Low Dose Testosterone

Originally published at Tips for Trans Men: Tip #26: Low Dose Testosterone


For an introduction to Testosterone Hormone Replacement Therapy (T HRT), see the first part of the series.

Why Take Low Dose?

Hormones are gradual. This can be very frustrating for people who can’t wait for the changes. But some of us approach the idea of hormones with a bit more trepidation, and would rather take things slow.

Some people simply want to take extra precautions with their body. Others may be struggling to figure out what their identity means to them while undertaking a physical transition, thus trying to reconcile the two. Moreover, it’s common to hear of people who want certain effects of hormones but not others, and want to find the right balance. Whether it’s because we’re not sure hormones are right for us, or because we’re not sure what we want out of hormones, or we just want to be extra careful, taking a low dose is a way of testing the waters, toe by toe.

It is actually recommended to start on a low dose, and build your way up to a regular dose. Not only do hormones hit you harder in the first 3-6 months, this also gives your body (and mind) time to adjust. Remember, puberty doesn’t happen in a day. Other instances in which low dose is recommended is for those who have pre-existing conditions of physical or mental health, such as thyroid disorders or a history of anxiety and depression. While these sorts of conditions do not usually make you ineligible for HRT, it is probably advisable to go low dose, at least at first.

By slowly ramping up the dose, you can be more in control of the changes you experience. Take it as an opportunity to gauge the effects hormones are having on you. Remember, it’s not just the obvious ones you need to look out for, like “am I finally sprouting chin hair?” Hormones have widespread effects on our bodies, and it’s usually the more subtle, invisible changes we should be watching out for, like “how’s my weight gain/loss?” or “am I suddenly feeling more anxious for no reason?”

Edit: While there is not a lot of official research, I have started to hear from more trans patients and doctors alike that they prefer taking lower dosages than the “standard” recommended dose. Check out this article for an example of the benefits of low dose for easing into your voice (especially if you are a singer, but also in general).

Options for Low Dose

Injections, gel, cream, and patch can all be taken low dose. (At first I was under the mis-impression that injectable T was not low-dose friendly, but this isn’t the case. However, it is still true that I’d rather avoid needles.)

Notes of Caution

If you take too low of a dose, it does nothing. Women are prescribed T to increase libido, and there is a magic low-enough dose where they don’t see the masculinization effects of it, yet do experience the side effect of increased sex drive. If you’re reading this, you probably want some of those masculinization effects, so be wary of taking too little. In some cases, taking too low a dose may even be counterproductive, as it “aromatizes” (converts) into estrogen!

If you take more than a low dose – that is, a “regular” dose – you might get changes quicker than you expect or want them. This is true whenever your dosage is different than the expected one, whether lower or higher. For the sake of self awareness and peace of mind, it’s simply better to have a good sense of how much T you’re getting, what changes you can expect, and at what pace.

If you take too much – that is, a high dose – it may end up being detrimental. Normally guys attempt to over-dose on T because they want to speed up the process. However, T aromatizes into estrogen, causing the reverse of what you’d want, namely less T and more E. The effects of this can include bloating (water weight), irregular menstrual cycles, weight gain, mood changes, including anxiety and depression, and other health effects, adverse or otherwise. So take a dose of patience instead!

Starting & Stopping T

If you are unsure of taking hormones, or of continuing to take them, you can always stop. Yep, at any time, you can just stop. You can stop because you are having adverse effects, because you need some extra time to think, or because you’ve just had enough. If and when you decide to start again, then you can always start again. It’s most advisable to be as consistent as possible, so starting and stopping often is not ideal, but the options are always open.

Dosages for “Low-Dose”

The dosages for being on a “low” dose of T are, well, lower than the regular dose. This varies widely from person to person, and by method. I’ve gathered some information from articles that lay out testosterone dosage, covered in the Introduction to Testosterone HRT post, and compiled it with various personal accounts of those on a self-reported low dose. Here are some rough estimates (ie, my best guess) on what constitutes a “low dose.”

Injectable

A standard bi-weekly starting dose is 50-100 mg. Some people take as low a dose as 30 mg bi-weekly. If I were to pick a dose, I’d choose 40mg or 50mg, just because it’s on the low range, but not the lowest. (Edit: I’ve been on 50mg bi-weekly, and have been super happy. See my progress here.)

