DIY topical testosterone for menopause: what the science says

What did @dr.meganlee actually say?

She proposed that clinicians skip expensive compounded testosterone creams (she cited prices of "60, 70, 80 dollars") and instead use FDA-approved 1% testosterone gel designed for men, measured into an oral syringe to deliver smaller doses. Her claim is that a pea-sized amount equals roughly 2.5 to 3 milligrams, and that a 90-day supply can cost as little as "$7 to $10." She framed this as a cost-saving workaround for women who need low-dose testosterone but lack access to affordable compounded products or a commercially available women's formulation.

She also noted that some insurance covers FDA-approved testosterone products, which she positioned as an advantage over compounded alternatives that are almost never covered.

Does the science back this up?

The underlying rationale, that women can benefit from low-dose testosterone therapy, has real support in the literature. But the delivery hack she describes introduces meaningful dosing uncertainty that the science on women's testosterone therapy makes hard to ignore.

A 2019 global consensus position statement published in The Journal of Clinical Endocrinology and Metabolism (Baber et al., 2019) confirmed that testosterone therapy in women has evidence for treating hypoactive sexual desire disorder, but explicitly noted that no product is currently approved for women in the U.S. and that dosing precision matters considerably. Women typically need 1/10th to 1/20th the male dose. Using a male-formulated gel and estimating dose by "a pea-sized amount" and oral syringe measurement is not a validated method. Gel concentration can vary by application site, skin thickness, and individual absorption rates (Davis et al., 2015, Climacteric). The cost argument is sound. The precision argument is shakier.

What did they get wrong (or right)?

Credit where it is due: she is right that compounded testosterone for women is expensive and inconsistently covered by insurance, and she is right that there is no FDA-approved testosterone product for women in the U.S. pharmacy system. Those are real problems that real patients face every day.

Where she runs into trouble is the dosing confidence. Saying "a pea-sized amount comes out to about 2.5 or 3 milligrams" treats a rough volumetric estimate as clinical precision. It is not. Gel viscosity, tube-to-tube variability, and the fact that she herself acknowledged patients can have sensitivity to "even the slightest increase" make this combination risky. Testosterone gel for men is also typically applied to the shoulders or upper arms, and absorption in those areas is calibrated for male skin physiology. Women applying the same gel to different sites may absorb more or less than expected.

She also said she will "start switching more patients over" to this method, which is a significant clinical decision announced on TikTok without acknowledging the need for careful monitoring or baseline labs. That framing deserves scrutiny.

What should you actually know?

If you are a patient considering this approach, do not attempt it without a prescribing clinician who can monitor serum testosterone levels. The Global Consensus Statement (Baber et al., 2019) recommends measuring free and total testosterone before and during therapy, with dose adjustments based on bloodwork, not syringe estimates. Supraphysiologic testosterone in women, even slightly elevated, is associated with acne, hair loss, clitoral enlargement, and voice changes, some of which are irreversible (Islam et al., 2019, JAMA Internal Medicine).

The cost argument is genuinely valid and worth advocating for. The method she describes is not inherently wrong in concept, but "creative" workarounds with hormones require tighter clinical guardrails than a TikTok video can reasonably convey. Patients should ask their provider specifically about monitoring protocols, not just the prescription.

• No FDA-approved testosterone product exists for women in the U.S. as of 2024.
• Compounded testosterone is legal but not FDA-reviewed for consistency or potency.
• Using male-formulated gel off-label for women is a common clinical practice, but dosing by volume estimate alone is not a validated method.
• Insurance coverage of FDA-approved testosterone (male formulations, used off-label) is variable and not guaranteed.