The Transgender Dictionary
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Testosterone

Table of Contents

Introduction

There are many terms used to refer to the administration of bioidentical testoterone such as; hormone replacement therapy (HRT), testosterone replacement therapy (TRT), and masculinizing hormone therapy (MHT). Some of these terms, such as TRT, originate from testosterone treatments intended for cisgender men. The term that will be used here is gender affirming hormone therapy (GAHT). As is the nature of a dictionary for transgender topics, this page will be discussing testosterone therapy as it pertains to both transgender men, and the nonbinary folks who seek it out.

GAHT is sought out by many, many transmasculine people as a very important part of their transitions. For those who seek it out, undergoing an estrogen-based puberty is traumatizing, and a massive source of gender dysphoria. Undergoing testosterone GAHT is a great way for these people to reduce (or sometimes eliminate) gender dysphoria caused by having the wrong bodily features. For these people, undergoing the changes caused by testosterone is a massive source of gender euphoria. This treatment can greatly reduce depression, anxiety, and suicidal ideation related to gender dysphoria. Testosterone helps many transgender men look like their authentic selves, and heavily boosts self-confidence, energy, and happiness.

While testosterone has predictible effects as a masculinizing hormone, please keep in mind that the exact presentation of its effects will vary from person to person. The main variables at play in regards to how the effects will appear are age and genetics. Just like cisgender men, a transgender man on testosterone is still at the mercy of the passage of time and the genetics passed down from his parents - in terms of what his body will look like after prolonged exposure to the male range of testosterone. The only thing that you can be garunteed with testosterone based GAHT is that masculine traits will be induced while feminine traits are suppressed.

If you are interested in pursuing GAHT, seek out an endocrinologist (a doctor who specilizes in hormones). If you feel as though this treatment is right for you, ask your primary care physician for a referral. If you are not interested in pursuing GAHT, but would still like to educate yourself on the topic, feel free to continue reading. If you come across terms that you do not understand, feel free to consult the alphabet menu buttons at the top of the page to find the relevant definitions.

Please keep in mind that not all transgender meen seek out GAHT, either due to personal, financial, or medical reasons. This does not make them any less transgender. That being said, the rest of this page will be discussing the majority of transgender men who do seek out this treatment.

General Information

Testosterone is a hormone that is produced in different quantities by both the ovaries and the testes respectively. For transgender men, there is generally a desire for additional testosterone in an effort to reach the normal male physiological range of 300–1000 ng/dl. The primary goal for a respectable endocrinologist is to bring their patient into this range. This can be achieved through the administration of bioidentical or synthetic testosterone.

For the first year of GAHT, patients are typically monitored with routine bloodwork, by the physician, for virilizing and adverse effects for every 3 months during the first year on GAHT, followed by once every 6-12 months. If a patient is given too high of a dose of testosterone, this can result in the excess testosterone being converted into estrogen by an enzyme called "aromatase."

Note that patients on testosterone are not being perpetually monitored for changes. Most timetables describing the effects of testosterone describe changes as occuring during timeframes such as the first 3-6 months or after 1-2 years. This is because these are the times where a patient typically visits his endocrinologist for monitoring. Certain effects can start earlier, or have continued effects that last for years after these time frames. These clinically available timeframes for changes are simply estimates.

Starting testoterone is an exciting time for transgender men. The initial mental impact of taking testosterone includes increased energy, happiness, and self-confidence. While some physical effects of testosterone can also occur very early on, they can take years to fully develop (similar to natural puberty). The physical effects of testoterone are cumulative, meaning that they build up gradually over time.

Transgender boys typically have stable gender identities. GAHT can be started at as young as 12 in countries such as Holland, however the minimum age in most countries (such as in The United States) is 16 years of age. Parental consent is universally required for minors looking to start GAHT. Some transgender boys are lucky enough to experience puberty blockers prior to undergoing GAHT, avoiding the worst of the effects of a natural puberty. Availability of treatments will vary depending on the country and local laws or regulations. Some locations have strict age requirements regarding starting hormones, while other countries (particularly in Europe) allow treatment based on the individual maturity of the patient.

