#hormone therapy

[serving-saucy-fanfics]

Medical people actually doing their job 🥰

So today I want to talk about puberty blockers for transgender kids, because despite being cisgender, this is a subject I’m actually well-versed in. Specifically, I want to talk about how far backwards things have gone.

This story starts almost 20 years ago, and it’s kind of long, but I think it’s important to give you the full history. At the time, I was working as an administrative assistant for a pediatric endocrinologist in a red state. Not a deep deep red state like Alabama, we had a little bit of a purple trend, but still very much red. (I don’t want to say the state at the risk of doxxing myself.) And I took a phone call from a woman who said, “My son is transgender. Does your doctor do hormone therapy?”

I said, “Good question! Let me find out.”

I went into the back and found the doctor playing Solitaire on his computer and said, “Do you do hormone therapy for transgender kids?” It had literally never come up before. He had opened his practice there in the early 2000s. This was roughly 2006, and the first time someone asked. Without looking up from his game of Solitaire, the doctor said, “I’ve never done it before, but I know how it works, so sure.”

I got back on the phone and told the mom, who was overjoyed, and scheduled an appointment for her son. He was the first transgender child we treated with puberty blockers. But not, by far, the first child we treated with puberty blockers, period. Because puberty blockers are used very commonly for children with precocious puberty (early-onset puberty). I would say about twenty percent of the kids our doctor treated were for precocious puberty and were on puberty blockers. They have been well studied and are widely used, safe, and effective.

Well. It turned out, the doctor I worked for was the only doctor in the state who was willing to do this. And word spread pretty fast in the tight-knit community of ‘parents of transgender children in a red state’. We started seeing more kids. A better drug came out. We saw some kids who were at the age where they were past puberty, and prescribed them estrogen or testosterone. Our doctor became, I’m fairly sure, a small folk hero to this community. 

Insurance coverage was a struggle. I remember copying articles and pages out of the Endocrine Society Manual to submit with prior authorization requests for the medications. Insurance coverage was a struggle for a lot of what we did, though. Growth hormone for kids with severe idiopathic short stature. Insulin pumps, which weren’t as common at the time, and then continuous glucose monitoring, when that came out. Insurance struggles were just part and parcel of the job.

I remember vividly when CVS Caremark, a pharmaceutical management company, changed their criteria and included gender dysphoria as a covered diagnosis for puberty blockers. I thought they had put the option on the questionnaire to trigger an automatic denial. But no - it triggered an approval. Medicaid started to cover it. I got so good at getting approvals with my by then tidy packet of articles and documentation that I actually had people in other states calling me to see what I was submitting (the pharmaceutical rep gave them my number because they wanted more people on their drug, which, shady, but sure. He did ask me if it was okay first).

And here’s the key point of this story:

At no point, during any of this, did it ever even occur to any of us that we might have to worry about whether or not what we were doing was legal.

It just never even came up. It was the medically recommended treatment so we did it. And seeing what’s happening in the UK and certain states in America is both terrifying and genuinely shocking to me, as someone who did this for almost fifteen years, without ever even wondering about the legality of it.

The doctor retired some years ago, at which point there were two other doctors in the state who were willing to prescribe the medications for transgender kids. I truly think that he would still be working if nobody else had been willing to take those kids on as patients. He was, by the way, a white cisgender heterosexual Boomer. I remember when he was introduced to the concept of ‘genderfluid’ because one of our patients on HRT wanted to go off. He said ‘that’s so interesting!’ and immediately went to Google to learn more about it. 

I watched these kids transform. I saw them come into the office the first time, sometimes anxious and uncertain, sometimes sullen and angry. I saw them come in the subsequent times, once they were on hormone therapy, how they gradually became happy and confident in themselves. I saw the smiles on their faces when I gave them a gender marker letter for the DMV. I heard them cheer when I called to tell them I’d gotten HRT approved by insurance and we were calling in a prescription. It was honestly amazing and I will always consider the work I did in that red state with those kids to be something I am incredibly proud of. I was honored to be a part of it.

When I see all this transgender backlash, it’s horrifying, because it was well on the way to become standard and accepted treatment. Insurances started to cover it. Other doctors were learning to prescribe it. And now … it’s fucking illegal? Like what the actual fuck. We have gone so far backwards that it makes me want to cry. I don’t know how to stop this slide. But I wrote this so people would understand exactly how steep the slide is.

[zinniajones]

Text of thread at https://kolektiva.social/@zinnia/110418489814171631:

Yes - this is what is happening in Florida due to SB 254, which was signed into law on Tuesday 5/17/2023, taking immediate effect. This immediately cut off 80%+ of adult trans people in Florida from having their HRT refilled, because SB 254 uniquely prohibits only nurse practitioners from prescribing only gender-affirming medications.

