Changes Caused By Testosterone

Physical


  • your skin will become a bit thicker and more oily
  • Your pores will become larger and there will be more oil production
  • You may develop acne, which in some cases can be bothersome or severe, but can be managed with good skin care practices and common acne treatments.
  • You’ll also notice that the odors of your sweat and urine will change and that you may sweat more overall.
  • Your breasts will not change much during transition, though you may notice some breast pain, or a slight decrease in size. For this reason, some breast surgeons recommend waiting at least six months after the start of testosterone therapy before having chest reconstructive surgery. Fat will diminish somewhat around your hips and thighs.
  • You may also gain fat around your abdomen, otherwise known as your “gut.”
  • Your arms and legs will develop more muscle definition, and a slightly rougher appearance, as the fat just beneath the skin becomes a bit thinner.
  • Your eyes and face will begin to develop a more angular, male appearance as facial fat decreases and shifts. Please note that it’s not likely your bone structure will change, though some people in their late teens or early twenties may see some subtle bone changes.
  • Your muscle mass will increase, as will your strength, although this will depend on a variety of factors including diet and exercise. Overall, you may gain or lose weight once you begin hormone therapy, depending on your diet, lifestyle, genetics and muscle mass.
  • Testosterone will cause a thickening of the vocal chords, which will result in a more male-sounding voice. Not all transmen will experience a full deepening of their voice with testosterone, and some men may find that practicing various vocal techniques or working with a speech therapist may help them develop a voice that feels more comfortable and fitting.
  • Man shaving his neck.
  • Beards vary from person to person. Some people develop a thick beard quite rapidly, others take several years, while some never develop a full and thick beard. This is a result of genetics and the age at which you start testosterone therapy. Non-transgender men have varying degrees of facial hair thickness and develop it at varying ages, just as with trans men.
  • The hair on your body, including your chest, back and arms will increase in thickness, become darker and will grow at a faster rate. You may expect to develop a pattern of body hair similar to other men in your family—just remember, though, that everyone is different and it can take 5 or more years to see the final results.
  • Most trans men notice some degree of frontal scalp balding, especially in the area of your temples. Depending on your age and family history, you may develop thinning hair, male pattern baldness or even complete hair loss.

Emotional Changes


  • You may find that you have access to a narrower range of emotions or feelings, or have different interests, tastes or pastimes, or behave differently in relationships with people.
  • Psychotherapy is not for everyone, but most people in transition will benefit from counseling that helps them get to know their new body and self while exploring their new thoughts and feelings.

Sexual Changes


  • You will likely notice a change in your libido.
  • Your clitoris will begin to grow and become even larger when you are aroused.
  • You may find that different sex acts or different parts of your body bring you erotic pleasure.
  • Safe Sex as a transperson.

Reproductive Changes


  • You may notice at first that your periods become lighter, arrive later, or are shorter in duration, though some may notice heavier or longer lasting periods for a few cycles before they stop altogether.
  • Testosterone greatly reduces your ability to become pregnant but it does not completely eliminate the risk of pregnancy.
  • Gif of a condom being put on a dildo.
  • If you do want to have a pregnancy, you’ll have to stop testosterone treatment and wait until your doctor tells you that it’s okay to begin trying to conceive.
  • It is also possible testosterone therapy may have caused you to completely lose the ability to become pregnant. Freezing fertilized eggs is a possibility but is very expensive and not always effective.

Treatment


  • Testosterone comes in several forms. Most transgender men use an injectable form to start.
  • Testosterone levels tend to be most even, over time, when the injections are given weekly.
  • In addition to injections, there are also transdermal forms of testosterone, including patches, gels, and creams. In some men these forms cause changes to progress at a slower pace.
  • it’s important to know that taking more testosterone will not make your changes progress more quickly, but could cause serious health complications.