Anecdotally, starting testosteorne later in life (age 50+) can result in less dramatic changes than starting earlier in life. That being said, many transgender men who have transitioned late in life have found happiness and satisfaction with their results. It is never too late to transition and find happiness in oneself.

Most transgender men will remain on testosterone therapy for the duration of their lives, unless forced to medically detransition due to external forces such as lack of access to treatment.

Unlike with feminizing hormone therapy, transgender men rarely (if ever) have to take an estrogen blocker alongside the synthetic or bioidentical testosterone. That being said, some men will seek out topical estrogen treatment to deal with the potential side effect of vaginal atrophy (note that this does not interfere with the masculinizing effects caused by testosterone).

Certain conditions that a patient may have may result in a health care provider discouraging masculinizing hormone therapy. Possible conditions include but are not limited to; hormone-sensitive cancers such as breast cancer, a history of blood clots, or other significant medical or behavioral issues that have not yet been addressed. Those who are pregnant and/or breastfeeding will not be able to have access to testosterone until no longer pregnant and/or breastfeeding.

Please keep in mind that testosterone is not a form of birth control. While testosterone can sometimes have an impact on fertility, it does not prevent pregnancy. If you are a transgender man on testosterone engaging in the type of sexual activity that can result in pregnancy, be sure to seek out actual birth control methods. If you become pregnant while on testosterone, and intend to keep the child, it is strictly advised to stop taking testosterone for the duration of the pregnancy.

Effects of Testosterone

Body Fat Redistribution

Testosterone causes body fat to migrate into a more masculine pattern, causing the patient to exhibit a masculine silhouette. This change typically starts during the first 6 months on testosterone, with the most noticable or extreme presentation of this effect settling in after around 2-5 years. Prior to testosterone, a patient will typically experience fat deposits in the hips, thighs, and buttocks. After testosterone, these fat deposits will slowly migrate to the abdomen.

Testosterone can also cause an increase in appetite, which can cause weight gain. For some transgender men, weight gain is a desirable trait. For others, this is something to be managed with additional exercise routines. Some transgender men also notice their faces becoming more angular, such as developing a squarer jaw.

Some transgender men may experience a decrease in breast density, occasionally going down a breast size. That being said, this is a fairly uncommon and minimal change. An even rarer phenomena is that of a transgender man with a very small chest that he is able to reduce down to a masculine physique with nothing but testosterone and exercise. Most transgender men who experience dysphoria regarding their breasts will still have to undergo a mastectomy to manage said dysphoria. Many surgeons recommend 6-12 months of testosterone prior to a mastectomy, to allow the contour of the muscles and the soft tissues of the chest to settle into their new pattern.

If a patient is forced to go off of testosterone, this effect will typically be reversed, though the reversal can be minimized through exercise.

Cessation of Menses

Testosterone hormone therapy typically stops or slows the menustral cycle within the first 6 months of treatment. Sometimes it can take 1-2 years for the menustral cycle to fully stop. Sometimes, starting testosterone can cause an extremely intense period, followed by never again having one. It can cause spotting or irregular or rare periods. For some patients, testosterone doesn't affect the menustral cycle at all. The exact effect that testosterone has on the menustral cycle varies from person to person. If testosterone does not stop your period, or causes a regular increased flow, talk to your doctor. Some patients are suggested to try certain types of birth control to stop the period cycle.

Due to the stopping of the menustral cycle, there is a common myth that testosterone causes infertility. It is not uncommon for transgender men to end up with high-risk unwanted pregnancies, due to the inaccurate assumption that they are unable to get pregnant due to being on testosterone. Transgender men who are engaging in sexual activities that could potentially result in pregnancy are advised to use birth control.

