Masculinizing hormone therapy involves the administration of testosterone through intramuscular (IM) injections, subcutaneous (SubQ) injections, transdermal (through the skin) patches, and/or topical cream/gel.

Testosterone helps to encourage the development of a more masculine appearance. Some folks may choose to only take testosterone for a short period of time to achieve some desired effects and then stop, and some folks choose to take testosterone for years. You and your care provider can discuss what path would best achieve your goals.
You can’t pick and choose what effects you do and don’t want–it’s possible that you may experience less favorable effects (like an onset of male balding or a receding hairline) alongside more favorable effects, like a changing voice or a more masculine body fat distribution. If you’re concerned about any changes that you’re not comfortable with, speak to your doctor about other delivery methods, a dose adjustment, or other methods to counteract effects that bother you.

Testosterone therapy does NOT cause “roid rage”, aggression, or violence, nor is it something to blame for mean or impulsive behavior. Many people seeking testosterone therapy have reported fears that starting T will make them abusive or unkind, something that’s been perpetuated by bad media representation and bad-faith actors. In reality, many transmasculine individuals have reported that T actually balanced out their moods and emotions, making it easier to react to frustration with a more level approach. If you’re concerned about pre-existing anger problems or fear of “roid rage”, speak to your doctor, other trans folks on testosterone, and your therapist to create a plan for how to cope with those concerns.

Testosterone therapy has been associated with a higher sex drive. It’s important to note that there are many safe sex options that are not hormonal birth control. Things like masturbation, non-penetrative sex, using clean sex toys, and internal and external condoms can protect against STIs and pregnancy. Copper IUDs, diaphragms, and cervical sponges can protect against pregnancy, but not STIs. Dental dams and finger cots can protect against STIs, but do not prevent pregnancy.

Even if your period stops while on testosterone, you can still become pregnant if you have unprotected sex with a sperm-producing partner. If that is something you are trying to avoid, use a previously-listed pregnancy prevention method–testosterone is not birth control.

If you’d like to have a biological child, speak to your doctor about options you may have to bank your eggs before starting T. While some people have been able to conceive after years of testosterone, there’s no guarantee that you’ll be able to preserve that option if that’s something important to you.

Staying on top of your blood tests is important! People taking testosterone may be at a higher risk of developing a higher hematocrit level or polycythemia, which means that their blood may become thicker from an increased volume of red blood cells. Often this can be easily remedied with regular blood donation, but your doctor should check this number regularly.

Bottom growth/clitoral growth may begin relatively early, depending on your starting dose–some folks have found this to be uncomfortable for the first few months due to the increased sensitivity associated with the clitoris becoming more exposed. Wearing loose-fitting underwear and pants will minimize uncomfortable rubbing or contact during this adjustment period.

Vaginal atrophy can be a consequence of testosterone hormone therapy–if you notice pain with penetration, an increase in yeast infections, dryness, redness, or other discomfort that is not associated with an STI or other infection, you should speak to your doctor about a low-dose, topical estrogen cream to try to counter the effects in that specific area of the body. This treatment does not “reverse” your testosterone therapy, it just keeps your body healthy and balanced. When atrophy is not treated, it may lead to more painful intercourse over time and put you at an increased risk of infections.

Increasing your dose without your doctor’s approval may have an unintended side effect–excess testosterone may convert, or aromatize, into estrogen, having the opposite effect that you may have been aiming for. Taking more testosterone than medically prescribed will not make changes happen faster. Just like cis boys have to go through years of puberty to have all of their physical changes, you will too. Time and patience will go a long way in this process, there’s no way to make it go faster.

Resources:

The Testosterone Survey Zine (available for free/donation)

UCSF–Information on Testosterone Hormone Therapy

UCSF–Overview of Masculinizing Hormone Therapy

Mayo Clinic–Masculinizing Hormone Therapy

Planned Parenthood–Effects of Masculinizing Hormone Therapy

Planned Parenthood–Information for Informed Consent, Masculinizing Hormone Therapy

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