All About Testosterone
Testosterone is used for trans men, non-binary people, and people assigned female at birth – basically anyone born female who identifies as not female and wants to take the steps to make their body more masculine than feminine.
Testosterone is a lot stronger than Estrogen, so anyone taking Testosterone won’t need to dampen their Estrogen production like someone assigned male at birth would need to do for their natural Testosterone production.
How To Get Testosterone
There are a few ways of doing this in the UK:
Gender Identity Clinics – You can be referred there through your GP. It’s normally the first medical treatment they offer you and can take about two appointments to get at an adult GIC. They’ll warn you of all the risks and benefits and have you sign a consent form to say you know what you’re doing and that you’re informed of any risks you’re potentially taking.
GPs – They can and should provide a bridging prescription for Testosterone whilst you wait for your GIC referral to go through, although most of the time they won’t, or they’ll require a lot of convincing to do so, because some of them don’t know how to medically help trans patients without the guidance of a GIC, and some of them don’t want to deal with trans patients. Our post on The Importance of a Good GP explains more about these issues and how to deal with them.
Privately – Expensive, but faster than waiting for a referral to a GIC. You will have to do a lot of the legwork as a patient trying to access healthcare, though, such as trying to get shared care between the place providing your private care and your GP. This can help with prescription costs and getting blood tests done.
DIY – You shouldn’t. It’s dangerous, and can lead to long-term health issues if done wrong. But if you’re going to anyway, tell your GP that you’re going to, and ask them to monitor you with blood tests. In their panic they might even offer you a bridging prescription so that your doses can be monitored and adjusted correctly.
So, you have a few options here, which is always good to know.
Types Of Testosterone
If you’re scared of needles, you might not want the injectable form of Testosterone, for example:
Injections – Subcutaneous Injections are the easiest type to do. They’re done every few weeks in small doses, typically into the upper, outer thigh. The leg they’re injected into is swapped every time to lower scarring. Sustanon is normally the type of Testosterone used for this, and they’re often for people who have just started T and don’t have any issues with needles.
Intramuscular Injections go straight into the lower back, closer to the bum, because they’re usually done every 3 or so months so are big doses of Testosterone and take a long time to be fully injected. Thus, they need more fat to be injected into, and are normally offered to people who have been on T for a long time - maybe around a year or more. IM Injections are normally done with Nebido (a type of Testosterone) in the UK.
Pellets – Not offered in the UK, but I thought I’d tell you about them anyway. They’re delivered under the skin and last around 3 – 6 months before they need replacing.
Topical – Rubbed into the skin daily, topical Testosterone is higher maintenance because of how often it has to be done. You also need to make sure not to touch anything or anyone for around an hour afterwards, otherwise they’ll get a dose of T themselves. You could also end up with a skin rash, but this depends on the person.
Oral – Unlikely in the UK, but these are pills taken twice a day, the effects of which are monitored closely because of how uncommon they are.
Effects Of Testosterone
Everything related to medicine has side effects. With Testosterone, some are good:
Lower growth – This is the first thing a lot of people notice within a week or so of being on T. It can be painful, but it means that the clitoris will grow, giving the genitals a more male appearance, as well as making sexual functions more pleasing. Libido might also go crazy for around a year, so watch out for that.
Periods might eventually stop – Doesn’t happen for everyone, unfortunately. But for most people, your monthly cycle should eventually cease to exist. It’ll be dormant, because if you stop taking T then periods can eventually come back over time. As Testosterone isn’t a contraceptive on its own you and your partner should also use things like condoms to prevent any STIs or pregnancy, unless you want to get pregnant, obviously.
Deeper voice – The thing most people look forward to. It’s different for everyone, and it can take weeks to months to years depending on the person. Sometimes the voice doesn’t drop that much, but will be more male-sounding overall.
Adam’s apple – As your voice drops, the vocal cords thicken, and you might notice a small bump in your throat that moves as you talk. Happens to anyone going through puberty where Testosterone is the dominant type of hormone.