Most transgender men are typically able to safely undergo pregnancy via stopping taking testosterone prior to and for the duration of pregnancy. Some transgender men who are interested in having biological children (but not giving birth) may try things such as mature oocyte cryopreservation (egg freezing), embryo cryopreservation (embryo freezing), or ovarian tissue cryopreservation. All that being said, most transgender men have no interest in undergoing pregnancy. Those who do are sometimes referred to as "seahorse dads" - a reference to the fact that male seahorses give birth.

If a patient stops testosterone therapy and has not undergone an oophorectomy, there will be a return of the menustral cycle. If the patient has undergone an oophorectomy, the patient will have to start estrogen therapy, as a significant lack of either hormone in the body can result in serious health issues, most notably a decrease in bone density.

Deepening of the Voice

The thickening of the vocal cords is a change that often starts during the first 6 months on testosterone. This thickening, also known as a "voice drop," causes the voice to sound deeper. By the 6 month mark, the vast majority of trasngender male testosterone patients will have a voice that is within the natural male range. The deepening of the voice can continue over the course of 5 or more years.

Some transgender men will experience something commonly referred to in the transgender community as "the t cold" aka mild soreness of the throat and temporarily increased post nasal drip a few weeks after starting testosterone as their voice and body starts to adjust to the medication. Many patients will experience intermittent "voice cracks" alongside the voice slowly dropping to a lower pitch.

Note that some transgender men who do not go on testosterone, or are unsatisfied with the results provided by testosterone may try voice training or voice masculinization surgery though these treatments are uncommon for transmasculine people.

The dropping of the voice is a permenant change of testosterone that will not be reversed if the patient ceases testosterone therapy.

Genital Changes

Changes to the genitalia for a patient on testosterone therapy typically start during the first 6 months. The maximum effect of these changes can occur around 1-2 years, though like any changes caused by testosterone, the effects can continue to advance past this time frame, and everyone's personal timelines can look different. Testosterone will typically cause a patient's libido to spike, in addition to the changes related to genital appearance. These changes are typically associated with increased satisfaction and decreased gender dysphoria during sexual activity. Changes in orgasm, arousal, and sexual interests/attractions may occur.

Alongside a more masculine genital appearance, many patient may also notice that their genitalia smells more masculine.

Note: The terms that every individual transgender men uses to refer to their personal anatomy varies based on personal preference. Good allies know not to assume what every individual transgender person will use to refer to their own anatomy. Some transgender men prefer to use terms such as "front hole" as opposed to vagina. More vulgar terminology can of course be used, which is also based on personal preference.

Changes to scent and libido will reverse if the patient ceases testosterone therapy.

Bottom Growth

There are many terms that an individual may use to refer to their own genitalia. These terms will vary based on personal preference. The more clinically acceptable terms for what will be discussed in this section are "bottom growth" and "clitoral enlargment."

The enlargment of the clitoris is often one of the first changes noticed after starting testosterone therapy. The appearance of this enlargment is similar to that of a micropenis. The clitoral hood will also grow, having the apperance of a prepuce. The labia may also grow. The patient may experience random erections.

This growth is often a prerequisite for surgeries such as metoidioplasty and phalloplasty.

If the patient stops taking testosterone, the clitoris will typically stay at the length and girth that it has grown to.

Dihydrotestosterone Cream

Also known as DHT cream, topical dihydrotestosterone cream is sometimes used by transgender men looking to enhance their "bottom growth." If you are a transgender man looking to enhance bottom growth, try asking your doctor or endocrinologist for a perscription for "10% Dihydrotestosterone cream." Be sure to specify that the cream should not contain alcohol. Sometimes, this substance can be difficult to acquire in places such as The United States, and must be manufactured at a compounding pharmacy. A typical dosage is 20 mg administered three times a day. A typical length of treatment is three months.

Hair loss is a potential side effect of DHT cream. Secondary exposure is also possible, so be sure to wash up after applying it, and avoid exposure to other living beings for at least an hour.