A standard weekly starting dose is 25-50 mg. Some have taken as low as 20 mg weekly, which is nearly (but not quite) equivalent to the 40 mg/biweekly.

As you may notice, another important factor to consider is the frequency of the injections. Bi-weekly has been the standard for quite some time, but nowadays some people are opting for 10 day or 7 day cycles.

Edit: deciphering the dosage for injectable T can be confusing (it still is for me). Usually the vials come in a formula of 200mg/mL, and you inject a cc amount. Previously, doctors have prescribed trans men 1cc, or 200mg, of bi-weekly injections (every 2 weeks). I’ve been on .25cc, or 50mg bi-weekly, and consider that a low dose. I would not recommend going lower. After speaking with my doctor recently, she said most of her trans men patients are on 100mg bi-weekly and they’re usually quite satisfied.

Gel

Gel is normally applied daily. According to the articles, a regular dose is between 2.5g and 10g per day of 1% gel, with a starting dose at around 2.5g/day.

It has taken me a while to figure this out (see below), so my best guess of a low dose would be anywhere between 2.5g and 7.5g, with the amount T in a 1% gel being 25-75 mg.

Cream Dosage

If you notice, none of the articles specify cream dosage, though some mention it is the same as for gel. That’s what I initially assumed; however, it was a little more complicated than that to decipher…

My guess for a low-dose cream would be between 50 and 75mg. From my experience, I would not go lower than 50 mg, and would call 100mg a “regular” dose.

Gel and Cream Dosage, De-mystified

When I opened my package of compounded T cream from Stroheckers, the conundrum I faced was – how much? You see, the cream came in two big tubs, akin to body lotion. My prescription said “2.5mg/g, 5g/day.” The label on the cream said “5% CRM” with instructions to “apply 2 grams (1/2 teaspoonful daily).” Not only was I not sure which dose was accurate (as my doctor usually prescribed injections), I had no clue how much either 2.5mg/g or 5% or 2 grams or even 1/2 teaspoon was!

My original prescription. Note that it’s for gel, and I ended up with cream.

Dosage for gels and creams is trickier to figure out, because there’s a lot more numbers to crunch. There is the base amount of testosterone the cream has, say 50mg. That’s usually the number you ultimately care about.

The label indicates the amount you apply in grams, and then what % of that is testosterone, or the concentration; a 1% gel contains 10 mg of testosterone per 1 gram of total gel (10 mg/g). (About 10% of those 10 mg is actually absorbed, so the “effective” amount comes down to 1 mg of T (1mg/10mg/g). Since the “effective” absorbed amount is variable, it’s usually ignored.) So going back to the 10mg, if you apply 5 grams of 1% gel daily, you’re getting 50mg of T daily (10mg/g x 5g = 50mg).

Confused? Don’t worry, this tripped me up too. Let’s try and do the math.

My T dosage

Testosterone in Compound Cream

Testosterone in Compound Cream

My prescription said 2.5mg/g, so if 10mg/g is 1%, this would be a .25% gel. Taken at 5g/day, it would amount to 12.5mg/day (2.5mg/g x 5g). If you consider the standard dose of 5g at 1% = 50mg, a fourth of this would be 5g at 0.25mg = 12.5mg.

But this was for gel; the cream I got has a different concentration, and cream is also absorbed differently. Right now I’ve been taking roughly 1 gram daily of the 5% cream. One gram of 1% cream is 10 mg of T, so 1 gram of 5% is five times as much, or 50 mg. (I’ve recently raised it 1.3g, so at 5% it’s 1,300mg x 0.05 = 65 mg).

(Trust me, it took me quite a while to go back and forth between the articles, my prescription, my current dosage, and my calculator, and even then I’m not entirely sure this is accurate. If it makes anybody feel any better…)

Finally, I met with my now-current physician, who also mentioned one very important thing: above all, try to get the same dose every day. It doesn’t matter if it’s absorbed differently every day, just try to be as consistent as possible. In order to do this, I had to get a small digital scale, and measure out 1 gram every morning. (I zero out the scale with the lid of the cream container, then put some cream on the lid.) Alternatively others have mentioned using a syringe, which also works.

Small digital scale for measuring cream T. Wallet for size comparison.

Small digital scale for measuring cream T. Wallet for size comparison.

