What numbers is your clinician actually aiming at? This page lays out the testosterone targets in the major guidelines, where they disagree, and, because your body still has an estrogen story too, what we know about estradiol and progesterone on testosterone.
Testosterone targets
The overall goal is to be around the average cis male range. Different guidelines express it differently:
- Endocrine Society 2017 / WPATH SOC8: for enanthate/cypionate injections, measure midway between injections, target 400-700 ng/dL. Alternatively, measure peak (the high point after a dose) and trough (the low point right before the next dose) to keep levels within the cisgender male reference range quoted as typically 320-1000 ng/dL (~11-35 nmol/L), though the exact band depends on the lab’s test method. Sustained supraphysiologic (above the natural male range) levels should be avoided.12
- UCSF: target is simply the lab’s male reference range (roughly 350-1100 ng/dL), titrated to goals and clinical response. Crucially: “Once within the normal male physiologic range, there is no evidence that higher doses/levels of testosterone result in a greater degree of virilization” and once you’re above the midpoint of the range, pushing the dose higher has unclear benefit.3
- NHS (UK) works in nmol/L and targets differ by formulation and clinic: gels titrated to mid adult cis male range, ~15-20 nmol/L (Tavistock) or 14-19 nmol/L (Nottingham); Sustanon trough 8-14 nmol/L (Nottingham) or 10-12 nmol/L (Sussex); Nebido trough in the lower third of male range, typically 10-15 nmol/L.4
- AusPATH (Australia): masculinizing target is a trough total testosterone of 10-15 nmol/L.5
These are roughly concordant (400-700 ng/dL ~ 14-24 nmol/L) but not identical. Note the tension at the low end: the Endocrine Society says adjust the undecanoate interval if the pre-injection trough is below 400 ng/dL (~14 nmol/L), while UK and Australian practice deliberately targets troughs of 10-15 nmol/L. Neither camp has trial evidence that its target produces better outcomes.
When the blood is drawn matters as much as the number
A result is only interpretable against where you were in the dosing cycle:124
| Formulation | When to draw | What the result means |
|---|---|---|
| Enanthate/cypionate injection | Midway between injections (or peak + trough if troubleshooting) | Mid-interval target 400-700 ng/dL |
| Testosterone undecanoate (Nebido/Reandron) | Just before the next injection (trough only) | <400 ng/dL → guidelines suggest adjusting interval; UK/AU aim for lower-third troughs |
| Gel / patch | After >=1 week of daily use, >=2 hours after application (UK: 4-6 h; no gel on the draw arm that day) | Compare against male range |
| Cyclic symptoms on any injection | Peak (1-2 days post-shot) and trough (just before next shot) | Reveals swings a mid-cycle draw hides |
What about estrogen and progesterone?
No major guideline recommends routine estradiol (E2) or progesterone (P4) monitoring for people on masculinizing therapy not WPATH SOC8, the Endocrine Society, UCSF, AusPATH, and not NHS protocols. Their schedules list only testosterone and hematocrit/hemoglobin (red-blood-cell measures); some add lipids or LFTs (cholesterol or liver tests). E2 appears at baseline in some protocols (AusPATH, Tavistock) and as an as-needed test at UCSF. Progesterone isn’t mentioned anywhere.235
I would recommend measuring E and Prog level just in case since you’re already getting blood tests, they can be useful data points for diagnosing any other issues you run into (expand upon this aria!)
Unit conversions (for reading your own results)
Labs report in different units depending on country and assay. Keep these:6
| Hormone | Conversion | Handy cheat sheet |
|---|---|---|
| Testosterone | nmol/L = ng/dL ÷ 28.84 | 400 ng/dL ~= 14 nmol/L | 700 ng/dL ~= 24 nmol/L |
| Estradiol (E2) | pmol/L = pg/mL x 1000 / 272.38 | 27 pg/mL ~= 100 pmol/L | 40 pg/mL ~= 147 pmol/L |
| Progesterone (P4) | nmol/L = ng/mL x 3.18 | 0.1 ng/mL ~= 0.3 nmol/L |
Further reading
Targets are one of those topics where it pays to read more than one source - start here.
- UCSF’s overview of masculinizing hormone therapy plain-language targets, plus the “higher isn’t better” evidence
- WPATH Standards of Care v8 Chapter 12, Table 5 is where the official numbers live
- Endocrine Society 2017 guideline the source of the 400-700 ng/dL mid-interval target
- Lakshmikanth et al. 2024 (open access) the highest-quality study of what estrogen and progesterone actually do on T
- AusPATH position statement the Australian targets (10-15 nmol/L troughs) in the national guidance
Footnotes
-
Endocrine Society Clinical Practice Guideline (Hembree WC, et al.), J Clin Endocrinol Metab 2017;102(11):3869-3903 - https://academic.oup.com/jcem/article/102/11/3869/4157558 ↩ ↩2
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WPATH Standards of Care v8 (Coleman E, et al., 2022), Chapter 12, Table 5 - https://pmc.ncbi.nlm.nih.gov/articles/PMC9553112/ ↩ ↩2 ↩3
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UCSF Gender Affirming Health Program, “Overview of masculinizing hormone therapy” - https://transcare.ucsf.edu/guidelines/masculinizing-therapy ↩ ↩2
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Tavistock & Portman NHS FT Shared Care Guideline (2022); Nottingham Centre for Transgender Health (2022); Tavistock patient leaflet “Hormone Treatment (masculine)” v2 (2024) - https://medicines.bedfordshirelutonandmiltonkeynes.icb.nhs.uk/wp-content/uploads/2021/12/Transgender-transmasculine-scg-tavistock-Jan-22.pdf ; https://www.nottsapc.nhs.uk/media/gxfnn13a/masculinising-hormones-information-sheet.pdf ; https://tavistockandportman.nhs.uk/wp-content/uploads/2024/08/Hormone-Treatment-masculine-v2-FINAL.pdf ↩ ↩2
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AusPATH / Cheung AS, et al., position statement, Med J Aust 2019;211:127-133 - https://auspath.org.au/ ↩ ↩2
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Synthesis of nine transmasculine cohorts with measured E2 (Defreyne 2020; Lakshmikanth 2024; Chan 2018; Kumar 2023; Wiepjes/de Blok 2021; Asseler 2024; Grouthier 2025; Borrás 2021; Hamilton 2024, et al.) ↩