Vaginal Atrophy

Sometimes referred to as "vaginal dryness," vaginal atrophy (also known as atrophic vaginitis, genitourinary syndrome of menopause/GSM, or vulvovaginal atrophy) is the thinning and inflammation of the vaginal walls. This can occur when the body has less estrogen. Increased testosterone being introduced to the body suppresses estrogen production. Vaginal tissues are dependant on estrogen. Lower levels of estrogen decrease the vagina's ability to self-lubricate and keep the tissues as thick, supple, and stretchy as they may have previously been. Cisgender women can sometimes experience this when going through changes such as menopause or breast cancer treatment. For transgender men, it is a more common occurrence.

While on testosterone, vaginal tissues can become easily irritated, thin, and more sensitive to internal friction. This area can sometimes feel dry, burning, painful, and/or itchy (an experienced summarized by the medical term "atrophy"). Some people may experience small tears in the tissue. This atrophy can result in the patient being more prone to bacterial vaginosis and yeast infections. The urethra can also be more suseptible urinary tract infections (UTIs) or bladder infections.

Vaginal atrophy can be treated with estrogen to improve the patient's quality of life. The main types of hormal treatment offered are estrogen tablets, estrogen cream, or an estrogen vaginal ring. These treatments do not interfere with the effects of testosterone therapy, and simply deliver the low dose of replacement estrogen to the affected tissues, helping with internal lubrication and alleviating discomfort.

If you engage in sexual activity, and are uninterested in in taking perscription medication, using lubrication is greatly advised for personal comfort.

Estrogen Cream

Estrogen cream is typically prescribed for daily use for the first 1-2 weeks, then used twice weekly afterward. Estrogen cream is inserted into the vagina using either a reusable or disposable applicator. If using a reusable applicator, be sure to keep it clean in between uses. Estrogen cream can be used both internally and on some of the external tissues for relief. Estrogen cream can sometimes be messy to use. The effectiveness of condoms, diaphragms, and cervical caps can be weakened if they are used within 72 hours of a dose of estrogen cream.

Estrogen Tablets

Estrogen tablets are small, approximately 6mm in diameter. A disposable applicator is included with the prescription to insert the tablet into the vagina daily for two weeks, and then twice weekly afterward. There is no mess with an estrogen tablet, but it can take hours to dissolve internally. The effectiveness of condoms, diaphragms, and cervical caps can be weakened if they are used within 72 hours of a dose of an estrogen tablet.

Hair Growth

Testosterone causes an increase of body and facial hair production. This increased hair growth typically starts around 6 to 12 months on testosterone, and will continue to grow over time. Some patients don't notice the effects they truly desire for up to 5 years. Like all body hair, growth continues indefinetly, though the extent of the thickening of hair is typically seen after 5 years of treatment.

Increased body hair can typically be found on the arms, legs, chest, belly, and back. Facial hair growth can include development of a beard, mustache, and thickening of the eyebrows. The extent of this will vary based on individual genetics.

Note that some transgender men who are unsatisfied with their hair growth turn to treatments such as minoxidil or finasteride. Some transmasculine people are unhappy with hair growth, and turn to hair removal treatments to cope with this change.

Changes to hair growth patterns will stop, but are unlikely to revert back to their previous state if the patient ceases hormonal therapy.

Height

If one is lucky enough to start testosterone before the fusing of his growth plates, he may grow taller. Someone who takes testosterone after their growth plates fuse is unlikely to gain any height. Other subtle changes may occur to bone structure if testosterone is taken during the patient's teenage years and/or early 20s.

More common effects that are not reliant on bone pliability that many transgender men tend to experience include an increase in the width/thickness of their hands, and an increase in the size of their feet (such as going up a shoe size). Broader shoulders is another, more common change.

These changes are all maximized if a patient is lucky enough to have had access to puberty blockers.

Increase of Red Blood Cells

Testosterone can cause an increase of red blood cell count, making the blood thicker. This increase is associated with a theoretical increased risk of blood clots and stroke. This increase is similar to the risks had by cisgender men, which is slightly higher than cisgender women.

This is one of the effects that is monitored through routine bloodwork by an endocrinologist. There are no documented cases of risks related to increased hemoglobin/hematocrit levels, but it is a good idea to monitor them anyway.

