@coachdarianbates's testosterone dosing claims, fact-checked

What did @coachdarianbates actually say?

The creator, who opens by acknowledging they are not a medical professional, argues that clinicians prescribing 25mg of injectable testosterone weekly to women are starting far too high. Their position: "your starting dose should be between 3 and 5mg a week," and they personally start most female clients at 3.5mg weekly. They claim that 25mg routinely pushes serum testosterone above the normal female range, producing lab results that "look more like a male than a female." They also push back on the framing that women are simply smaller men, which is worth taking seriously as a clinical philosophy. The caption adds a comparison to transgender male dosing (50-100mg weekly), suggesting 25mg puts a cisgender woman halfway toward a masculinizing dose. That framing is loose, but the underlying concern about supraphysiologic levels is legitimate.

Does the science back this up?

Broadly, yes. The evidence on testosterone dosing in cisgender women consistently points toward very low doses being effective, and high doses carrying real androgenic side effect risk. The Endocrine Society and ISSM guidelines do not formally endorse a specific injectable testosterone protocol for women, partly because no injectable product is FDA-approved for this population. But published research supports the low-dose principle. Davis et al. (2019, The Lancet Diabetes and Endocrinology) found that testosterone therapy in women is effective at physiologic doses, with the normal female serum range sitting roughly between 15 and 70 ng/dL depending on the assay and phase of cycle. Wierman et al. (2014, Journal of Clinical Endocrinology and Metabolism) noted that supraphysiologic testosterone levels in women are associated with acne, hirsutism, clitoral enlargement, and voice changes. A 25mg weekly injectable dose is consistent with producing supraphysiologic levels in most women, based on known pharmacokinetics of testosterone cypionate and enanthate.

What did they get wrong (or right)?

They got the core pharmacologic point right: 25mg weekly is almost certainly too high for most cisgender women starting TRT. That is not a controversial position among endocrinologists who work with this population. The "females are not small men" line is clinically sound, not just rhetoric. Where things get shakier is the creator's invocation of their own client outcomes as evidence. Anecdote is not data, and phrases like "I haven't come across it" are not the same as published safety data. The reference to a serum ceiling of "190g per deciliter" in the caption appears to be a transcription artifact, likely meaning 190 ng/dL, which is itself above the standard female reference range. The transgender dosing comparison in the caption is imprecise and adds more noise than clarity. Credit where it's due: recommending bloodwork at 6 weeks before adjusting dose is consistent with standard monitoring practice (Glaser and Dimitrakakis, 2013, Maturitas).

What should you actually know?

If you are a woman being prescribed testosterone, the dose and route matter significantly, and so does the prescriber's familiarity with female physiology. Injectable testosterone is not FDA-approved for women in the United States, meaning any such prescription is off-label. That does not make it wrong, but it does mean there is wide variation in how clinicians approach dosing. The Endocrine Society specifically warns against exceeding the normal female physiologic range. Supraphysiologic testosterone in women can cause irreversible virilizing effects, including permanent voice lowering and clitoral enlargement, even after stopping the hormone. Bloodwork monitoring, ideally at baseline and 4-8 weeks after initiation or dose change, is not optional. If a provider is not routinely checking your labs, that is a problem regardless of the dose. No online creator, coach, or fact-checker can substitute for a clinician who reviews your individual bloodwork and health history.