This has already been in effect for 7 days now.

Trans adults in Florida have already been cut off from their HRT refills for a week now, including those of us who have been stable on these medications for years or decades.

This is VERY different from the general situation of trans youth care bans in 19 states, many still working their way through the courts.

This has *already* happened, to *all* of us: all trans adults in the third most populous state in the US.

The number of trans adults on HRT massively exceeds the sliver of the population that are under 18 and are prescribed puberty blockers or hormone therapy.

These laws, advanced under the pretext of 'protecting children', are now directly impacting a far larger group of people who are not children and are not subject to those pretextual concerns.

Other arguments about withholding public Medicaid funding for transition treatment also do not apply here: SB 254 does not even allow receiving this care through private insurance or paying cash out of pocket. The care isn't simply not covered - the care itself cannot be provided regardless.

What is happening in Florida requires special attention above the situation of trans youth care bans nationally. This is having a vastly larger impact quantifiably.

It will have worse impacts qualitatively as well: adults are responsible for taking care of and protecting trans kids and making sure they do not hurt themselves.

Whereas as a trans adult, we have no one standing guard at the brink but our own self and the void to which we are accountable.

These are the facts as they stand right now. These are the facts as they have stood for a WEEK and NO ONE nationally is putting any attention on this because there are 19 trans youth care bans all across the country going on, along with everything else targeting trans people and the LGBT community broadly.

This is a specific harm that is happening now and has been happening for 168 hours.

It is not a hypothetical issue to raise awareness of, as if it were at the stage of some proposal that needs to be fought back. This has already happened and is happening right now. Active harm is happening until this law is rolled back.

For all of Florida's history since the inception of the applicable regulatory and licensing bodies, nurse practitioners have been allowed to prescribe hormone therapy, testosterone blockers and other relevant gender-affirming medications.

That has been the case since I moved here in 2011. There was no reason why this wouldn't be the case. It's also the case in every other state.

This new law is a carveout of prescriptions when used for one purpose, gender-affirming care, from nurse practitioners specifically, in a way that has never been done before. It affects all ages.

It has immediately obstructed access to HRT prescription refills for more than 80% of TRANS ADULTS in Florida.

It has also prohibited first appointments for HRT via telehealth with in-state or out-of-state MDs or DOs - first appointments must be in person. This will require expensive and time-consuming travel that is beyond most trans people's means: driving to Georgia from Florida can take 8 hours.

This was an intentional targeting of almost all trans adults in Florida, and the means by which we have received our generic, FDA-approved medications for years. And it included closing every possible door that would let us find another way to keep taking the medications we have taken for...

Well, for me it was 3,891 days when the clock stopped

[femcelbassmentdweller]

Overview of My First Year of HRT (2021-2022)

Hi, my name is Sylvie, and I'm transfemme! I started hormone replacement therapy on September 25th, 2021 and I've been through quite a lot on my journey to a year of HRT so I'm making two separate posts: this one focusing on the medical side and physical changes, and another that will focus on the social side of transitioning. So, here we go!

I realized I was trans the last week of August 2021, then September 9th I came out publicly, September 15th I had my first appointment with Plume, and I received my first Estradiol script September 24th, but consider my official "first day" of HRT the 25th.

I started HRT on sublingual Estradiol pills, 2mg twice a day (morning and night). Psychologically, taking the first pill hit me like a psychosomatic lightning bolt, and the first meaningful change estrogen granted me was an opening of my feelings- I could suddenly experience a "true range" of emotion, I experienced ambivalence for the first time. Physically, within the first week, I was experiencing tingling in my chest/nipples and by three weeks they actively ached, and after about two months my nipples looked different (darker, larger), and my chest started to stick out (36" to 37")

At 2 months my Estradiol was increased to three times a day and Progesterone 100mg (at night) added. By two months, my body's sensitivity had reached astronomical levels, particularly in areas that weren't sensitive before: for me, this was my nipples, armpits, and butt. My skin overall became more sensitive, slight touches made me quiver and my pain tolerance dropped sharply. During my second month my body's smell changed too and my sweat production cut back.

At 3 months, Spironolactone 50mg once a day (morning) was added and during this month my nipples had noticeably expanded and become dark enough to see through shirts, and my chest had grown enough to be noticeable small mounds in a tight shirt (38"). Also by 3 months, random erections completely stopped happening, whether asleep or awake.