This effect will reverse if the patient stops taking testosterone.

Muscles and Strength

Testosterone makes it easier to gain and maintain muscle mass. Patient on testosterone typically show an increase in muscle mass and strength, something that typically comes alongside increased physical energy. Many transgender men will experience an increase in appitite. The increase of muscle mass is associated with a decrease of overall body fat percentage. Muscles are denser and heavier than fat, which is part of why some patients may experience weight gain while on testosterone.

These changes typically occur around 6 to 12 months on testosterone, and continue for a maximum effect around 2 to 5 years. That being said, bodybuilders (or anyone else with a vigorous exercise routines) will continue to notice changes relating to increasing strength and muscles.

Oily Skin/Acne/Other Skin Changes

Testosterone causes increased activity of the skin's oil glands, often resulting in thicker, oily skin with larger pores. The increase in oily skin can sometimes result in acne production. Acne is typically a temporary change caused by testosterone, peaking during the first year before improving. Acne can be treated with topical medication.

Testosterone treatment often results in the patient having a higher body temperature, and and increased sweat production. The skin will typically feel rougher in feeling and/or appearance. Overall body odor typically changes to a more masculine scent fairly early on while taking testosterone, as does the scent of one's urine. Patients may also experience having prominent veins that were not previously as visible.

Oily skin and acne caused by testosterone typically begins during the first 1-6 months, with the full effect occuring around 1-2 years.

All of these changes will likely reverse if the patient stops taking testosterone.

Scalp Hair Loss

Potential hair loss at the temples and crown of the head may occur, resulting in a more masculine hairline. Some patients may also experience thinning of the hair, most commonly frontal scalp hair thinning.

Like with facial hair growth, male pattern baldness (MPB) is based on genetics. Receding hairlines can be dealt with with treatments such as mioxidil or finasteride if one so chooses. If you are to start taking testosterone at a young age, it is unlikely that you will see dramatic hair loss very early on, unless the men in your family are prone to going bald young.

Male pattern baldness can start at around 6-12 months on testosterone, continuing for upwards of 5 years. Earlier changes regarding one's hairline are typically subtle, unless genetics dictate otherwise.

Changes to hair growth patterns will stop, but are unlikely to revert back to their previous state if the patient ceases hormonal therapy.

Ways to Take T

The method a patient uses will vary depending on personal preference, insurance coverage, and preexisting health conditions. Note that while some common name brands are mentioned, most types of testosterone are also available as lower-cost generics, though this will vary based on location. There is no clear evidence to suggest that any method has "better" or "worse" or faster results than any other method, though some people respond differently to different methods of testosterone administration.

This information is intended to serve both as a refresher for people who have already been perscribed testosterone, and a reference for those interested in learning about available options.

Gel (Transdermal)

Testosterone gel is an alcohol-based substance with the consistency of hand sanitizer that is administered daily and absorbed through the skin. If you have forgotten a dose, take one as soon as you remember. A typical dosage for testosterone 1% gel is 2.5 – 10 grams per day. Testosterone gel can sometimes cause changes to be more gradual over time, depending on how the patient's body is able to absorb the gel. Different people's skin are not always able to absorb topical medication at the same rate. For this reason, nonbinary patients looking for slower changes will seek out this form of testosterone. Keep in mind that testosterone gel has the same overall effects as any other method of testosterone, and changes may occur at a typical rate depending on the body's ability to absorb topical medication.

It is recommended that testosterone gel be applied on a spot of the body that is not particuarily bendy; such as the upper arms, shoulders, thighs, abdomen, or the back of the knees. Some patients may experience skin irritation at the site of application. Testosterone gel is mostly absorbed through the skin within minutes, but can take 5-6 hours to be fully absorbed. It is recommended that the gel be applied somewhere that will be covered by clothing, so that it does not rub off on others through skin-to-skin contact as it continues to dry and be absorbed. Wash your hands off after self-administering testosterone gel. If administering gel for someone else, use gloves.

