Want to Start Testosterone-Based Hormone Therapy? Here's What to Know

Testosterone-based hormone therapy can help align a person's inner gender experience with their outward gender expression.
Image Credit: jacoblund/iStock/GettyImages

One of the biggest milestones of any transgender person's life is going on hormones. And yet, there are so many questions you may have around the process, especially when it comes to the physical and mental changes to expect.

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Testosterone-based gender-affirming hormone therapy (GAHT) helps people masculinize their bodies to better match their gender identity.

While the term used to be hormone-replacement therapy (HRT), the way we talk about the same procedures now has changed, says Michelle Forcier, MD, MPH, a clinician with Folx Health.

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Here's why terminology is important: "For vulnerable and disadvantaged populations, it indicates that we see you, we acknowledge and accept you and your lived experience and we will respectfully utilize your preferred language to demonstrate this acceptance and respect," Dr. Forcier says.

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Another common term, female-to-male or FtM, is also not widely used anymore because it's too limiting, says Jerrica Kirkley, MD, CMO and co-founder of Plume, which provides gender-affirming care via telemedicine.

"FTM is a term still used by some, but not by all folks who desire to be on testosterone," Dr. Kirkley tells LIVESTRONG.com. "FTM refers to a binary of going from one gender to another, [but] many folks on T don't identify as masculine or male. We use the term 'testosterone-based gender-affirming hormone therapy' to encompass the wide breadth of gender identity, including non-binary, genderqueer, agender, gender-fluid and other identities."

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Knowing the right terminology is just the first step in understanding testosterone-based gender-affirming therapy. Here's a look at who it's right for and the changes to expect, plus tips on how to find the best doctor for you.

What Is Testosterone-Based GAHT?

Testosterone-based gender-affirming hormone therapy is the use of hormones to help a person develop a more masculine appearance. It's used by folks whose gender identity (their own personal sense of where they fall on the gender spectrum) does not align with the sex they were assigned at birth.

"Testosterone is the primary medication used," Dr. Kirkley says. "The most common prescription forms come as injections, gels and patches."

And just as there are multiple ways to administer testosterone, it may be administered in different dosages and frequencies depending on the person's desired outcome, Dr. Forcier says.

Getting the dose just right is one big reason it's important to work with a doctor, she adds, because it is possible to take too much, which can be dangerous.

Testosterone can cause a high hemoglobin count, says Mary Jacobson, ob-gyn, chief medical advisor at telemedicine company Alpha Medical. Hemoglobin is a protein in red blood cells that carries oxygen to the body's organs and tissues and transports carbon dioxide back to the lungs. Too much can cause a stroke, heart attack or other conditions, Dr. Jacobson says.

Who Is Testosterone-Based GAHT Right For?

Starting a medical transition is a highly individual process, and patients have many reasons for seeking out gender-affirming hormonal therapy. However, most of those reasons have to do with a desire to feel more like themselves.

"Patients who know themselves to be transgender, gender-diverse or non-binary seek out GAHT in order to live as their most authentic and healthful selves," Dr. Kirkley says.

In other words, these people want to undergo GAHT so they can align their inner gender experience with their outward gender expression.

What Kind of Transition Timeline Is Typical for Folks Taking Testosterone?

Each person has widely different biology, so exactly how they'll respond to hormone therapy can be hard to predict. However, after having treated hundreds of patients seeking testosterone-based gender-affirming therapy, both Drs. Kirkley and Forcier have found a general timeline that seems to match the experience of many of their patients.

"Testosterone is a very powerful hormone in regards to body changes, so many folks are often pleasantly surprised with how quick they and others start to notice changes," Dr. Kirkley says.

"Earliest changes include: emotional and cognitive effects of having a hormone that is more in line with your gender identity, cracking and eventually lowering of voice pitch, starting to grow some more facial and body hair and less or no menstrual bleeding," Dr. Forcier says. "These earlier effects start within the first three to six months. Over time, muscle and fat redistribution into a masculine habitus, no periods, more face and body hair along with a low-pitched voice work to change the body to be read by others as masculine or male."

