Sarah uses kitchen measuring spoons to dispense just the right dose—between a pinch and a smidge—of testosterone gel formulated for men to treat her low sexual desire. “This is an absurd way for women to get testosterone therapy,” acknowledged 58-year-old Sarah’s physician, Sharon Parish, MD, a professor of clinical medicine at Weill Cornell Medical College in New York City. But with no female-tailored testosterone product on the market, it’s a necessary workaround.

Parish and an international group of researchers recently published a position statement on female testosterone therapy. In line with these first global recommendations, Parish advises some of her postmenopausal patients with low libido like Sarah to use one-tenth of a male dose to approximate their premenopausal testosterone levels.

Many clinicians aren’t as judicious. Juliana Kling, MD, an associate professor of medicine at the Mayo Clinic in Phoenix, said she cringes each time a new patient tells her that she’s had testosterone pellets implanted into her buttocks by another clinician, often a naturopath or alternative medicine practitioner. “It’s very difficult or impossible to get a physiologic level of testosterone with pellets,” Kling said. She’s seen women whose off-label, high-dose testosterone use for low libido and other concerns has led to hair loss, voice changes, and even an enlarged clitoris. In some cases, the adverse effects are irreversible.

莎拉（Sarah）使用厨房量匙在男性和男性之间分配适量的睾丸激素凝胶，以治疗男性的性欲低下。“这是女性获得睾丸激素治疗的一种荒谬方式，”现年58岁的莎拉（Sarah）的医师，纽约威尔维尔康奈尔医学院临床医学教授莎朗·帕里斯（Sharon Parish）承认。但是，在市场上没有女性定制的睾丸激素产品，这是一种必要的解决方法。

教区和一个国际研究小组最近发表了关于女性睾丸激素治疗的立场声明。根据这些最初的全球建议，Parish建议她的一些性欲低下的绝经后患者，例如Sarah，使用男性剂量的十分之一来估计其绝经前的睾丸激素水平。

许多临床医生并不明智。凤凰城梅奥诊所的医学副教授朱莉安娜·克林（Juliana Kling）表示，每当一名新患者告诉她自己的另一名临床医生（通常是自然疗法或替代医学的医生）将睾丸激素丸植入臀部时，她都会感到不安。克林说：“要获得生理水平的睾丸激素是非常困难或不可能的。” 她曾见过一些女性，这些女性使用标签外的高剂量睾丸激素来降低性欲和其他忧虑，导致脱发，声音变化甚至阴蒂增大。在某些情况下，不良反应是不可逆的。