Brands such as Androgel, Axiron and Testim are examples of possible testosterone gel options. Sometimes it comes in a small packet (typically dosed at 25mg or 50mg each). Other times it comes in a pump bottle (dispensed at 12.5mg or 20.25mg per pump). A pump bottle is the most common way it can come. Testosterone gel can be pumped from the bottle directly onto the skin. Testosterone gel can also be administered via a nasal spray, such as with natesto.

Make sure to take a shower after applying testosterone gel and before going to a doctor appointment to have bloodwork monitored. If the testosterone gel gets on the lab needle, the hormone level results may be skewed.

Implants

Treatments wherin a pellet is inserted underneath the skin to administer testosterone over time are known as implants. These pellets can provide the dosing of testosterone for 3-6 months depending on the type. These pellets are around the size of a grain of rice, and are typically inserted into the abdomen or buttocks by a physician.

One issue with testosterone implants is that if the dosage needs to be adjusted, it is not possible to do so.

Testopel is an available implant brand.

Injections (Parenteral)

Testosterone treatments administered by needle are known as injections. This is the most common delivery method for testosterone. The frequency of injections can vary based on personal preference and needs. Testosterone enanthate or testosterone cypionate can be injected at a rate of 50–200mg per week or 100–200mg biweekly. Testosterone undecanoate can be injected at a rate of 1000 mg every 12 weeks. Some nonbinary patients prefer to space testosterone injections further out to get slower effects (sometimes known as going on a "low dose" of testosterone). Keep in mind that no matter how slowly the changes caused by testosterone come on, they will still be the same changes.

To reduce pain and injury, keep the following things in mind. Medication should be kept at room temperature. Keep your body warm and relaxed before and during an injection. When doing an injection, be sure to break through the skin quickly with the needle. Do not inject in the same spot over and over again, and change the location of the injections every time. After an injection, pull the needle straight out without wiggling it around. Do not massage the site of the injection. Ice or numbing cream can be applied to the injection site prior to cleaning it as a way to prepare for possible pain with injection.

Never share or reuse syringes or needles. Use new needles and syringes every time you inject. Most pharmacies sell syringes and needles. Free needles can sometimes be found at a needle exchange program. Do NOT dispose of needles in the recycling. Do not let needles touch any surfaces (outside of when it is being used to draw up or inject medication) to prevent infection.

Peak testosterone levels can be measured 24 – 48 hours after injection. Trough levels can be measured immediately before injection.

An autoinjector known as xyosted is also available. Autoinjectors can be useful for people who experience anxiety regarding the usage of needles.

Note that if you experience significant redness or swelling at the injection site that you may be allergic to the oil-based solution that the testosterone is suspended in, and may have to discuss alternatives with your provider.

Note that needle sizes are measured in a unit known as gagues. The higher the number, the smaller the gague, and therefore the smaller size the needle is. For example, a needle that is 22 gague is physically much smaller needle than a needle that is 18 gague. Having a bigger gague needle makes it easier to draw up liquid from a vial. Having a smaller gague needle makes it less painful to inject medication into the body.

Intramuscular

Intramuscular (i.m.) injections are injected directly into the muscle. Intramuscular injections typically require the help of a doctor, friend, or family member to administer. Intramuscular injections can be more painful than subcutaneous injections. Intramuscular injections can go into the thighs (aim for halfway between your knee and your hip on the outer part of your thigh) or buttocks (aim for where the top of your pants pocket would be to avoid hitting a sciatic nerve). If you choose to inject into the thighs, you will most likely need help from another person. If you feel an extreme amount of pain during an intramuscular injection, immediately remove the needle (pull it straight out), as this indicates that you hit a nerve.

  1. Make sure to gather all of your supplies before injecting. The required supplies consists of an alcohol wipe or pad or rubbing alcohol (two alcohol wipes are ideal), the vial of medication, a syringe, two needles (a single 18 or 20 gauge needle to draw up medication & a single 22 or 23 gauge needle for the injection), cotton ball or gauze, and a puncture-proof sharps container (or a hard plastic detergent bottle or milk jug) to safely dispose of needles. Check the expiration date, dosage, and concentration of your medication (double and triple check this throughout the process to ensure that you are getting the correct dose).

