I am not a doctor. This is my personal experience as a trans person regarding my first year on testosterone, which I wish I was able to see more of when first making my decision about whether to start HRT. In this article I speak openly about bodily functions and sex as related to my trans masculine experience.
What is Masculinizing Hormone Replacement Therapy?
Hormone replacement therapy (HRT) helps gender-nonconforming people feel more in tune with their bodies by inciting physical changes. For those who are designated female at birth and would like to achieve a more masculine appearance, taking testosterone helps reduce the amount of estrogen your body makes and boosts your testosterone levels high enough to develop characteristics like facial hair and a deeper voice.
It is important to work with your healthcare provider, as too much testosterone can have a negative effect on the body, such as thickening the blood. My endocrinologist started me on a low dose and worked up to where I am now, and I will continue taking the same dose until I feel that I don't need to take it anymore.
Ways of Taking Testosterone
Testosterone comes in several forms. What you and your medical provider decide on will mostly be based on preference, lifestyle, and medical needs.
Injections are usually given weekly to maintain even levels of testosterone in the blood.
Gel and patches are applied to the skin daily.
Pellets under the skin can be inserted by a doctor every few months in a minor in-office procedure.
Pills: An oral form, taken as a pill, is still relatively new but has been approved for use.
I decided to take the injections and they have worked well for me. It is not hard to self-administer the shots, and my main struggle is remembering to take it on the same day every week.
Discrimination in the Healthcare System
Trans folks are often met with barriers to healthcare through discrimination, lack of financial resources, insurance issues, or restrictive laws. Trans individuals are also less likely to have insurance than cisgender people and many insurance plans do not cover the cost of gender-affirming medical interventions.Â
While I was able to find a healthcare provider who respected me and had my best interests at heart, I experienced a lot of discrimination at the pharmacy. Whenever I picked up my testosterone, the staff did not want to give me the needles that were supposed to go with it. They would claim I was asking for extra to use for "some other purpose", or that I didn't need them, despite it being an intramuscular medication. Or they would give me needles that were very thick and not only hurt to use but gave me large welts for weeks afterward. To avoid this issue, my endocrinologist recommended that I buy in bulk from healthwarehouse.com, which has been much better for me. I also switched pharmacies from Walgreens to CVS.
I also experienced discrimination with my insurance company, which refused to cover either my testosterone or acne medications, claiming that they were "cosmetic" and therefore unnecessary. I finally gave up on insurance, but was also able to get a discount directly from the pharmacy to reduce the cost.
Don't be afraid to advocate for yourself or ask for help if you are facing barriers to access regarding your hormone replacement therapy.
What Are the Effects?
The effects of testosterone may show up within as soon as a month for some people, with the full effect taking two to five years. I have met trans masculine people who decided they were happy with their bodies and stopped after one year, as well as those who plan to continue for the rest of their lives. This is because your body responds differently depending on individual factors such as age and genetics, and some effects (like hair growth and voice deepening) are permanent while others (like body fat redistribution and reduced periods) only last as long as you are on testosterone.
Some physical changes to be expected when taking testosterone:
Oily skin and acne: Your skin will become a bit thicker and more oily. I immediately sprouted serious acne and still battle with it today, when it was never an issue for me before. I found some relief by requesting prescription acne medication from my healthcare provider.
Sweaty and smelly: The odors of your sweat and urine will change and you may sweat more overall. In my first few months of taking testosterone, I was very bothered by my general body odor and sweatiness. I have adjusted my toiletries and shower routine to accommodate my new needs.
Reduced periods: My period went away immediately. Apparently I'm very lucky, because for many people their periods take longer to go away or never do.
More facial and body hair: I was looking forward to having some facial hair, but it is only just now happening after a year and a half. However the amount of hair everywhere else on my body significantly increased pretty quickly.
Greater muscle mass and strength: Testosterone doesn't make you buff, but it does make it easier to build muscle. Because I work out a lot, I have been able to see this benefit.
Body fat redistribution: This means the fat deposits many AFAB people have centralized in their hips and thighs become more centralized in the abdomen. As a thicker person, this has been my least favorite thing. Your eyes and face may develop a more angular appearance as facial fat decreases and shifts.
A deeper voice: Testosterone causes a thickening of the vocal chords, which can result in a deeper voice. My throat was hoarse and my voice broke often for the first few months, and I found some creative ways to explain it away to people who didn't know I was on testosterone. Some people also do voice training to fully make use of their deeper voice and sound more masculine.
