
Low SHBG may explain androgenic side effects when your total testosterone is within range. Acne. Hair growth. A normal number. It’s associated with type 2 diabetes, metabolic syndrome, and higher body weight. If you’ve been told “your labs are fine, so it must be something else” while your skin is telling you otherwise—there’s a real mechanism here. Both ISSWSH and the BMS name it explicitly. See also: Testosterone side effects in depth.
The one thing that isn’t the answer:
Do not let anyone raise your testosterone above the female range to “overcome” high SHBG. The VA: increasing the dose beyond the physiologic range to overcome elevated SHBG is not recommended. ISSWSH says the same. It walks you straight into the side effects.
Does the route change the monitoring?
Answer: Yes. Transdermal testosterone at roughly one-tenth of a male dose is the route major consensus guidance prefers, because it can be adjusted toward physiologic levels and has the strongest evidence base. Pellets and injections can produce supraphysiologic concentrations and are not recommended when they do.
Route
FDA status in the US
Adjustable after you take it?
Overshoot concern
Guidance position
Transdermal cream/gel
No FDA-approved female product; off-label or compounded
Yes — daily, immediately
Possible; still needs monitoring
Preferred route
Pellets
No FDA-approved female product
No — removal needs a procedure
Early peaks above 100–250 ng/dL documented in studies
Not recommended
Injections
No FDA-approved female product
No — not until it wears off
Wide swings well beyond physiologic levels (ISSWSH)
Not recommended
Oral / troches / lozenges
No FDA-approved female product
Partially
Unpredictable absorption; can affect lipids
Not recommended
Verified .
Pellets — why the guidance says no
The Global Consensus Position Statement is unambiguous: use of any testosterone preparation that results in supraphysiologic concentrations, including pellets and injections, is not recommended. A 2025 review reported early peaks above 100–250 ng/dLin some published pellet studies—well past the female range. Pellets aren’t readily dose-adjustable once implanted; removal may require a procedure and doesn’t instantly reverse exposure. An excessive result is simply harder to manage than with a cream you can turn down tomorrow.
ACOG advises testing patients already using pellets or compounded testosterone to rule out supraphysiologic exposure—a medical body naming one product category and saying: go check those women. No affiliate link here. You’re worried, not shopping.
Compounded testosterone: what you need to know
Compounded testosterone is not FDA-approved.The FDA does not verify a compounded drug’s safety, effectiveness, or quality before marketing. It must never be presented as FDA-approved, FDA-reviewed, or equivalent in regulatory status to an FDA-approved drug.
⚠️ISSWSHrecommends against compounded testosterone for HSDD, because efficacy, safety, and concentration consistency aren’t sufficiently established.
⚠️BMS (2026): compounded bioidentical testosterone preparations are not recommended by the regulatory authorities or the menopause societies.
We’re telling you that even though compounded is what most American women on testosterone are actually taking. It’s what the sources say. And it’s exactly why the pharmacy question is one to ask out loud.
Testosterone is a controlled substance
Testosterone is a Schedule III controlled substance in the United States. It requires a prescription from a licensed clinician. Federal law limits Schedule III prescriptions to no more than five refills, and no fill or refill more than six months after the prescription was issued. Some telehealth platforms don’t prescribe controlled substances at all—which turns out to matter more than you’d think. See our full guide to testosterone’s FDA and legal status.
Which telehealth providers publicly offer testosterone care?
Answer:Of five well-known US women’s telehealth brands checked in July 2026, only Midi Health publicly published a testosterone product together with a monitoring schedule. Winona offers DHEA, a precursor rather than testosterone. Hers’ published formulary does not list testosterone. Sesame’s own safety information says its providers cannot prescribe controlled substances online.
We checked each company’s own published pages—not review sites—on .
Provider
Provider-stated offer
What we verified
Monitoring protocol published?
Unresolved before you pay
Midi Health
Compounded testosterone cream
Testosterone offered; 24 states + DC listed on its map; most women complete two visits before an Rx; declines pellets
Yes — start → 4–6 wks → every 6–12 months
Whether the lab order defaults to LC-MS/MS; medication and lab costs; your state
Sesame Care
Menopause subscription; basic lab work included
Included labs are CBC, A1c, thyroid, lipid panel, and CMP—total testosterone and SHBG are not on the list. Its own safety information states providers cannot prescribe controlled substances online.
n/a
Everything. We removed our link from this page.
Winona
DHEA — described by Winona as a testosterone precursor
Winona’s own help center explains why it doesn’t prescribe testosterone
Not published
What follow-up applies to DHEA
Hers
Estradiol + progesterone
Published menopause formulary does not list testosterone
Not published
State eligibility; whether the formulary has changed
Confirmed. Public page doesn’t disclose a separate testosterone pathway, price, states, or monitoring
Not published
Everything about the separate testosterone pathway
Read that Sesame row again.