  2. Find a spot that is well lit, clean, and has a lot of space available for your supplies. Wash your hands with either antibacterial soap and water or an alcohol-based gel aka hand sanitizer (if soap and water are not available). Hold up the bottle of medication to the light. If it is cloudy, or there are little bits floating in it, don't use it (it is expired).

  3. Take the cap off the medication vial. Clean the rubber stopper with an alcohol wipe for 15-20 seconds. Let it dry. Clean the injection site (thigh or butt) with another alcohol pad or pour alcohol over the area. Clean the area on your body where you intend to do the injection with a circular motion from the center moving out. Let it dry.

  4. Secure the larger gauge needle for drawing up medication on the syringe. Pull the needle cover straight off the syringe. Pull back the plunger to the number on the syringe that matches your dose. Insert the needle straight down into the bottle (through the rubber stopper), and push the plunger of the syringe all the way down, injecting air into the vial.

  5. Turn the vial upside down (keep holding it and the syringe steadily). Slowly pull back the plunger to fill the syringe with medication, and check to make sure you have the correct dosage. Gently tap the syringe with your fingers until the larger air bubbles rise to the top. Slowly push the plunger up to force the air bubbles out. After the air bubbles are out, slowly pull the plunger down to the number corresponding with the correct dosage of medication.

  6. Dispose of the drawing up needle (put it in the sharps box). Replace the drawing up needle with the smaller gauge injection needle.

  7. Pull the skin taught around the injection site. Quickly and firmly push the needle straight through the skin (at a 90° angle) and into the muscle. If you experience extreme pain while doing this, immediately remove the needle, as this indicates you hit a nerve. Slowly push the plunger to inject the hormones. Wait 5 seconds, then let go of the skin that was being pulled taut. Pull the syringe straight back out to remove from skin.

  8. Safely dispose of injection needle (put it in the sharps box along with the syringe). If bleeding after the injection, use a cotton ball or tissue to clean up. Apply a band-aid as necessary. Wash hands with warm water and soap. Keep sharps container out of reach of children.

Subcutaneous

Subcutaneous injections are injected just under the skin. It is easier to self-inject a subcutaneous injection, as opposed to intramuscular ones. Subcutaneous injections can go in the stomach (below and away from the bellybutton, avoid boney areas), the side or back of the upper arms (aim for below the shoulder and above the elbow), and thighs (aim for halfway between your knee and your hip on the outer part of your thigh). The risk of hitting a nerve is significantly reduced compared to with intramuscular injections, as subcutaneous needles are much smaller.

The best type of syringe to use is one that is 1cc (or 1 milliliter). Larger syringes make it more difficult to do subcutaneous injections with oily substances such as hormonal medication. A 1.5 inch 20 gauge needle is optimal for drawing up the liquid medication. A 0.5 inch 30 gauge needle is optimal for injecting the medication into the body. Some healthcare providers will give patients slightly larger gauge needles, such as 22 gauge, which can be slightly more painful when injecting.

  1. Make sure to gather all of your supplies before injecting. The required supplies consists of an alcohol wipe or pad or rubbing alcohol (two alcohol wipes are ideal), the vial of medication, a syringe, two needles (a single 1.5 inch 20 gauge needle for drawing up medication & a 0.5 inch 30 gauge needle for injecting), and a sharps container (or a hard plastic detergent bottle or milk jug) to safely dispose of needles. Check the expiration date, dosage, and concentration of your medication.

  2. Find a spot that is well lit, clean, and has a lot of space available for your supplies. Wash your hands with either antibacterial soap and water or an alcohol-based gel aka hand sanitizer (if soap and water are not available). Hold up the bottle of medication to the light. If it is cloudy, or there are bits floating in it, don't use it (its expired).