Bottom growth: I was very worried about growing a penis when I first started taking testosterone because I did not want one and most of the resources I consulted said it would happen. Even many medical resources refer to the clitoral growth from HRT as "a small penis". While many people find gender confirmation in referring to their bottom growth as a t-dick, you will not grow a penis. Instead, your clitoris grows in size, especially during sex when it becomes erect similar to a penis. Avoiding tight or ill-fitting pants or underwear is helpful as it is sensitive in the beginning.
Increased libido: During the first few months, this was very uncomfortable for me. As an asexual person, I generally don't think about or interact with my genitals unless my partner desires it, and constantly feeling aroused was very bothersome. Thankfully, I now feel at equilibrium with my body again. Whether or not you have a partner, buying a sleeve or air pulse vibrator for your bottom growth can be helpful to understand how your body works and avoid any shame from having an increased libido.
Vaginal atrophy: This is thinning, drying, and inflammation of the vaginal walls that can occur when your body has less estrogen. It can leave you more susceptible to HIV and other sexually transmitted infections due to the lack of protective mucus in the vaginal walls. It is important to use lube and protection, as well as talk to your partner(s) about your sexual health.
Hair thinning or male pattern baldness: Thankfully I did not experience any hair loss. As with everything, this depends on the individual.
Weight gain: Testosterone can increase your appetite and lead to weight gain.
Cramps: These were not mentioned in many of the medical articles or by my doctor, but thankfully I watched a lot of YouTube videos. One of my favorite trans content creators described his cramps as being bad enough for him to get a hysterectomy, and it made me feel less alone. Similar to this person, I experienced debilitating cramps after orgasming. Unfortunately, I also experienced them throughout the rest of the day, and at times they were so bad that I could do nothing but curl up in my bed and moan between work meetings. When I asked my endocrinologist she agreed it was because of the testosterone but so far there is no way to fix it outside of a hysterectomy. Thankfully they faded after a few months and are now completely gone.
Not all changes are physical. Some things I experienced after starting on testosterone:
Confidence: I generally felt calmer and more secure in myself, which may be from the gender confirmation that I get from taking HRT.
Crying: Before taking T, I was a big crybaby. When I got emotional about anything, whether it was about a stressful situation, an argument with my partner, or taking a wrong turn while driving and getting lost, I would cry. I found that this was significantly reduced, and I was able to think when stressed without being overtaken by my emotions. This is not to say that HRT takes away your ability to cry. I simply feel like it happens less often now.
Emotional Awareness: When new to testosterone I felt that I reacted to things differently. Situations that would make me slightly annoyed now made me very frustrated. I learned how to take a break when angry and come back to the situation that I was struggling with after I had calmed down.
Sexual/ Romantic Orientation: Taking testosterone does not change your sexual or romantic orientation. However, understanding yourself more deeply may give you a deeper understanding of how you want to relate to other people, and what people you are interested in sexual or romantic relationships with. I was personally in a lesbian relationship when I started taking testosterone and hadn't put any thought into my sexual identity. By the end of my first year the relationship had ended, I came to understand and treasure my asexuality, and I now identify as panromantic.
How testosterone makes you feel is different for everyone, and there is not always a way of telling what is from testosterone and what is a result of exploring your gender identity. Talking to my therapist was a great way to sort through all the changes I was experiencing, how it affected my relationships, and how I felt about my identity.
Myths
There are many myths about masculinizing hormone replacement therapy. Testosterone didn't make me lose my ability to cry or care about people, I didn't become an angry person, and I didn't suddenly sprout bulging muscles. Here are some more myths and their explanations:
Summary
HRT and other gender-affirming health procedures are still relatively new, and we do not yet know all of the effects. It is important to talk to a medical professional about whether or not this is right for you. Due to my family history, I am at risk for heart problems, so my endocrinologist not only helped me find the right dose to take for my body but also ensures that I take regular lab tests to watch out for any negative effects.
If you feel that masculinizing hormone therapy would make your life better but are experiencing discrimination by a healthcare provider, insurance company, or pharmacy, don't be afraid to advocate for yourself or go elsewhere. Gender-affirming hormones are critical to the health and well-being of us who need them, and you deserve to be treated fairly.
My journey isn't over. I still sound like a fourteen-year-old boy and the fabled facial hair is just now starting to grow in. I gained some weight when I first started HRT and am still working to get it off. However, I am happy with my body. I feel that my more masculine outside fits how I feel on the inside. As a bonus, people can't seem to tell what gender I am by looking at me, and that's just the way I like it.