Beard growth – Some people are lucky, and it starts happening really quickly and really thickens out. But for most people, as is the same for cis men, beard growth can take years to fully develop, which is when you’ll want to start learning about the exciting world of grooming - instead of just shaving the bits of stubble you can currently grow.
Body fat redistribution – This will be more noticeable if you like to exercise. In anyone whose dominant hormone is Testosterone, body fat will move from the hips and the thighs to the muscles and chest. In a trans person assigned female at birth, it will make your chest look smaller and less feminine, although your breasts haven’t necessarily gotten smaller, they will appear as though they have.
Body hair – Can be both good and bad. Your armpits, legs, stomach, and back will likely get more hairy depending on genes. Great if it alleviates dysphoria and makes you look and feel more masculine, not so good in summer.
Testosterone can also make you feel warmer overall – Bad for summer, great for winter.
You might get taller if you start T young enough, but this is rare.
And some are bad:
Atrophy – I didn’t know much about this when starting T, but vaginal atrophy can cause dryness in and around the vaginal area. This can lead to pain when having sex, or inserting anything into the vagina, including a speculum during a smear test, or a tampon or cup for periods, for example. There are creams to deal with this.
Frequent urination – Some people may feel the need to pee more often, as T thins the urethra and makes it weaker. Testosterone essentially puts your body into a (very) early menopause, so anything that your mom went through, you might be experiencing a little earlier than most people.
Period pain – Doesn’t always go away, and you can even get phantom period pains during when you’re supposed to be having a period, or after masturbation. You should only be worried if the pain is really, really intense, or is accompanied by a lot of blood.
Weight gain – T can make you overweight, especially if you’re predisposed to weight gain because of your genes, or already have people in your family who are larger. Exercising and a good diet can help out with this, to an extent.
Acne – Taking Testosterone is what many people call a ‘second puberty,’ and for good reason! There are creams for acne, and other forms of treatment from specialists like Dermatologists if yours gets particularly bad. It’s likely to be worse if it was already bad during your ‘first’ puberty.
Hair loss – Happens to the best of us. Can happen for a year or so before slowing down, but as always, this is different for everyone and can heavily depend on genetics. Minoxidil can be used before the hair loss gets really bad, but it has to be before your hairline really starts receding, as Minoxidil can’t bring that back, only regrow and revive already dormant hair follicles. This is why it is also sometimes used for beard growth.
But Minoxidil has its own negative effects that should be researched and looked into, and you also have to use it consistently, every day for it to work properly. If you stop using it, it stops working.
High blood pressure, cholesterol issues, and liver problems.
Mood swings – You’ve seen what teenage boys are like, and it might happen to you too, but maybe just not as badly. Doesn’t happen to everyone.
Worsening of any pre-existing mental health conditions – Starting your medical transition can be a wonderful thing, but hormones impact every part of the body, so it doesn’t necessarily mean you’ve made a mistake if your anxiety, depression, etc gets worse on T, but it may mean you need to wait it out or tell your Endocrinologist or specialist about it to see if switching doses is a good idea.
The Bottom Line
Testosterone masculinizes the body and has both negative and positive side effects. It’s also not a contraceptive and should not be used alone to prevent pregnancy or STIs.
One thing to think about – fertility. You are offered the choice to freeze your eggs in the UK before starting Testosterone or any type of hormone replacement therapy. This is completely up to you and is a whole process on its own. It also has its own risks and rewards, like being able to have a baby ten years down the line that is biologically yours, although adoption works just as well if you’re not overly worried about your kids being related to you in biological terms.
It costs money to freeze your eggs and keep them frozen. They’re also not viable after a certain amount of time. It’s more difficult to try to go back and freeze your eggs after starting hormones than it is beforehand.
Noah Finnce knows more about egg freezing than I do:
If you have anymore questions about Testosterone or HRT feel free to leave them in the comments section below.