  3. Take the cap off the medication vial. Clean the rubber stopper with an alcohol wipe for 15-20 seconds. Let it dry. Clean the injection site (thigh, butt, or upper arm) with another alcohol pad or pour alcohol over the area. Clean the area on your body where you intend to do the injection with a circular motion from the center moving out. Let it dry.

  4. Secure the larger gauge needle for drawing up medication on the syringe. Pull the needle cover straight off the syringe. Pull back the plunger to the number on the syringe that matches your dose. Insert the needle straight down into the bottle (through the rubber stopper), and push the plunger of the syringe all the way down, injecting air into the vial.

  5. Turn the vial upside down (keep holding it and the syringe steadily). Slowly pull back the plunger to fill the syringe with medication, and check to make sure you have the correct dosage. Gently tap the syringe with your fingers until the larger air bubbles rise to the top. Slowly push the plunger up to force the air bubbles out. After the air bubbles are out, slowly pull the plunger down to the number corresponding with the correct dosage of medication.

  6. Dispose of the drawing up needle (put it in the sharps box). Replace the drawing up needle with the smaller gauge injection needle.

  7. Pinch an inch of skin at the injection site. Quickly and firmly insert needle just under the skin. The needle can be inserted straight up and down, or at a 45⁰ angle. If you experience extreme pain while doing this, immediately remove the needle, as this indicates you hit a nerve. Slowly push the plunger to inject hormones. Wait 5 seconds. Pull the syringe straight back to remove from skin.

  8. Safely dispose of injection needle (put it in the sharps box along with the syringe). If bleeding after the injection, use a cotton ball or tissue to clean up. Apply a band-aid as necessary. Wash hands with warm water and soap. Keep sharps container out of reach of children.

Oral Tablets

This is testosterone taken in pill form. Though fairly uncommon, it is still a potential administrative route. 160–240mg/day of testosterone undecanoate is the typical dosage for orally administered testosterone pills. Due to the infrequent usage of oral tablets in regards to testosterone therapy, it can be difficult to find a provider willing to perscribe it depending on your location.

In the past, orally administered testosterone was heavily discouraged due to negative effects on the liver. With the introduction of newer medications (such as Kyzatrex, Jatenzo, and Tlando), oral tablets are much, much safer. That beign said, they are still uncommon, especially depending on location.

Topical Patches (Transdermal)

Patches are essentially medicated stickers via which testosterone can be absorbed through the skin. A typical dosage for testosterone patches is 2.5 – 7.5 mg per day. The patches are replaced daily. The location of the patch should be changed upon replacement. Like other transdermal forms of testosterone medication, these can cause skin irritation.

Due to manufacturing issues, these are harder to obtain in the United States after common brands (androderm) were discontinued.

Miscellaneous Others

Some forms of testosterone are uncommon enough to only be available through compounding pharmacies. Such forms include sublingual oral troches (administered under the tongue), lozenges (medicated candy), topical cream (similar to gel but a cream), and suppositories (goes up your butt).

Disclaimer/Side Notes

The above lists are not all-inclusive of every possible change. Changes and timelines can vary from person to person.

Some additional possible side effects of going on testosterone include; sleep apnea, high blood pressure, and an increased risk of blood clots. When going on T, ideally, your health will be monitered reguarlly by a doctor to minimize risks.

As for what route you take T (injections, patches, etc) this will vary depending on what is avaliable where you are, or preference. Effectiveness of various routes will vary depending on the person and their body.

While testosterone can sometimes lead to infertility, it is absolutely NOT birth control. It is still possible to get pregnant while on HRT. In fact, it is somewhat common to end up pregnant while under the assumption that testosterone prevents pregnancy. Please keep this in mind if you are sexually active, and seek out actual forms of birth control. If you become pregnant while on testosterone, and intend to keep the child, it is required that you stop taking the testosterone, as it can cause birth defects.

As an additional disclaimer, I am not a physician. I am not a medical professional. The information provided is simply derived from my own experiences and research. Do not consider me a primary source of medical advice. If you are interested in testosterone replacement therapy, please consult an endocrinologist.