If you do get a gel or a cream, make sure you understand the dosages. Look at how much you’re applying (grams) and multiply that by the concentration (%) to get the amount of T (in mg). And when using cream or gel, don’t forget to wash your hands thoroughly and cover the area with clothing so as not to rub it off on a partner, child, or even pet!

Me on T

If you’re interested in learning more about my personal journey with hormones, you can read a few articles on my blog. I have yet to give an update on the newest developments; just know that the story doesn’t end there.

40 responses to “Low Dose Testosterone

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  3. hey! I am on low-dose testosterone cream and wanted to put in my experience since it’s very different from what you described.

    I have a 10% cream and I am applying .5 grams daily. It comes to me in a small white plastic container with a pump on it. One pump = .5 grams, so I just apply one pump every morning just like it was lotion.

    I don’t think this is a high enough dose for me (I’ve been on T for over six months and periods haven’t stopped) but it is very simple and apparently this method of packaging is standard for Strohecker’s now.

  4. 10% cream is NOT considered low dose (not saying you said so), but it is more full dose and you will transition. It might take a tad longer than injections, but I know a couple guys who transitioned completely on this and they developed all secondary sex characteristics (hair, voice, etc). Some guys do not absorb the t-cream or gel as well so they would in effect have a low dose. But that’s another issue. So this might be the issue with anon who posted here. I use a little teaspoon measure (1/4 on one side and 1/8 on another). The pump is metered I believe, wasn’t aware that this was used for cream. I think the cream I have might be a bit thick for that.

    • Hmm, perhaps anon has a gel? I also never heard of pump for the cream. And the gel-cream dosages differ. The dosage depends on the % concentration but also how much of it you put on… It’s very confusing!

      Anyway, by “low dose” I didn’t want to imply “you won’t see any changes” it simply means you’ll do so more slowly.

      • Yeah it’s confusing all right. You did a good job of outlining the factors on figuring out dosage.

        You’re right re: low dose not meaning no changes. There are folks out there (yaninbananin on youtube) who actually ended up transitioning but after 4 years or so. But I don’t think that the usually amt. (1/4 t) at 10% is even that slow. Maybe slow for a lot of people who are anxious to transition. I am having a somewhat typical transition, imo. Might be a bit slower, but I started on low dose and was on low dose for about 3-4 months.

        Sounds like anon might be talking gel. I don’t think that mine would pump as well, esp when it was about 1/4 full.

  5. What is the safe dosage for 30year old women ? I’m using oral supplements and hoping to increase my libido, muscle mass and memory.

    • I honestly don’t know, it’s different if you don’t want to transition (ie, masculinize) and I have no idea about oral dosages. Best thing to do is contact your doctor.

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  8. “Some people take a low dose of 30 mg bi-weekly.”

    Do you mean 15mg per shot or 30 mg which will result 60 mg/week?

    • I believe I meant to say one 30mg shot every two weeks, though in retrospect that sounds too low. I may have also confused the dosages :S I don’t know why I put the dosages in this format… the standard notation is Xcc of 200mg/mL.

      So for instance, right now I take one shot .25cc of 200mg/mL every two weeks, which would come out to be 50mg.

      I think that is the lowest advisable dose, any lower and the effects would be cancelled out or even aromatized into estrogen.

  9. Thank you for this post. I’m apparently on a “high dose” injectable. Mine’s 200mg/mL bi-weekly. Meaning, on a 3mL syringe, I fill up to the 1mL line. I thought this was “standard” and have been on it for several years. FYI, according to my doctor, too high of a dose can also result into the “aromatization” effect and temporarily increase your estrogen levels. :/

    This post is great for helping me boost my confidence in talking to my doctor to going down to 100mg (.5mL on the 3mL syringe). She had recommended to me that going lower than .25mL (or 50mg) bi-weekly won’t do anything “noticeable” but I’m reading that it does…just slower.

    When I started taking T, I didn’t know any better and followed her advice, since she’s rather knowledgeable about hormones. I’ve been on it, at the 200mg bi-weekly for almost 5 years now and for the last 1-1 1/2 years have felt like it’s not where I want to be. I want something that will put me in the more androgynous zone of physical appearance, not where I’m at right now (I also hate the male side of my genetics with the body hair).

    So thanks again for dedicating the time and compiling all this information. 🙂 I’m going to print it out and take it with me to my doctor in March. 🙂

    • Glad this was helpful! The best standard is yourself: how do you feel? It sounds like you want to try a lower dose for a couple of months, maybe that will work better for you. In any case you can always go back up.

