Transgender and transmasculine folks looking to achieve and sustain certain changes often use testosterone therapy long term. Here’s what to expect.
Testosterone is a hormone that naturally exists in all people, regardless of their sex assigned at birth.
That’s right: While testosterone is typically dubbed the “male reproductive hormone” or “male sex hormone,” it’s a hormone that everyone naturally has some of.
For a variety of reasons — ranging from gender identity to desired aesthetic to improved sexual function — sometimes people need or want higher testosterone levels than their bodies naturally have.
In these cases, you may start something called testosterone therapy.
“Testosterone therapy” is the broad term for any medical treatment that involves orally ingesting, injecting, or topically applying testosterone to raise the levels of that hormone in the body, explains Lisa Golding-Granado, MD, founder and medical director of Synergy Wellness and MediSpa in Red Bank, New Jersey.
“Testosterone therapy can be taken as part of gender affirming care for transgender men and in gender diverse people to bring about physical changes that align with their gender identity,” says Golding-Granado.
In these cases, testosterone is prescribed to spur physical changes such as:
- increased facial and body hair
- deepened voice
- increased muscle mass
The extent of these changes depends on the dosage, which varies based on the degree of change you’re after.
Yes! There are a number of different application methods for testosterone:
- oral pills taken twice daily
- topicals, including patches, lotions, and gels, applied to a specific part of the body every day
- subcutaneous injections, which involve a needle injection into the muscle, every 1 to 4 weeks
- “pellet” implants inserted under the skin every few months via a minor in-office procedure
A healthcare professional can help you figure out the best option for you and advise you on the next steps.
“Each person has different priorities and therefore different routes of administering testosterone might fit them better than others,” says Michelle Forcier, MD, a gender affirming clinician with virtual healthcare service FOLX.
“If you hate taking medicine daily, the gel won’t be a great fit,” she says. “If you want to get your levels higher faster and more reliably, then subcutaneous injections weekly might achieve your goal more easily.”
Generally speaking, access to gender affirming care — which includes testosterone therapy — is limited to consenting adults ages 18 and older.
If you’re under age 18, you may be able to receive testosterone therapy with parental consent.
Your geographic location may also play a role. Several U.S. states have laws designed to restrict adolescent and adult access to gender affirming care.
Your clinician may also have certain requirements before they will allow you to move forward with testosterone therapy.
Start by finding a qualified clinician who is knowledgeable in testosterone therapy. Some healthcare professionals specialize in working with cisgender men with low testosterone, while others specialize in providing gender affirming care.
Once you find a clinician, “discuss and outline your medical history with them, including preexisting conditions, family history, allergies, and other medications you may be taking,” says Golding-Granado.
Then, ask all of the questions you may have.
“It’s important to fully understand the risks and benefits of any therapy, including testosterone therapy, which may be ongoing for months to years,” she says. “This discussion should include what your potential benefits or side effects and long-term health implications could be.”
“Testosterone therapy can affect fertility, depending on the age you start treatment,” says Golding-Granado. ”So, fertility preservation options should be discussed with your provider.”
A number of physical, mental, and emotional changes are possible with testosterone therapy, such as:
- thicker, more oily skin
- change in body odor
- increased body sweat
- redistribution of weight from thighs and hips to abdomen
- increased muscle mass
- more angular face and jaw
- deepened vocal pitch
- darker, thicker, more abundant facial and body hair
- access to different range of emotions
- increased libido
- change in clitoral size and length when aroused or at rest
- shorter or absent menstruation
“A transgender male who wants full masculinization might take higher doses to try to achieve higher levels of testosterone,” explains Forcier.
A person who is nonbinary or androgynous might want to take a lower dose of testosterone to reach higher levels of testosterone than they naturally have, but not so high as to be in the average range for a cisgender man, she says.
“The extent of changes observed really depends on several factors,” explains Golding-Granado. This includes:
- your age
- your overall health
- the dose of testosterone
- the method of application or ingestion
Testosterone therapy is used for as long as a person and their healthcare team feels that it benefits them and affirms their gender, says Forcier. In some cases, that’s forever. In others, that’s for a few months, they say.
Often, people who are looking to sustain certain changes will take testosterone therapy for the rest of their lives.
Some people will only take testosterone for as long as it takes to develop changes that are usually considered permanent, like a deeper voice and increased body hair.
“It’s important to have continuous, real, and honest conversations with your healthcare provider so that they can help determine what is the best course of action and timeline for you,” Forcier says.
It will take different amounts of time to see different results. Below, Forcier shares common timelines for changes associated with gender affirming testosterone therapy:
|Change||Onset of start||When changes stop|
|deepened voice||1–3 months||1–2 years|
|acne and other skin changes||1–6 months||1–2 years|
|fat redistribution||1–6 months||2–5 years|
|vaginal atrophy||2–6 months||1–2 years|
|irregular or absent menstruation||2–6 months||—|
|increased libido||2–6 months||—|
|increased clitoral length||3–6 months||1–2 years|
|increased muscle mass||6–12 months||2–5 years|
|increased facial and body hair||6–12 months||4–5 years|
“Like all medicines, it’s important to discuss the potential benefits, risks, and side effects before you start,” says Forcier.
Testosterone therapy can increase your risk of:
- high cholesterol, which may increase the risk of heart disease
- high red blood cell count (erythrocytosis)
- high blood pressure (hypertension)
- type 2 diabetes
- blood clots
- fertility issues
Some people experience changes similar to puberty, such as:
Worsened sleep and hair growth patterns, including hair loss, have also been reported.
These are all signs that your testosterone dosage is too high.
Many providers that offer gender affirming care on an informed-consent model — like FOLX, Plume, and Planned Parenthood — have a robust library of articles designed to answer the most frequently asked questions.
Here are some to get you started:
- 9 Myths You Might Have Believed About Testosterone HRT
- How Testosterone HRT Impacts Hair Growth and Loss: Facial, Body and More
- Bottom Growth and Genital Changes on Testosterone
- Understanding How Testosterone Can Affect Your Emotions During Transition
These platforms also offer the option to connect virtually with a trans-inclusive healthcare professional, so you can ask your personal questions to figure out whether testosterone therapy is right for you.
Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.