Testosterone-Based Hormone Therapy

Some trans and gender diverse people benefit from gender-affirming hormone therapy to promote physical characteristics reflective of one’s gender identity or gender expression.
Testosterone is used to reduce estrogen-related features, induce testosterone-related features and relieve gender-related distress. This page sets out the advantages and disadvantages, expected effects, and potential risks associated with testosterone-based hormone therapy. The list of therapies is not exhaustive. Talk to your health care provider to determine the best fit for you.
Common therapies

Common testosterone therapies 

Injectable testosterone (testosterone cypionate or testosterone enanthate)

  • description: a medication you inject once a week or once every two weeks
  • advantages: lower cost (around $10 a month) and is widely available
  • disadvantages: may lead to highs and lows in energy and mood in between doses (becoming worse with every two-week injection)

Testosterone patch

  • brand name: Androderm
  • description: a  patch you wear every day on your back, upper arm, thigh or stomach
  • advantages: administered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosterone
  • disadvantages: relatively expensive (around $130 a month). Some people have a skin reaction to the adhesive

Testosterone gel (compounded testosterone gel or cream) 

  • brand name: Androgel
  • description: a  gel or cream applied to your skin at the same time each day
  • advantages: administered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosterone
  • disadvantages: relatively expensive (around $130 a month). When you are in intimate contact with someone, it can be challenging to avoid exposing them to the gel

Oral testosterone (testosterone undecanoate)

  • description: a  pill you take once a day
  • advantages: it is administered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosterone
  • disadvantages: not commonly used because it is less effective at stopping monthly bleeding, and felt to be less safe. Costs $130 a month
These therapies are also known as masculinizing hormones. To be more inclusive of diverse gender identities, we are using language that focuses on anatomy, treatments and presenting concerns, rather than gender. 


Effects

Expected effects of testosterone-based hormone therapies

Increased sex drive

  • usually starts in 1 to 3 months

Monthly bleeding stops

  • usually happens within 2 – 6 months
  • you may still be able to get pregnant even when your monthly bleeding stops (Note: it is not safe to take testosterone while pregnant)
  • reversible change, if you stop taking testosterone

Bigger erectile tissue (clitoris)

  • usually starts in 3 to 6 months
  • reaches full size in 1 to 2 years
  • size typically ranges from 1 to 3 cm
  • likely permanent change, even if you stop taking testosterone

More facial & body hair

  • usually starts in 3 to 6 months
  • maximum effect in 3 to 5 years
  • gradual growth of facial hair
  • more hair and thicker and coarser hairs on abdomen, arms, chest, back and legs
  • likely permanent change, even if you stop taking testosterone

Scalp hair loss

  • usually starts in less than 12 months
  • hair loss at temples and along the crown of head
  • possibility of becoming completely bald
  • likely permanent change, even if you stop taking testosterone
  • you can take medications to minimize this

Oily skin & acne

  • usually starts in 1 to 6 months
  • maximum effect in 1 to 2 years
  • more acne and may permanently scar
  • you can take medications to minimize this
  • not a permanent change if you stop taking testosterone

Increased Muscle Mass and Strength

  • usually starts in 6 to 12 months
  • maximum effect in 2 to 5 years
  • not a permanent change if you stop taking testosterone

Body fat redistribution

  • usually starts in 3 to 6 months
  • maximum effect in 2 to 5 years
  • more abdominal fat
  • less fat around buttocks, hips and thighs
  • not a permanent change if you stop taking testosterone

Deepened voice

  • usually starts in 3 to 12 months
  • maximum effect in 1 to 2 years
  • while your voice may deepen, other aspects of the way you speak may not be perceived as typically male. You can work with a speech language pathologist to achieve this, if desired
  • permanent change

Changes to lining of internal genitals (vagina)

  • usually starts in 3 to 6 months
  • maximum effect in 1 to 2 years
  • thinning and drying of the lining of the internal genitals (vagina)
  • may make penetration uncomfortable (treatments are available)

Emotional changes

  • overall emotional state may or may not change; this varies from person to person
  • many people experience positive mood changes
  • may experience a narrower range of emotions or feelings
  • may become irritable, frustrated or angry more easily
Risks

Risks associated with testosterone-based hormone therapies

With testosterone-based hormone therapies, there is:

  • a likely increased risk of polycythemia (blood disorder), weight gain, acne, androgenic alopecia (balding) and sleep apnea
  • a possible increased risk of elevated liver enzymes and hyperlipidemia
  • a possible increased risk (with the presence of additional risk factors) of destabilization of certain psychiatric disorders (bipolar disorder, psychotic disorders), cardiovascular disease, hypertension (high blood pressure) and type 2 diabetes

There is either no increased risk of bone density loss or cancer (breast, cervical, ovarian, uterine), or the research is inconclusive 

If you are injecting testosterone, your emotional changes may be the result of your fluctuating testosterone level. You may want to talk to your doctor about switching to more frequent injections or topical testosterone). Any mood changes that cause you concern should be discussed with your primary care provider.

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SOURCE: Testosterone-Based Hormone Therapy ( )
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