      The dosages sound accurate. I am on the .25mL/50mg bi-weekly, and you could technically go lower – though my doctor also thinks it wouldn’t do anything at this point – but I would recommend switching to another method like gel or cream. And yes, too high of a dose can be counter-productive as well.

  10. I think people are putting WAY too much emphasis on the dose, and not their actual T levels. You want your natural T levels to be that of cis men, that is somewhere (according to my dr.) between the 300-500 range. Different people will take different doses to get in that range. I take .25 weekly… according to you, this a “low” dose. However, at the END of my T cycle (before I take my next shot), my blood tests show my T level ABOVE the 500 range… this means at the peak of my T cycle, my levels are above the T range of the average cis guy. My dr said he would normally LOWER my dose, but since I’m not experiencing any adverse side effects, he’ll keep it where it is. So I don’t understand when people want to up their dose only because it’s X amount of months. Your dr. should be checking your T levels and adjusting your dose based on that, and not on some superficial time frame. On that note. My “low dose” has me changing pretty fast. My voice dropped completely after 4 months, and I have facial hair at 5 months. If I didn’t want these changes, I’d say the “low dose” “option” failed to give me “time to figure stuff out.” More needs to be said about T levels, and less about dosage levels.

    • Max – thanks for your comment. You are absolutely right, dosage should not be the primary focus.

      The reason I go into so much detail is to give people a baseline to start from. When I first started researching testosterone, the numbers were all very confusing, and I had no idea what would be in the “lower” range. Also, the message I got was that you HAD to go with the “standard” dose. Like you said, people shouldn’t just up their dose because it’s been X months and it’s what everyone else is on.

      Interestingly, I have never had my T levels checked. My doctor monitors the usual liver panel, red blood cell count, cholesterol, thyroid, etc. Each doctor has their own individual quirks and methods and “best practices” and that’s why it’s also important as an individual to know the options and alternatives, and the many ways in which you can affect your outcome.

      The takeaway point from all this: go with what feels good for you.

      • You absolutely should have your levels checked, especially T levels

        This is 100% the purpose of the treatment, to give you male typical levels so that your development will mirror a males…

        If your levels are very high and you are still on a high dose, you are simply adding extra risk and side effects to the mix unnecessarily, because achieving an adequate T level could be done on a lower dose

  11. So confusing about dosage. I’m a menopausal woman and get my testosterone and estrogen creams in a Topi-click dispenser. You just screw the bottom clockwise until it “clicks” to deliver the correct dose. You should ask for them most pharmacies will order them for you.

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  14. Thanks on your marvelous posting! I genuinely enjoyed reading it,
    you might be a great author. I will make certain to bookmark your blog and definitely will come back
    in the future. I want to encourage that you continue your great job,
    have a nice day!

  15. Hi Micah. I have been prescribed a T gel. In the immediate instance, it is for increase in clitoral growth. Within a matter of days I will be receiving T injection. I am pretty happy with the strength of the gel I am taking currently and hope to keep the injection dose somewhere closer to the gel dose. Can you help me figure out how much my gel is compared to the potential dose or T injections? Currently my gel is 2 pumps of 12.5mg/1.25g. Thank you!

    • I’m not familiar with gel doses. This is definitely a question for your doctor. And remember, it’s really about how you feel, not what your dose is.

      • Micah,
        Thanks for your quick response. I agree with you that it is all about how you feel not your dosage. I have definitely found this to be true with even my minimal dose I’m on now. I also am very familiar with my body and can tell even the slightest amount of any medication I put into my body. Thank you for all of your info.

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  17. Just looking over your blog again. I have been on T pellets to bring my levels up to the normal female range (my T was nearly zero) but have decided to switch to injections and go a bit higher in dose. Went to an informed consent clinic today and was surprised to find that the practitioner was kind of dismissive of my desire to start very low and go slow. I explained I’m gender queer but still going by female pronouns and want to start very cautiously so that I’m comfortable and don’t get freaked out by any rapid changes. The response was “all of my patients want to take higher doses – they all start at 50-100mg weekly”. I had to argue my case to get her to agree to write for a lower dose – she finally wrote for 25mg bi-weekly, though I might start at 20mg bi-weekly until I feel more comfortable. I’m in no rush and I was concerned that she seemed to want to rush me – to pressure me into doing what all the others in her practice do. I’m so glad your blog exists! Helped me remember that it’s okay to want to ease in and that I don’t have to fit into the mold that PA wanted to shove me into.