Between months 3 and 5 a lot of things happened in my life; the stress and inactivity caused me to lose 50 lbs. As a result, I lost a ton of muscle mass. My thighs, upper arms, and butt became soft and jiggly, I could not lift things I could before, even with great effort.

3 month bloodwork results: E @ 133 and T @ 320

At 4 months, I asked my doctor for Finasteride, which is a DHT blocker- DHT is an androgen created by testosterone and an excess of DHT is related to hair loss, as well as some research I read back then relating to DHT and thicker/darker body hair. Since starting Finasteride, I have only shaved and used Nair on my body itself and I have experienced 75%-80% body hair loss, and much of what hair remains is now vellus hair (light, short, soft).

Between months 4 and 5, I started experiencing sexual dysfunction. Even if aroused, it was a 50/50 shot of whether I could get hard or not. Likewise, I began producing much less semen. This was when I started experimenting with different forms of masturbating too (i.e. using a vibrator).

Between months 5 and 6 I started gaining weight again, and this was when my breast growth was the greatest, going from 38" to almost 41". However, in the growth it seems I lost the sensitivity I had in the early months- my nipples and armpits are still erogenous zones, but not as potent. Additionally, I noticed fat redistribution caused my hips and waist to take a more stereotypically feminine, almost hourglass appearance (and increased from 32" and 34" respectively to 35" and 38" by 10 months).

6 month bloodwork results: E @ 258 and T @ 22

Months 7, 8, and 9 saw only slight breast growth (41 1/2") due to losing weight again from stress, but at this point I have very little body hair left, and even areas which were full before (armpits, groin) thinned out significantly over time- the most astounding of all being my butt, which the cheek hair just disappeared without me doing anything, like the hair just fell off.

Somewhere during months 8 and 9, I completely lost the ability to become erect without medication (doctor prescribed me Sildenafil, aka viagra) and no more ejaculating. Reaching orgasm became a concentrated effort instead of something that came easily, and very little clear liquid would come out during.

9 month bloodwork results: E @ 57 and T @ 28

For some reason my levels dropped between 6 and 9 months, and during that time I became very mentally and emotionally unwell due to the hormone imbalances. My doctor suggested a few things: me not waiting/letting the pill dissolve long enough in my mouth or the pill just not having the same potency on me anymore. So...

At month 10 I started injections and almost immediately started feeling much better. There is a hormonal low day for me every week, the day before I do my injection again, but it's not hard to deal with. I feel like myself!

Now months 11 and 12, nothing really noteworthy to update except I'm desperately trying to eat more so I can gain weight to grow my boobs. Just stopped taking Spiro though, but I use Tgel to maintain my girldick because I'm a Switch.

Lastly, I'd like to say I'm open to any questions anyone might have, and I'll do my best to answer them. You can DM me, email me secretly from a fake account (bellatrixnovus@gmail.com is my email), whatever! I just hope this information is of some value to someone out there!

[acti-veg]

is it true that hormones given to trans people are animal derived? is there any alternative to this?

They will usually contain either gelatine, or lactose, or both. They have also been tested on animals. That latter reason is why almost no medication is cruelty free, even if it doesn’t contain animal ingredients. There is no alternative to that, at least not for hormones.

We should keep in mind though, that hormone treatment is medical care in the same way any other medication is, whether it is used for gender transition, fertility, erectile dysfunction or menopause. Hormone therapy is life altering, and in many cases life saving.

We can’t reasonably expect anyone to avoid all medicine because it involves animal exploitation, and there is no way to effectively boycott modern medicine. People should take their meds and advocate for change, that is really all anyone who is forced to rely on animal tested/derived medication can do.

[clowningcrows]

im literally gnawing on the bars of my enclosure all i can fucking think about lately is getting on testosterone

[bynux]

Detailed description of HRT's sexual effects below the cut. Can use some input from other transfems on this.

Minors please skip this one. :P

So I guess my body's nerves and responses to touch have just decided I have a pussy now.

I don't. Like, bottom surgery is likely a decade or so away from me at this rate, both because it's not a super high priority and because it's expensive af.

But being touched between my legs, having pressure put where the vaginal opening would be? It does so fucking much for me now. Being eaten out or rubbed when I'm bent over or have my legs spread is a surefire way to get me off…which leads to the other side of this.

Climaxing is now an entirely different experience than it used to be.

Like, I'm now capable of having two distinct kinds of orgasms. I still get the one I'm used to, that's stronger than it was pre-HRT but is still primarily based around my genitals. It's now actually a rare occurrence and extremely difficult to achieve, but it's possible.

But then there's the new kind. It feels like an extremely intense version of the relief you feel after a really good stretch. When I'm touched like a cis woman, these massive waves of ecstasy c r a s h over me and leave me damn near breathless.

