What is the optimal blood level for testosterone in women?
Channel: BioBalance Healthcast
Date: 2022-07-25

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog/
Women always ask about my goal for their blood level of free Testosterone after insertion of testosterone pellets.  That is a good question, and it is not easily answered. When I was trained by Dr Gino Tutera in 2002, and he taught me that the optimal range for Free T in women who take T pellets to be over 15 pg/ml.  He taught me that each woman is an individual and the blood level that they need is specific to their metabolism and genetics.   To determine the perfect level of T free for an individual we should follow the resolution of her symptoms after her T pellets are inserted. Today we will talk about the research done by Dr Rebecca Glaser, published in Maturitis 74(2013) that confirms my practice of adjusting the dose of pellets based primarily on the resolution of Low T symptoms.  Prescribing pellet Testosterone for woman is not easy and her doctor must find her own ideal blood level.


Testosterone replacement for women has been ignored as an essential hormone replacement for women, and until recently was not considered a major sex hormone in women. Premenopausal women have 15-20 times more testosterone than estradiol circulating in their blood streams. This makes testosterone the most prevalent sex hormone in premenopausal women, yet it is still mislabeled as a strictly male hormone! 

After late 30s to mid 40s women develop a deficiency in testosterone and develop a host of symptoms that doctors have sadly called the symptoms of “aging”, when the symptoms are directly related to the lack of free T in a woman’s circulation.

Both pre- and post-menopausal women over 36 may experience the following symptoms of testosterone deficiency:
• Sexual dysfunction-lack of libido and loss of orgasmic function
• Anxiety, irritability, depression
• Physical fatigue
• Lack of the feeling of well-being
• Poor cognition
• Memory loss
• Insomnia
• Hot flashes
• New autoimmune diseases
• Arthritis
• Weight gain
• Muscle loss and physical weakness
• Pain
• Vaginal Dryness
• Irritable Bladder
• Migraine headaches
• Osteoporosis


One of the reasons that the majority of doctors don’t use T pellets is because it takes intense individual training after residency and time and attention to each patient, her symptoms, and time for multiple adjustments of dose before the maintenance dose is determined.  This is something a doctor or nurse must do all the time to be good at it and the doctor must have a complete grasp of endocrinology, nutrition, and gynecology to become good at this type of T hormone treatment.

Once the pellet dose is determined it is the most convenient dosing schedule (once q 4 months, only 3 doctor visits a year) with 100% compliance because the T Pellet dose is given in the office, very rare complications, and an amazingly complete resolution of symptoms, which has not been seen in any other T preparations, bio-identical or not, given with a different delivery system.

With the right doctor or Nurse Practitioner, a knowledge of pharmacology, endocrinology, gynecology and nutrition, this form of T delivery to women brings them back to a more youthful body and mind as well as prevents diseases of old age such as Osteoporosis, Heart disease, Sexual Dysfunction, mood disorders and autoimmune diseases to name a few.

In the research paper by Dr Rebecca Glaser: Testosterone implants in women: Maturitis 2013 Dr Glaser explains that there are many problems secondary to following blood levels to determine dosage, and explains why following symptom resolution is the preferred way to provide this type of Testosterone replacement: 

There is a small percentage of women of women who do not tolerate TA pellets.  They feel like they have no sex drive and don’t feel their T free as they should….it is an opposite reaction, because in everyone else the T free is higher, they feel more sex drive and lose belly fat.  If the “opposite” patients still need to lose belly fat and lower their T-free, DIM, zinc, and Calcium D glucarate can be used to lower the Estrogen in the circulation.

I agree with Dr Rebecca Glaser MD, who states that dosage should be guided by safety, tolerability and clinical response, rather than a random T or T free levels, yet I always draw blood levels to find out if a woman’s ideal blood level specific to her has been reached, and if it is repeatable.