    • Argh, this makes me so upset. I’m glad you’ve had the resources and courage to advocate for yourself, but doctors should not push people towards options they clearly don’t want, just because “all other patients are doing it.”

      Ultimately, regardless of how much your dr prescribes, you can always choose to take less of it (if you self-inject), but that’s not the point. I was lucky in that all of my doctors have been extremely open about what I wanted, letting me take the lead. This gave me a lot of confidence in slowly moving forward and exploring the options at my own pace.

      You should refer your doctor to my site, maybe once she’s informed she’ll change her practice.

  18. First off, thank you for this site! I’ve been debating whether to start T for years now and reading about low dose here really helped me decide to go for it. Did you apply your cream/gel at night or in the morning? I’m inclined to do it at night because that’s when I shower, plus so I don’t have to worry about forgetting if I’m rushed in the morning, but my doctor said applying it at night might make it difficult to sleep.

    • Glad you’ve found this helpful!

      It’s advised to apply cream/gel after you shower, whenever that is, mainly so it doesn’t rub off as quickly.

      I don’t believe T makes it difficult to sleep; the absorption happens slowly and gradually so that wouldn’t make sense. However, some people report feeling an energy boost, so I could be wrong. You should just try it out and see what happens.

  19. I am so thankful for this. I am bigender and want to keep some of my feminine traits, but gain a few masculine ones. I don’t want to be hairy just muscular and have a deeper voice. would taking testosterone cream or gel only once in a while do the trick?

    • Hormones shouldn’t really be “once in a while.” You’re either on or off, with the option of stopping after some time, or on a low dose, which only slows down progress.

      I recommend doing more research on the permanent vs reversible effects as well. You can gain muscle without T – it’s a matter of working out – because that is a reversible effect. Hair, on the other hand, is permanent.

    • Oh it most definitely works. You can apply it anywhere, but since you need a large surface and to minimize contact with others, I applied it on my thighs. Other recommended places are shoulders and back or stomach area.

  20. I take 0.5 in testosterone and 0.75 in estrogen. I take this in Toche’s. I’m scared of taking to much because of the side effects. If anyone is familiar with this dose please give me any input

  21. Hi Y’all,
    I am hoping some of you out There have gone through a similar experience to me and can shed a little light on things. So I’m genderqueer/non binary and transitioning. and have been applying low dose t cream daily for 3 months. I haven’t seen any effects except more acne. So I’m upping my dose a bit. The question is how much is too much vs not enough? I know every body is different. But I’m confused if I’m doing the right thing here and my endo doesn’t have any appointments for 6 weeks.
    I still want to take things slow and be on a low dose that’s really important to me. These last 3 months of seeing no changes have reaffirmed for me that I do want to masculinize, and want it to happen slowly.
    So far I’ve been applying .5 grams of a 2.5%cream daily for about 3-4 months. No changes at all 😦
    So I just increased to 1gram of 2.5% cream. Has anyone seen changes at that dose of cream?
    My endo says a more “standard dose or full dose” would be 1 gram of a 5% cream daily. If that’s the case then my new dose is half of a “typical full dose” for cream. And what I was on for the last 3+months would be considered a quarter dose.
    Is there any one out there on a similar dose?
    If so have you seen any results, or did you have to increase?

    • Luka,
      My best guess is that cream is not absorbed as efficiently, so the low dose might be too low. I definitely saw changes within the first 3 months (too many in fact!) so the best course of action is to up the dose slowly, maybe weekly for 2 or 3 weeks, until you get to that mid-dose, or are satisfied with the changes you’re seeing. You can always drop it down too if you it’s going too fast.
      Keep in mind too that with cream, the % composition may not exactly linear, so 2.5% is not half of 5% – because your body absorbs it at a different rate. So that may be another factor.
      The other possibility is that you need a higher dose to kickstart the changes than to maintain them.
      Lastly, you can consider switching to gel or injections since these methods seem to be more effective, and there are more benchmarks for dosages.
      Anyway, incremental increases are the way to go. So just be patient with your body, you’ll get there eventually!

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