We had a link there. We pulled it. Sesame’s menopause subscription includes lab work—but the labs it includes are CBC, A1c, thyroid, lipid panel, and CMP. Total testosterone isn’t on that list. Neither is SHBG. We’re not going to send you to buy a subscription that doesn’t cover the one test this page spent 2,000 words telling you to ask for.
The Winona one is the easiest to misread
Winona’s own help center explains that it offers DHEA—a hormone your body canconvert into testosterone—rather than testosterone. ISSWSH: oral DHEA “cannot be recommended for the treatment of HSDD in postmenopausal women with normal adrenal function.” BMS (2026): more research is needed before DHEA can be recommended. If you sign up somewhere expecting testosterone monitoring and receive DHEA, the schedule on this page doesn’t automatically apply.
Midi’s protocol against the guidelines
Midi (published)
Global Consensus
ISSWSH
VA
Baseline
Labs at start
Total T
Total T + SHBG + LFTs + lipids
Total T + SHBG + LFTs + lipids
First recheck
4–6 weeks
3–6 weeks
3–6 weeks
3–6 weeks
Once stable
Every 6–12 months
Every 6 months
Every 4–6 months
Every 4–6 months
Pellets
Declines ✓
Not recommended ✓
Not recommended ✓
Not recommended ✓
Verified .
The honest part. Hear it from us before you pay.
Midi does NOT commit to the tightest monitoring interval on this page. Its published range runs to twelve months—double the Global Consensus and triple the tight end of ISSWSH. If a guaranteed four-month recheck is your priority, an in-person menopause specialist will serve you better, and our Find My HRT Path tool will flag when that’s the right call.
But because Midi publishes a protocol at all, you can hold them to it.Three of the five platforms above publish nothing. A published 6–12 month range is a range with clinician judgment inside it—and a range is something you can have a conversation about.
You need a prescriber who’ll actually monitor you
If you need someone who will prescribe testosterone, order labs, publish what they check and when, and won’t put you on pellets—Midi Health was the only one of the five platforms we reviewed whose current public materials clearly published both a testosterone product and a monitoring schedule. Costs to expect: the visit is billed to insurance; compounded testosterone usually isn’t covered; labs are separate.
Two questions to bring: which interval within 6–12 months does the clinician plan to use, and does the lab order default to LC-MS/MS?
What should happen if your testosterone result is high?
Answer:Confirm the assay, units, and reference interval; record the application site and timing; consider sample contamination; and contact the prescriber. ISSWSH advises clinician-guided dose reduction and a repeat test in 2–3 weeks when a result is supraphysiologic, even when no side effects are present.
Six steps, in order:
1
Check the units and the reference range.
A number alone isn't a result. ng/dL and nmol/L differ by about 29×.
2
Check the method.
If it was an immunoassay, the number may be falsely high before anything else is considered.
3
Check for contamination.
Where did you apply it? Which arm did they draw from? How long between?
4
Contact your prescriber.
Tell them all of the above.
5
Don't adjust your own dose.
Not up, not down, not 'just for a bit.'
6
Confirm the repeat plan.
ISSWSH advises clinician-guided dose reduction and a repeat test in 2–3 weeks when a level is supraphysiologic — even if you feel completely fine.
That last one surprises people. Waiting for symptoms isn’t the plan. Preventing them is.
What are the signs your dose is too high?
Answer: Androgen excess appears as acne or oily skin, increased facial or body hair, and thinning scalp hair. These usually improve after clinician-guided dose reduction. Voice deepening and clitoral enlargement are rare at physiologic levels and may not reverse, which is why they warrant contacting a prescriber promptly.
The BMS puts it clearly: adverse effects are uncommon if levels stay in the female physiological range.The most common are excess hair growth, acne, and weight gain—usually reversible with a reduction in dose or stopping. Take the reassurance. It’s real. And notice why it holds: because someone is watching the level.
🟡 Usually improve after a clinician-guided change
Acne or oily skin
More facial or body hair
Hair growth at the application site
Thinning scalp hair
Tell your prescriber. Don’t stop on your own.
🔴 Don’t wait for these
Voice deepening
Clitoral enlargement
Fast-moving hair loss
A very high lab result
Accidental exposure in a child or partner
Contact your prescriber promptly—not at your next scheduled visit. Some of these may not reverse.
If your level is normal but you’re getting side effects: re-read the SHBG section above. Low SHBG may explain androgenic effects despite a total testosterone within range. Both ISSWSH and the BMS name it. If you’ve been dismissed on this, take it back to your clinician. There’s a mechanism, and it’s in the guidelines.
