Testosterone injections for women: what TikTok gets wrong about access and dosing

What did @fullonkaren actually say?

She's not making medical claims here. She's describing a supply problem. Karen says her DMs are full of women who can't find telehealth providers willing to prescribe testosterone injections, women whose testosterone levels are "in the single digits, even the teens," who've tried creams without results, or who want to move away from pellets due to scar tissue. She's crowd-sourcing providers. That's the video. There's no dosing advice, no cure claims, just a woman with a small audience trying to solve an access puzzle she keeps getting asked about.

Worth noting: she name-drops Dr. Kelly Casperson, Dr. Mary Claire Haver, Dr. Rachel Rubin, and Dr. Bose, framing them as advocates working to expand options for women. That framing is accurate. All four are clinicians who have publicly discussed the evidence gap and access barriers around testosterone therapy for women.

Does the science back this up?

Yes, and more than most people realize. Female testosterone deficiency is real, under-studied, and genuinely hard to treat in the U.S. because no FDA-approved testosterone product exists for women. That regulatory gap creates the exact access problem Karen is describing.

The 2019 Global Consensus Position Statement on testosterone therapy for women, published in the Journal of Clinical Endocrinology and Metabolism, concluded that testosterone therapy in women has demonstrated benefit for hypoactive sexual desire disorder and that more research is needed on other symptoms, including fatigue, mood, and cognitive changes. The panel included authors from the Endocrine Society, the British Menopause Society, and others. It explicitly acknowledged the lack of approved products as a barrier to care.

Regarding her point about low numbers causing symptoms in women in their early 30s: testosterone does decline with age in women, and perimenopause can start a decade before menopause. Davis et al. (2019, Climacteric) documented that testosterone decline begins in a woman's 20s and is largely complete by menopause. Low levels can precede any estrogen symptoms by years. Karen's framing that "a lot of them start suffering in their early 30s" is not alarmist. It's consistent with the literature.

What did they get wrong (or right)?

She got the core problem right. The access gap is real and documented. What she doesn't address, and this matters, is why many providers are reluctant. Testosterone injections in women are off-label, the dosing evidence is thinner for injections than for gels or pellets, and the pharmacokinetics of injectable testosterone in women are not well established at the doses used for female patients. Injection intervals designed for men can cause supraphysiologic spikes and troughs that are harder to manage in women.

Her critique of creams not moving numbers for some patients is worth taking seriously. Transdermal absorption varies significantly between individuals. Glaser and Dimitrakakis (2013, Maturitas) noted that topical testosterone can be inconsistent due to skin differences, application site, and product formulation. Injections do offer more predictable delivery, but that predictability cuts both ways: overshoot is also more predictable.

She mentions scar tissue from pellets as a reason some women want to switch to injections. That is a legitimate clinical complaint. Subcutaneous pellet insertion does carry a small but real risk of extrusion and fibrosis, particularly with repeated insertions. The concern is valid.

What should you actually know?

If you're a woman investigating testosterone therapy, here's what the evidence actually supports. First, low testosterone in women is a recognized clinical condition with established symptom patterns, chiefly low libido, fatigue, and reduced sense of wellbeing. Second, the only consensus-backed indication with strong evidence is hypoactive sexual desire disorder, per the 2019 global position statement. Third, no testosterone product is FDA-approved for women in the U.S., which means any prescription is off-label and requires a provider willing to work within that framework.

Injectable testosterone for women is not inherently unsafe, but it is less studied than transdermal options in female populations. If a provider prescribes it, labs should be drawn regularly to avoid supraphysiologic levels, which carry their own risks including androgenic side effects. The providers Karen mentions, Casperson, Haver, Rubin, have all advocated publicly for better research and access without recommending reckless dosing. That distinction matters.

Finding a telehealth provider who takes this seriously is genuinely difficult. Karen's frustration on behalf of her community is legitimate. The ask, that providers identify themselves and that patients share who helped them, is a reasonable community response to a broken system. It does not substitute for clinical evaluation.