Testosterone

Transition

Disclaimer: I am NOT a doctor or any other kind of medical professional. The information I've shared here is gleaned from my own experience and research through the years. I've done my best to be as accurate as I possibly can but I strongly encourage you to talk to your doctor if you have any questions about your own specific treatment.

MAYO CLINIC: MASCULINIZING HORMONE THERAPY

I began testosterone on June 3, 2015. I have taken it ever since. Check out this Instagram post for a series of videos about testosterone, this post for information on how I made the decision to take it, and this video for why I got top surgery before starting T.

Where can I get testosterone?

Testosterone can be prescribed by an MD (doctor) and, in some states, a physicians assistant (PA) and nurse practicioners (NP). Usually the doctor is an endocrinologist, but they do not have to be. Typically, you will also need a letter from a psychologist or doctor that says you need testosterone to treat gender dysphoria. The requirements vary for different insurances, in different states, and for different doctors. I’d advise you to visit a local LGBTQ center, or, (even better) a LGBTQ health center if there is one around you and ask for resources and advice. You could also start with your primary care physician, if you feel they are trans friendly. Absolutely do not take testosterone without consulting a medical professional first.

What happens when I take testosterone? What are the side effects?

Taking testosterone is physiologically identical to going through puberty. The “side effects” are puberty. The table below indicates the changes resulting from testosterone, as well as the permanence of the effect.

My mom is worried testosterone will harm my body. What should I tell her?

I would assure her that testosterone therapy is safe & researched and that many cis people actually take testosterone for various reasons – some boys assigned male at birth have to or choose to take T because their bodies don’t produce the ‘right’ amount of it. That said, you are seeing a doctor (I assume, and if not you really, really should) and that will ensure that your treatment is well managed and all the more safe.

Does testosterone cause cancer?

There is little to no empirical evidence that testosterone "causes cancer." But you can still get cancer in the reproductive organs that you have and many trans folks don't end up getting the proper routine exams for these organs because either they are not comfortable seeing their doctors or their doctors do not know they are transgender and therefore assume they do not have the organs that they do. It's important to remember that taking testosterone does not mean you stop having to take care of the reproductive organs that you still have. You still need to get routine exams -- such as pap smears -- to make sure they are healthy and screen for any cancer.

How can I take testosterone? Do I have to take shots?

There are three main ways to administer testosterone in the US:

  1. Injections. Typically involves a weekly or biweekly (every other week) shot of testosterone. There are two main types of injections:
  2. Intramuscular (IM): Injected into the muscle -- usually the thigh or glutes, but could also do the deltoid/shoulder. This is typically done with a 1-1.5in 21g needle.
  3. Subcutaneous (SubQ): Injected into the subcutaneous layer, beneath the dermis, which is essentially fat. This is typically done in one's stomach fat or "love handles" with a smaller needle -- 0.5in and 25g or so.
  4. Topical gels/lotions. Spread on one's skin daily, where the testosterone is then absorbed and processed. Many people report the speed of changes to be slower with this mode, but the overall/end results are no different. This is usually a better option for those looking for more gradual and slow changes, or people very averse to needles.
  5. Testopel. Tiny rice-sized pellets are inserted subdermally (beneath your skin), usually in your buttocks, and dissolve over 3-6months time to release testosterone slowly into your bloodstream. This is an outpatient surgical procedure that must be done in a doctor's office. Many people prefer this as it means no daily lotions, no weekly shots/needles -- only having to go to the doctor 2-4x a year for the procedure. For more on my experience with testopel, see this video

In many European countries, something called Nebido is legal. This is a long-lasting shot of testosterone that you only need once every several months or so. It is very similar to Testopel, but without the whole insertion of pellets. It's just a shot. For some reason the FDA has not legalized it here in the US.

Please note: There really is NO “standard” or “average” or “typical” dosage. Comparing dosages is super harmful and toxic and absolutely unnecessary. Every body is different and therefore metabolizes testosterone differently! Although I have shared my dosage before, I believe it was unnecessary to have done so - your testosterone dosage is yours; mine is mine! Neither is better or worse as long as it works for you!

What kind of testosterone do you take? What's your dose?

I take testosterone cypionate. That's just what my first doctor prescribed me and I haven't needed to change it. There really is NO “standard” or “average” or “typical” dosage. Comparing dosages is super harmful and toxic and absolutely unnecessary. Every body is different and therefore metabolizes testosterone differently! I only shared my own dosage because I was sharing each step of my own testosterone usage, but I realize now that it was unnecessary to have done so - your testosterone dosage is yours; mine is mine! Neither is better or worse as long as it works for you!

How much does testosterone cost?

This depends on your insurance. With my insurance (BlueCross BlueShield), my testosterone costs $12-24 for 4-6 weeks' worth. It’s fairly inexpensive with most insurances that cover it, and many insurances do these days.

What is your experience like with testosterone and school? Did taking T affect school?

I started testosterone on June 3, 2015, three months before I began college. (Here's my video for my first T shot, and here's the Instagram post.) I presented as male in college. I do not regret the timing of my starting T – I think I would have done it earlier, though, if I’d known. (I didn’t come out as trans until my gap year before I started college.)I don’t think hormones affected my academic/social experience my first year too much. However, I spent my first three months on hormones at home and I experienced a lot of mood swings during my first 1-3 months, so I would be aware of that. Make sure you give yourself time and space to breathe – especially during stressful times and moments when you feel like you might get angry. Take a step back. Taking T is going through puberty all over again, at an accelerated rate. Sometimes you’re going to be moody. And that’s okay. But give yourself and others space so you don’t do anything you might not be proud of.

Can I use testosterone and compete in college?

The short answer is yes! For more, visit my page on NCAA regulations for trans folks.

Some relevant Instagram posts:

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