@professorsusandavis's testosterone claims, fact-checked

What did @professorsusandavis actually say?

Davis laid out a dose-comparison framework for testosterone in postmenopausal women, focused on countries where it has regulatory approval. Her core claims: a 5mg testosterone cream is the approved starting dose in Australia, New Zealand, South Africa, and the UK; a 2.5mg testosterone gel (formulated for men) approximates that same 5mg cream dose due to permeation enhancers in the gel; and pellet doses of 100-200mg are producing supraphysiologic testosterone levels "2 to 3 fold above the upper limit of normal" for premenopausal women, causing androgenic side effects.

She also said she does not recommend testosterone pellets for women because they cannot be easily removed if side effects occur, though she acknowledged historical use of 50mg pellets in Australian clinical practice. Her tone was measured and explicitly limited to postmenopausal women with low sexual desire, which is the approved indication.

Does the science back this up?

Largely, yes. The approval claims and dosing framework are grounded in published consensus. The claim about pellets driving supraphysiologic levels is probably the most clinically important thing she said, and the evidence supports it.

The 2019 Global Consensus Position Statement on testosterone therapy for women (Baber et al., Climacteric) and the associated endorsement by the Endocrine Society confirmed that transdermal testosterone is recommended to achieve serum levels in the physiologic premenopausal range, roughly 0.5-2.4 nmol/L. The same document explicitly warned against supraphysiologic dosing and noted that pellets lack regulatory approval for women in most jurisdictions and are associated with inconsistent absorption.

Davis's equivalence claim, that 2.5mg testosterone gel approximates 5mg testosterone cream, is clinically reasonable but requires a caveat: this is a clinical approximation, not a pharmacokinetically validated equivalence. Absorption varies significantly between individuals, formulations, application sites, and skin condition. The comparison is a useful clinical heuristic, not a substitution guarantee.

Her list of androgenic side effects at supraphysiologic doses, including hirsutism, clitoromegaly, and voice changes, is consistent with published case reports and the 2019 consensus warnings.

What did they get wrong (or right)?

She got the big things right. The regulatory status of testosterone cream in Australia, New Zealand, South Africa, and the UK is accurate. The approved indication, low sexual desire with distress in postmenopausal women, is correct. Her concern about pellets is supported by the literature and is not a fringe position.

Where she could have been more precise: the gel-to-cream dose comparison. Saying 2.5mg testosterone gel is "approximately" equivalent to 5mg cream is a reasonable clinical estimate, but she presents it with more confidence than the pharmacokinetic data fully supports. Studies comparing absorption between male-formulated testosterone gels and female-specific creams are limited. The Global Consensus Statement (Davis et al., 2019, Journal of Clinical Endocrinology and Metabolism) notes that male-formulated products used off-label in women require careful dose titration and monitoring precisely because absorption is less predictable.

Her blanket statement that she does not recommend pellets at all is a defensible clinical preference, but it is worth noting that some clinicians argue 50mg pellets with proper monitoring are a reasonable option where other formulations are not accessible. That nuance is absent here.

What should you actually know?

If you are a postmenopausal woman being offered testosterone therapy, the dosing question is real and the stakes matter. The approved indication is specifically low sexual desire with distress, not general fatigue, mood, or muscle mass, though research in those areas is ongoing.

The pellet dosing concern Davis raises is not fearmongering. A 2021 retrospective analysis (Glaser and Dimitrakakis, Maturitas) and multiple case series have documented androgenic adverse effects in women receiving high-dose pellet therapy. The problem is not pellets as a delivery system in theory; it is that 100-200mg doses in women produce testosterone levels that far exceed what any regulatory body considers a physiologic replacement range for females.

On the gel equivalence: do not self-adjust your dose based on a social media video, including this one. If you are using a male-formulated testosterone gel off-label because the approved cream is not available to you, that is a clinical decision that requires a prescriber who can order and interpret serum testosterone levels. The 2019 Global Consensus Statement is publicly available and is a reasonable reference document to bring to a clinical appointment.

• Testosterone cream approved for women exists in Australia, UK, New Zealand, and South Africa for a specific indication.
• The cream-to-gel dose comparison Davis cites is a clinical heuristic, not a pharmacokinetically validated equivalence.
• Pellet doses of 100-200mg in women are documented to produce supraphysiologic testosterone levels with androgenic side effects.
• Any testosterone therapy in women requires serum level monitoring to stay within the premenopausal physiologic range.