Expected Timeline of Bodily Changes From Testosterone Therapy

Expected Onset

Max Effect

Mental health benefits

Immediate

Lifetime

Cease of menstrual cycle

2 to 6 months

Lifetime with some intermittent bleeding

Redistribution of body fat from hips to central areas

3 to 6 months

2 to 5 years

Increased muscle mass and strength

6 to 12 months

2 to 5 years

Genitalia changes (clitoral growth and atrophy of genital tissues)

3 to 6 months

2 to 3 years

Increased acne and skin oiliness

1 to 6 months

1 to 2 years

Voice deepening

3 to 12 months

1 to 2 years

Increased body hair growth

3 to 6 months

3 to 5 years

Increased sex drive

1 to 3 months

3 to 6 months

Source: Dr. Jerrica Kirkley

Which Parts of Testosterone-Based GAHT Are Permanent?

While many aspects of medical transition fade as soon as a patient stops taking hormones, there are some aspects that won't go away even if one stops taking hormones.

"There are only three permanent changes that would need some time on testosterone to occur," Dr. Forcier says. These include, "lower voice, more male-pattern face and body hair and clitomegaly or some enlargement of the clitoris."

Dr. Kirkley adds that patients also tend to retain the improvements in their mental health that were originally reached by starting hormonal transition.

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Benefits and Side Effects of a Testosterone-Based Transition

Just like puberty, testosterone-based transition takes time. Many who start GAHT are anxious to see immediate results. However, hormones don't work that way. Some people see results within a few months, while others have to be on testosterone for years before they feel like they have gotten close to the results they want.

Because testosterone increases appetite, some who undergo GAHT gain weight and fat, especially around their abdomen. Many folks experience other health concerns that come with rapid weight gain, such as sleep apnea, high cholesterol and high blood pressure.

However, for most people, the benefits they get from transitioning far outweigh the side effects that come with it.

"Our patients often tell us how much more confident they feel and that they feel less anxious and depressed," Dr. Kirkley says, adding that many people report being more active in their communities and picking up healthy habits like exercising and eating better. "Many describe it as a '180' from where they were before starting GAHT."

Dr. Forcier notes that many people see improved self-esteem and confidence because they are acknowledged and accepted by themselves and others.

"Hormones typically can have some effects on or change mood, emotions and how we think and process information," she adds. "But by far the majority of effects are very, very positive."

My Personal Experience With GAHT

I started transitioning in December 2015. At the time, I was only out to my partner and one or two friends as non-binary. I live in a religiously conservative state and didn't personally know anyone else who was transgender and non-binary. I knew a few transgender folks, but not well enough to feel like I could ask them about the experience.

When I started transitioning, I didn't plan to fully transition into what the transgender community calls "passing" — meaning that when you are in public, strangers immediately gender you as male or female. At the time, I didn't want to fit into societally defined gender roles and expectations.

Before I started transitioning, I was diagnosed with social anxiety. I was constantly afraid of what other people would think of me.

One of the biggest affirmations of my gender identity is that about a month after I had been on testosterone, my anxiety decreased more than any medication has ever done. And once I started passing as male — several years into my transition — I stopped having social anxiety altogether.

How to Find a Doctor to Help You Transition

While you might be able to get testosterone prescribed to you by a primary care physician, it's best to seek gender-affirming care from someone who's had experience treating transgender patients.

If you have insurance, most insurance companies have resources on gender-affirming care providers they cover. You can call the number on the back of your insurance card for more information.

If you aren't covered by insurance, CenterLink is a community of LGBT Centers that can help you find a center close to you. Start there, and contact your local pride center.

You can also search for providers certified through the World Professional Association for Transgender Health at WPATH.org.

And telehealth companies like Folx Health, Plume and Alpha Medical are great resources, too.

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