Is there an FDA-approved alternative to testosterone for HSDD?
Answer: Yes. In December 2025, the FDA expanded the approved indication for Addyi (flibanserin) to women under 65 with acquired, generalized HSDD, regardless of reproductive status. It is non-hormonal and requires no testosterone monitoring.
There is no FDA-approved testosterone product for women in the United States. Every testosterone prescription written for a woman here is either off-label use of a product approved for men, or compounded. Internationally that’s shifting—1% testosterone cream is now licensed in Australia, New Zealand, South Africa, and the UK. Not here.
But something did change here. In December 2025, the FDA revised Addyi’s label. Previously approved only for premenopausal women, Addyi now indicates it for women under 65 with acquired, generalized HSDD—low sexual desire causing marked distress, not due to another condition, relationship problems, or another medication.
The postmenopausal trial (Study 6): 447 women under 65 received Addyi and 455 received placebo.At week 24, the mean change in satisfying sexual events per 28 days was 0.9 with Addyi versus 0.6 with placebo—a treatment difference of 0.4. Modest. We’re not going to oversell it, and we’re not going to compare it to testosterone’s numbers.
What the label says you’d be signing up for:
One tablet daily at bedtime
Common effects: dizziness (7.9%), sleepiness (7.7%), nausea (6.6%)
Boxed warning: severe low blood pressure and fainting when taken close in time with alcohol
Contraindicated with moderate or strong CYP3A4 inhibitors (including grapefruit juice) and in anyone with liver impairment
Discontinue after 8 weeks if symptoms haven’t improved
No hormone monitoring. No lab codes. No contamination window. That’s the trade you’re weighing.
A clinic that only ever offers the thing it sells is worth a second look. Ask what they think of Addyi. Listen for whether you get an answer or a redirect.
No affiliate link in this section. Addyi isn’t a partner. That’s rather the point.
Does this apply in perimenopause or after surgical menopause?
Answer: The monitoring principles apply whenever testosterone is prescribed, but the strongest consensus evidence concerns postmenopausal HSDD. The VA states that testosterone is generally not recommended in premenopausal women due to insufficient evidence.
Perimenopause
The evidence base thins out fast. The VA says testosterone is generally not recommended in premenopausal women due to insufficient evidence. The BMS calls it a controversial area needing more research. If you’re still cycling and you’ve been offered testosterone, that’s not automatically wrong—but it’s off the map the guidelines drew, and you deserve to know that before you start.
Surgical menopause
This is where the biology actually changes suddenly. ISSWSH cites data showing women who had both ovaries removed had substantially lower testosterone than age-matched women who reached menopause naturally. The monitoring schedule doesn’t change. The context does.
Either way, the same rules hold: no level diagnoses HSDD, no level predicts benefit, and the test is there to keep you from overshooting.
How to get ready for your next appointment
Answer: Bring the product or a photo of its label, the full lab report including units, reference range, and method, the timing and location of your last application, and notes on benefit and side effects. Do not change or skip medication for the appointment unless your prescriber tells you to.
You’ve got about fifteen minutes with someone. Here’s how to use them.
📋 Bring
The product—or a photo of the label
Whether it’s compounded or an FDA-approved product used off-label
Start date and date of any dose change
Last application: date, time, and body site
The full lab report—units, reference range, and method, not just the number
What’s improved and what’s new (acne, hair, mood, skin)
Other medicines—especially oral estrogen and thyroid replacement (both raise SHBG)
❌ Don’t
Don’t report the number without the units and range
Don’t use a range from the internet in place of your lab’s
Don’t change your dose on your own
Don’t skip mentioning side effects because the number looked fine
Don’t assume a normal result means it’s working. It doesn’t mean that. It has never meant that.
Ten questions worth asking
1
What's the goal of testosterone in my case, specifically?
2
What did my baseline rule in or out?
3
Which lab reference range are you using?
4
Was my test run by LC-MS/MS?
5
Why did you order SHBG — or why not?
6
Does your protocol include liver and lipid tests at baseline?
7
When do we retest after a dose change?
8
Which symptoms should make me call you before the next visit?
9
What's the plan if I don't feel a meaningful difference by six months?
10
Who owns my monitoring and refills going forward?
Print your monitoring appointment checklist
Fills in your dates, your product, your lab method, and the ten questions above. No email required.
