Serious Adverse Events Following Subcutaneous Testosterone Pellet Therapy in Women: A Structured Narrative Review of Published Case Reports

Objectives To identify and critically examine published case reports describing serious adverse events potentially associated with subcutaneous testosterone pellet therapy in women, and to assess the strength of the available evidence regarding the safety of this intervention. Methods A structured narrative review was conducted following the PRISMA 2020 framework for study identification and selection. PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception to May 12, 2026. Eligible publications were case reports describing women exposed to subcutaneous testosterone pellets who experienced serious adverse events. Methodological quality of included reports was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. Findings were synthesized narratively. Results The search identified 74 records, of which three case reports met the eligibility criteria. Reported serious adverse events included non-arteritic cilioretinal artery occlusion, severe psychiatric manifestations, and portomesenteric venous thrombosis. The strength of the association varied across reports, and definitive causality could not be established in any case. Methodological reporting quality was generally high, although intervention details were unclear in two reports. Conclusions The published case-report evidence identified in this review comprised only three reports. Although theoretical concerns exist regarding dose variability and supraphysiologic exposure with testosterone pellet therapy, published reports of serious adverse events in women remain scarce. These findings highlight the need for improved pharmacovigilance and higher-quality studies.