Testosterone

Introduction

For many transgender men (and some nonbinary transmascs), testosterone hormone therapy plays a key role in reducing gender dysphoria and obtaining gender euphoria. It helps with passing as a man, and feeling overall self-confidence in oneself as a trans man.

Some cisgender and some intersex men also take TRT due to various health conditions.

General Information

Testosterone is a hormone that is produced in different quantities by both the ovaries and the testes respectively. In the context of this page, "testosterone" is refering to synthetic testosterone for the purpose of gender-affirming hormone replacement therapy. As mentioned previously, it is generally desired by transgender men to increase the testosterone in their bodies.

Unlike with feminizing hormone therapy, transgender men rarely (if ever) have to take an estrogen blocker alongside the synthetic testosterone.

A common initial side effect of taking testosterone is increased energy, happiness, and self-confidence.

Effects of Testosterone

Body Fat Redistribution

This change typically occurs during the first 1-6 months, and reaches its maximum effect after around 2-5 years.

Cessation of Menses

Testosterone hormone therapy typically stops the menustral cycle. Sometimes, it can cause an extremely intense period, followed by never again having one. It can cause irregular or rare periods. For some people, it doesn't stop them at all. It varies from person to person.

If it does not stop your period, or causes a regular increased flow, talk to your doctor.

Typically starts during the first 1-6 months, reaching maximum effect around 1-2 years.

Deepening of Voice

Typically starts during the first 6 months, continuing for years.

Genital Changes

Along with an increased libido, testosterone can cause clitoral growth and vaginal atrophy.

Typically starts around 1-6 months, reaching maximum effect around 1-2 years.

Hair Growth

Testosterone causes an increase of body and facial hair production. Wondering what your future face may have in store? Look to your mother's side of the family. Facial hair genetics (typically) come from the maternal side of the family. Does your mother's father have a full beard? Well than you may be in luck. Remember though, this will still vary from person to person.

Some transgender men who are unsatisfied with their hair growth turn to treatments such as minoxidil or finasteride.

Some transgender men dislike hair growth, and turn to hair removal

Facial and body hair growth typically starts around 6-12 months on testosterone, and can continue to grow for upwards of 5 years.

Height

If one is lucky enough to start testosterone before the fusing of his growth plates, he may grow taller.

Muscles and Strength

Taking testosterone makes it easier to gain/maintain muscle mass, and thus those who take it typically show an increase in muscle mass and strength.

Increased muscles and strength can also come along with increased physical energy.

This change typically occurs at around 6-12 months on t, continuing for a maximum effect at around 2-5 years (though if you are a bodybuilder or anyone else who does a whole lot of exercise, it will assumedly continue.

Oily Skin/Acne

Testosterone often results in becoming sweatier (due to a higher body temperature). Alongside this, testosterone can acne (which can be treated with topical medication).

Oily skin and acne caused by testosterone typically begins during the first 1-6 months, with the full effect occuring around 1-2 years. Typically the increase of acne production is not permenant.

Scalp Hair Loss

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.

Ways to Take T

Gel

Testosterone administered through a gel and absorbed through the skin. Testosterone gel is administered daily.

With the consistency of hand sanitizer, the substance is rubbed on the upper arms and absorbed through the skin within minutes. It is recommended that you apply it somewhere on your body that will be covered with clothing, and wash your hands after administering it. After being applied, it can take 5-6 hours to be fully absorbed.

Androgel is one such gel available. Alternative brands such as Axiron also exist. Testosterone gel can also be administered via a nasal spray, such as with natesto. Sometimes it comes in a small packet. Other times it comes in a pump bottle.

Implants

Treatments wherin a pellet is inserted underneath the skin to administer testosterone over time are known as implants.

Testopel is an available implant for administering testosterone to the body for several months at a time.

Injections

Testosterone treatments administered by needle are known as injections.

Injections can be done either weekly or biweekly, typically using testosterone cypionate injections or testosterone enanthate. Some people go for more spaced out testosterone undecanoate injections every 10 weeks for a lower dose.

Intramuscular injections are injected straight into the muscle. They often require the help of a doctor or a family member to administer. They can be more painful than subcutaneous injections

Subcutaneous injections are injected just under the skin. They are easier to self-inject than intramuscular injections, and can be less painful.

An autoinjector known as xyosted is also available.

Oral Tablets

This is testosterone taken in pill form. Though fairly uncommon, it is still a potential administrative route. One avaliable pill is known as Jatenzo.

Topical Patches

Patches are essentially stickers via which testosterone can be absorbed through the skin.

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 possible side effects of going on testosterone include; weight gain, acne, sleep apnea, high blood pressure, and a 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 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.

United States-Based Resources

FOLXHEALTH GALAP - The Gender Affirming Letter Access Project
out2enroll - connect with a health insurance provider
Plume
queer med

Additional Resources

Andrology - Effects of testosterone on the transgender male voice
BJA - Hormone replacement therapy (HRT) and anaesthesia
Cleveland Clinic - Testosterone
diyhrt.wiki
FDA approves new oral testosterone capsule for treatment of men with certain forms of hypogonadism
Harvard Health Publishing - Hereditary-patterned baldness
Healthline - How to Fight the Baldness Gene (and Other Factors)
Healthline - TRT: Separating Fact from Fiction
International Journal of Transgenderism - Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review
Prostatic metaplasia of the vagina in transmasculine individuals (pdf)
PubMed - Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures
Queer Science Lab - The cops may know about your testosterone prescription
Reddit - r/GrowYourTDick
Springer Nature Link - Prostatic metaplasia of the vagina in transmasculine individuals
trans guys - DHT
Trans Solidarity Project - HRT 101
Urology Health - Low Testosterone
Wikipedia - Finasteride
Wikipedia - Minoxidil

The Transgender Dictionary