Read the primary documents directly (JCEM, J Sex Med, ACOG, VA, BMS)
Midi's protocol
Midi's own testosterone page and FAQ
Quest 15983; LabCorp 070001 & 004226
The labs' own test directories and technical documents
Quest direct-purchase price ($69 + $6 fee)
Quest's own consumer storefront
Reference intervals
ACOG, Quest, Clinical Chemistry, ISSWSH-cited data — assembled and labeled by us
Sesame's included lab list
Sesame's own menopause FAQ — testosterone and SHBG are not included
Which platforms offer testosterone
Each provider's own published pages, fetched directly
Gel contamination
Peer-reviewed Clinical Chemistry review, 2023
Addyi indication, trial data, boxed warning
The current FDA prescribing information (revised 12/2025)
Schedule III refill limits
21 CFR 1306.22
Who wrote this and how.The HRT Index Editorial Team. We read the primary guidelines instead of other people’s summaries of them, pulled the lab codes from the laboratories’ own directories, read the FDA label rather than the press release, and dated every claim. This is editorial research. It has not been reviewed by a clinician—we don’t put a clinician’s name on work a clinician didn’t do.
Disclosure.The HRT Index earns a commission if you start care through some links on this page, including Midi Health. It didn’t change what we found. The clearest evidence of that: we removed our own Sesame link from this page after checking its included lab list. How we’re funded.
How often should a woman on testosterone get her levels checked?
US-oriented guidance says a baseline before starting, a recheck 3–6 weeks after starting or changing dose, then every 4–6 months once stable. The Global Consensus Position Statement says every 6 months. The British Menopause Society says every 6–12 months.
Do I need a low testosterone result before I can be treated?
No. No total testosterone cutoff diagnoses HSDD or predicts who will benefit, and no androgen cutoff separates women with sexual dysfunction from women without it. A high baseline, though, suggests your symptoms probably are not about testosterone.
What is a normal testosterone level for a menopausal woman?
There is not one number. ACOG cites 20–80 ng/dL as the physiologic premenopausal range for women on testosterone therapy. Quest reports 2–45 ng/dL as its adult-female reference interval for LC-MS/MS test 15983. Those answer different questions — your result only means something against your lab's range and your lab's method.
Should total or free testosterone be monitored?
Total testosterone. The Global Consensus, ISSWSH, and the BMS all name it the best practical measure. The BMS says free testosterone assays are not recommended because their link to biological activity has not been confirmed.
Why did my clinician order SHBG?
It helps explain two things: why testosterone might not be working (high SHBG), or why you might be getting side effects at a normal total (low SHBG).
Do liver and cholesterol need checking?
It depends whose protocol your clinician follows. The VA and ISSWSH include them at baseline. The BMS in 2026 says routine safety bloods like lipids or FBC are not needed at female doses. Ask which and why.
Should I skip my testosterone the morning of my blood test?
Do not invent a rule. UK guidance from NHS Highland advises omitting the dose before a test because it can read falsely high, but this varies by product and protocol. Ask your prescriber — and either way, do not apply gel near the arm they will draw from.
My result is normal but I don't feel any different. What now?
A normal result is not evidence it is working. Raise the six-month checkpoint with your clinician — major guidance says if there is no meaningful benefit by six months, treatment should be stopped or reconsidered rather than continued because the level looks fine.
My result is high but I feel fine. Does that matter?
Yes. ISSWSH advises clinician-guided dose reduction and a repeat test in 2–3 weeks when a result is supraphysiologic, even without side effects. But first — ask whether gel contamination could explain the number.
Are pellets monitored differently?
They need the same checks, with one critical difference: pellets are not readily dose-adjustable once implanted, so an excessive result is harder to manage. ACOG advises testing patients using pellets or compounded testosterone for supraphysiologic exposure.
Is testosterone FDA-approved for women in the US?
No. There is no FDA-approved testosterone product for women in the United States. All use is off-label or compounded. 1% testosterone cream is licensed in Australia, New Zealand, South Africa, and the UK.
How long before I know if it's working?
Noticeable improvement usually shows by 6–8 weeks; maximum effect around 12 weeks. The BMS says allow 3–6 months for a full picture. If there is no meaningful benefit by six months, guidance says stop or reconsider.
Can testosterone help fatigue or brain fog?
The evidence does not currently support it. The BMS (2026) says randomized trials have not demonstrated benefit for cognition, mood, energy, or musculoskeletal health. The VA does not recommend off-label use for those indications. The ESTEEM trial is now studying it.
Can I use an at-home testosterone test to monitor?
It may produce a number, but the method, reference range, timing, and clinical review still decide whether it means anything. It is not a monitoring plan or a treatment decision.
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The HRT Index is the independent menopause HRT decision layer for women. Educational only—not medical advice. Not reviewed by a clinician.
Primary sources are linked inline throughout this page. Monitoring facts come from published clinical practice guidelines and government guidance documents. Lab facts come from each laboratory’s own test directories. Regulatory facts come from FDA announcements and prescribing information. Provider facts are provider-published and dated.