Risk


  • If you miss a dose of testosterone or change your dosage, you may experience a small amount of spotting or bleeding. However if your periods have stopped, be sure to report any return of bleeding or spotting to your doctor, who may request an ultrasound to be certain the bleeding isn’t a symptom of an imbalance of the lining of the uterus.
  • Some men may experience a return of spotting or heavier bleeding after months or even years of testosterone treatment. In most cases this represents changes in the body’s metabolism over time. To be safe, always discuss any new or changes in bleeding patterns with your doctor.
  • Heatlh written in pills
  • It is unclear if testosterone treatment causes an increased risk of ovarian cancer.
  • Your risk of cervical cancer, or HPV, relates to your past and current sexual practices, but even people who have never had a penis in contact with their vagina may still contract an HPV infection. The HPV vaccine, can greatly reduce your risk of cervical cancer, and you may want to discuss this with your provider
  • Some experts recommend a full hysterectomy which would include removal of the uterus, ovaries, and fallopian tubes--5-10 years after beginning testosterone treatment to minimize the risk of cancer and eliminate the need for screening.
  • Testosterone treatment does not seem to significantly increase the risk of breast cancer, but there’s not enough research to be certain. However it is still important to receive periodic mammograms or other screening procedures as recommended by your doctor.
  • After breast removal surgery, there is still a small amount of breast tissue left behind. It may be difficult to screen this small amount of tissue for breast cancer, though there are almost no cases of breast cancer in transgender men after chest reconstruction surgery.
  • Your risk of heart disease, diabetes, high blood pressure, and high cholesterol may go up, though these risks may still be less than a cisgender man’s risks.
  • Testsosterone can make your blood become too thick, otherwise known as a high hematocrit count, which can cause a stroke, heart attack or other conditions. This can be a particular problem if you are taking a dose that is too high for your body’s metabolism.

