Recommends reviewing serum testosterone levels every 6 months during ongoing therapy to monitor for excessive use and signs of androgen excess such as hirsutism or acne. It is indicated when a clinician manages a woman receiving long-term testosterone therapy and needs to evaluate for adverse effects or consider dose adjustment.
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---
name: endo-t-ongoing-monitoring-6mo
description: Recommends reviewing serum testosterone levels every 6 months during ongoing therapy to monitor for excessive use and signs of androgen excess such as hirsutism or acne. It is indicated when a clinician manages a woman receiving long-term testosterone therapy and needs to evaluate for adverse effects or consider dose adjustment.
---
# Suggest routine testosterone monitoring every 6 months during ongoing therapy
## STEP 1 — Gather Information
Collect current testosterone therapy details (dose, formulation, duration), baseline testosterone level if available, and assess for symptoms of androgen excess (hirsutism, acne, voice changes, clitoromegaly) and any adverse effects.
## STEP 2 — Rule In / Rule Out
Is the patient receiving ongoing testosterone therapy? If yes, proceed to Step 3; if no, monitoring per this guideline is not required.
## STEP 3 — Classify or Stratify
Evaluate testosterone level and symptoms: Is the level within the target premenopausal range and are there no signs of androgen excess? If yes, classify as “adequate”; if level is elevated or symptoms of excess are present, classify as “excess”.
## STEP 4 — Decide
If classified as “adequate”, continue current therapy and schedule next testosterone check in 6 months. If classified as “excess”, reduce dose, discontinue therapy, or investigate further before adjusting treatment.
## Clinical Guardrails / Mimics / Pitfalls
Do not rely solely on symptoms; always pair with serum testosterone measurement. Avoid using testosterone levels to diagnose androgen deficiency in healthy women. Do not prescribe oral testosterone formulations due to safety concerns. Monitor for virilizing signs even if levels appear normal, as tissue sensitivity varies. Do not exceed physiological dosing regimens without specialist guidance.
## Concrete Clinical Example
A 52-year-old woman on transdermal testosterone 300 µg/day for HSDD reports no new hair growth or acne at her routine visit. Her serum testosterone is 38 ng/dL (within premenopausal range). Decision: Continue current dose and repeat testosterone measurement in 6 months.
**Source:** Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI:10.1210/jc.2014-2260