On top of them being significantly more intense than "guy" orgasms, they can also happen much more quickly and frequently. I can cum again and again and have it absolutely rock me to my core every fucking time.

And, unlike "guy" orgasms that leave me tired and satisfied, cumming in this new way often leaves me craving even more until I'm too physically tired to continue. It's very reminiscent of how some cis lesbians have described their sexual encounters to me.

So I guess I'm just trying to ask…is this normal? Am I imagining something? Or is my body just this enthusiastic about me being a woman(-ish person)?

[frameacloud]

Zinnia Jones (May 31, 2021). "Early use of masculinizing steroid oxandrolone in trans boys can add 2 more inches of height compared to testosterone." Gender Analysis. Live link. Archive.

The above blog post is about a study about looking for more suitable sorts of puberty blocking and hormone therapy for transmasculine youth. It found a treatment that is more effective for letting them grow up to be a couple inches taller, if they start it early, at age thirteen or fourteen. It's about this study:

Grimstad, F. W., Knoll, M. M., & Jacobson, J. D. (2021). "Oxandrolone Use in Trans-Masculine Youth Appears to Increase Adult Height: Preliminary Evidence." LGBT health, 8(4), 300–306. https://doi.org/10.1089/lgbt.2020.0355

[frankencanon]

*HRT stands for Hormone Replacement Therapy, while GAHT stands for Gender Affirming Hormone Therapy.

-

Edit:

Yes, GAHT is a real thing.

To my understanding, GAHT specifically refers to the type of hormone therapy that's prescribed for trans reasons, while HRT is more of a broad term for any type of hormone therapy in general.

Online health services for trans peoples (such as Plume and FOLX) use the term GAHT in place of HRT (which is where I learnt of it).

[mercurialbadger]

Whoever invented hondosing was certainly an evil genius - to see this attack on transfemininity be carved into culture as ubiquitous eunuch syndrome in sympathetic depictions of transfem people will go in history alongside prominent thyroid on paintings and lead makeup.

And, before you ask, no, estradiol is an anabolic compound, you should be gaining muscle and bone on proper dosages:

If you feel like you are getting weaker because of HRT - your dosage is probably off.

[artisticallygay]

This is real. This is actually happening.

Ever since I'd come to realize I was trans at 15-16, being able to start testosterone was one of my main goals, to be able to help this body feel more like myself.

But with the way my life was at the time--conservative state, no money, no insurance, unsupportive parents--I didn't know when or if I'd be able to reach that goal, even after becoming an adult.

Then I packed myself up and took off to Kansas, where my amazing partner @saturn-seraphim and his family took me in, taking care of me and helping me and treating me like one of the family. Without them and the help of my therapist who've I've been seeing for over a year now, I wouldn't have been able to do this, at least not for a while. I didn't expect to be able to start testosterone until I was maybe in my mid-30s if I was lucky and had a good job.

But I get to finally have something go right in my life for once, starting testosterone at just a month shy of turning 23.

I've never felt happier about my identity than I do now. 💖

[perfidious-prophet]

The fucking things they dont tell you when you fucking start Testosterone.

Yeah, everybody knows about the deeper voice and the dreaded asshair, but these were my unfunny little surprises after 3 months on T. Reminder that shit will always vary from person to person because we're not all clones of each other, whatever.

1. Bottom growth fucking hurts. Sometimes I don't want to wear pants. I knew it would happen, didn't know it'd be so uncomfortable. And it starts fast. Like first dose fast.

2. The irritability goes fucking CRAZY it's like I'm constantly PMSing. I get why dudes punch walls. Oh my god. I know how to keep my anger wraps, but holy shit.

3. On the topic of PMSing. I had temporary worsening of menstrual cramps. Jesus fuck. I was having pain before menstruation started for days, and sometimes just randomly. I hope it doesn't flare up, but it seems to be calming down now. I think my body is freaking out over weird hormone levels.

4. Vocal fatigue. Talking hurts. I expected voice cracks, obviously, but why the fuck does this shit hurt? I don't even want to talk that much anymore. My voice just gives out. It's still deepening, so a win is a win, I guess.

5. Apathy, emptiness, anhedonia, and numbness. My motivation has tanked. I don't fucking care anymore. I just want people to leave me alone so I can take a nap. I already had mental issues before starting T, and I don't think T gave this to me, but it's definitely changed how I feel my mental illnesses. I have to like relearn how to cope and shit. I don't recommend starting hormones if you're an emotionally unstable dumbass like myself. This is literally second puberty, mood swings and teen angst included. I am a volatile, angry little man.