FAQs


What is the process for getting onto testosterone?
The first visit is always a consultation you won't get T day one. It's a process. Many doctors' offices require a letter from another doctor's office but usually from a mental health provider.
Second appointment is usually blood work and you should fast to allow for accurate results but follow your doctor’s recommendations.
Third appointment they call you back and discuss your results.
Fourth appointment. They teach you how to inject yourself or schedule your first dose. Congratulations!
After this you are on your own you need to schedule appointments to continue to check your testosterone levels and to make sure that your transition is going smoothly.
Not everyone passes right away.
While passing is not an all or nothing game, not everyone passes as soon as they start socially or medically transitioning. It's okay for it to take time and for you to choose the pace of your transition.
There is no such thing as a standard dose of T.
Your dose of T is based off of your lab work. Your provider knows what testosterone levels are safe for you but you can always talk to them about adjusting your dose.
Excess testosterone can be converted to estrogen, which may increase your risks of uterine imbalance or cancer. It can also make you feel anxious or agitated, and cause your cholesterol or blood count to get too high. So always make sure that you are using the correct dose for you.
“Stealth” isn’t an all or nothing.
Some people can be out to friends while they are stealth at work or at home. You are not being deceptive by not being out to the world. Your safety comes before anything else.
You can change your name again.
You may find a name that fits better after you thought you had one. Not everyone will be patient with you always changing your name but finding a name that you find fits you is important.
A picture of a peach
Butt hair
It's unfortunate, but it doesn't happen to everyone. For those that it does happen to, you don't really have much you can do except keep it trimmed or leave it alone.
Your body fat does not shift.
Starting testosterone is great. You build muscle. The downside you also gain more fat. Your body fat shifts around a bit but ultimately you gain more weight. This is normal though you will now need to work harder to manage your weight. Just check with your medical provider to make sure you are staying healthy.
There is nothing wrong with detransitioning.
There is a stigma in the world about detransitioning. That it's wrong or that you transitioned for the attention. Some may say that transitioning was a phase or that you were lying. This is simply untrue and it is a stereotype we should break down. Not everyone can afford nor wants to stay on hormones for their entire lives. Transitioning is a personal experience, gender is not static and therefore your transition should not need to be a static or linear one either.
What is T? Is it synthetic?
Testosterone & yes.
Can I do my own shot?
This depends on your provider and you. Some doctors will have a nurse on site to teach you to inject yourself. Other providers may have you come in biweekly to attain your shot.
How often would I inject?
It depends. Testosterone is most often given once a week to help balance the rise and fall of testosterone levels in your body.
Is testosterone right for me?
That is a personal journey. Finding a gender therapist can help you make this decision if you are questioning hormones.
How often do I need to have follow-up appointments?
It is recommended that you start to meet with your doctor every 3 months the first year, 6 months the next year, and then once a year.
Will T make me a different person.
No. While testosterone can make you happier and more confident it does not change your personality. Being aware of how testosterone effects your body and your mood is important but it is not as large of a factor as rumored to be.
If I double my dose will the changes happen twice as fast?
No. Doubling up is not only dangerous but can slow down your transition. Testosterone thickens your blood which can lead to blood clots and heart problems. Your body may also turn extra testosterone into estrogen as a safety against testosterone poisoning.
Can I decide which changes I will get?
No. As much as we would love to pick and choose the effects of testosterone on our bodies we cannot.
Do I have to stay on hormones my entire life?
No. Hormones are a large decision and while most effects of testosterone are permanent some of them are not. You can stop testosterone at any time with the assistance of a doctor to make sure that you are safe. Most effects of testosterone are completed in the first two years of hormone replacement therapy and from there people using hormones continue on a maintenance dose.
What happens if I stopping taking T? What is permanent?
Some of the effects of hormone therapy are reversible, if you stop taking them. The degree to which they can be reversed depends on how long you have been taking testosterone. Clitoral growth, facial hair growth, voice changes and male-pattern baldness are not reversible. You may start to lose muscle mass and your face may start to appear more feminine after stopping testosterone. You may also get your period again. Always talk to your medical provider before stopping any medications.
If you have had your ovaries removed, it is important to remain on at least a low dose of hormones post-op until you’re at least 50 and perhaps older to prevent a weakening of the bones, otherwise known as osteoporosis.
What are the different types of testosterone and how do I take them?
Intramuscular Injection – most common.
Subcutaneous Injection – longest standing.
Transdermal Application - gel, cream, or patch.
Both intramuscular and subcutaneous are scheduled injection. How often you get a testosterone shot depends on you and your doctor. Most people start with biweekly injections.
Transdermal testosterone has been shown to be less effective at causing changes but is more effective and holding testosterone levels consistent in a person body. Transdermal testosterone can be applied to the skin in gel, cream, or patch form. These are harder to have insured.
How long do I have to be in therapy before I could start testosterone?
More providers are moving towards an informed consent model. Those who require you be in therapy usually require a letter. WPATH has no standard time period for any individual to be in therapy before receiving a letter for hormone replacement therapy.
What does the letter from my therapist need to say?
The recommended content of the referral letter for masculinizing hormone therapy is as follows:
  • The client’s general identifying characteristics;
  • Results of the client’s psychosocial assessment, including any diagnoses;
  • The duration of the referring health professional’s relationship with the client, including the type of evaluation and therapy or counseling to date;
  • An explanation that the criteria for hormone therapy have been met, and a brief description of the clinical rationale for supporting the client’s request for hormone therapy;
  • A statement about the fact that informed consent has been obtained from the patient;
  • A statement that the referring health professional is available for coordination of care and welcomes a phone call to establish this.
For providers working within a multidisciplinary specialty team, a letter may not be necessary, rather, the assessment and recommendation can be documented in the patient’s chart. From WPATH.
Effect Expected Onset Expected Maximum Effect
Skin oiliness/acne 1-6 months 1-2 years
Facial/Body Hair Growth 3-6 months 3-5 years
Hair Loss (depending on genetics) >12 months variable
Increased Muscle Strength 6-12 months 2-5 years (depending on amount of exercise)
Body Fat Redistribution 3-6 months 2-5 years
Menstruation Ceases 2-6 months Variable
Clitoral Enlargement 3-6 months 1-2 years
Vaginal Atrophy(thinning of tissue/lubrication) 3-6 months 1-2 years
Deepened Voice 3-12 1-2 Years

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