6. Anxiety. Like I said, teen angst. My panic attacks now include intense nausea, which is New and Uncool. Dunno why that happened. But I'm just nervous. There's nothing to be nervous about. I consistently feel like I've forgotten to do homework. I am not even in school anymore. Rad!

7. Psychosis? I had my first intense psychotic break at 14. It lasted 6 months, give or take. I've had shorter episodes on and off since then. My symptoms are stress based. The emotional strain is, naturally, pushing me towards the edge again. I am sure I will explode brilliantly and violently within the weeks to come.

8. Male loneliness is real dudes. Have friends.

9. It's harder to mask. I've been periodically going mute again. I'd never really stopped, but it's more frequent now.

Anyway that's my rant I think.

I'm not telling you not to do hormones. I'm not your dad. But it's not fucking easy. Anyway I have no intention of stopping. I am thuggin that shit out. I had a really really tough time during first puberty, and I suspect I'm going to have issues the second time around.

I am happy with the changes I am experiencing physically. I still feel confident and sure of my identity as a trans man. I am just not very happy about losing control over my mental state again. We'll see how it goes. If I'm lucky, I'll get medicated. I can't afford a therapist right now.

Good luck out there, whoever you are.

[skywalkerbootleg]

BEST thing that happened to me because of testosterone: I stopped looking like a 12 year old!

I was looking through pictures from 1-2 years ago (when I was 16/17) and I really looked like a child as in I would have guessed maybe 13. Finally I look and sound my age, yippie for transsexuality

[zinniajones]

FLORIDA HRT CRISIS: SB 254, effective May 17 2023, banned nearly all new HRT prescriptions and refills of existing prescriptions for trans adults, for up to 6 more weeks or until “emergency” state-mandated consent forms are published by the Boards of Medicine.

Trans care bans were never about “protecting children” — they were about making all trans existence completely impossible. See for yourself.

(Full quality version)

Please share to help Florida's trans community survive SB 254!

[poisonwaterlily3]

Very personal post, but I feel the need to share my thoughts.

I could have started HRT at 16 years old. My state wouldn't let me.

Fair warning, this post will just be me ranting. Read if you'd like, I'd love any kind words you can spare.

I realized I was trans at 14 years old. I came out to my parents a few months later and they were supportive. Down the line, we approached my 16th birthday and I'd be able to start hrt. Just a few months before though, my state passed a bill preventing anyone under 18 from medically transitioning. It hurt then. It still hurts.

I'm approaching 18 now, so I will be able to start soon, but those are two years I won't be able to get back. I haven't gotten any good answers on the difference in effectiveness between now and then, but it doesn't look bright. My "full" transition won't be as complete as if I had started when I could have. It never will be.

Any comforting words or advice to maximize the effects when I do start will be greatly appreciated. I need to make up for as much lost time as I can. Fuck this godforsaken place.

[answersfromzestual]

Information on Testosterone Hormone Therapy:

As you prepare to begin treatment, now is a great time to think through what your goals are, as the approach to hormone therapy is definitely not one-size-fits-all.

Do you want to get started right away on a path to the maximum safe effects? Or, do you want to begin at a lower dose and allow things to progress more slowly? Perhaps your long term goal is to seek less-than-maximal effects and you would like to remain on a low dose for the long term. Thinking about your goals will help you communicate more effectively with your medical provider (an endocrinologist is the best way) as you work together to map out your care plan.

Many people are eager for hormonal changes to take place rapidly- understandably so. But it's very important to remember that the extent of, and rate at which your changes take place, depend on many factors. These factors include your genetics, the age at which you start taking hormones, and your overall state of health.

Consider the effects of hormone therapy as a second puberty, and puberty normally takes years for the full effects to be seen. Taking higher doses of hormones will not necessarily bring about faster changes, but it could endanger your health. And because everyone is different, your medicines or dosages may vary widely from those of your friends, or what you may have read in books or in online forums. Use caution when reading about hormone regimens that promise specific, rapid, or drastic effects. While it is possible to make adjustments in medications and dosing to achieve certain specific goals, in large part the way your body changes in response to hormones is more dependent on genetics and the age at which you start, rather than the specific dose, route, frequency, or types of medications you are taking.

While I will speak about the approach to hormone therapy in transgender men, my comments are also applicable to non-binary people who were assigned female at birth and are seeking masculinizing hormone therapy.

There are four areas where you can expect changes to occur as your hormone therapy progresses: Physical, emotional, sexual, and reproductive.

Physical

The first physical changes you will probably notice are that your skin will become a bit thicker and more oily. Your pores will become larger and there will be more oil production. You’ll also notice that the odors of your sweat and urine will change and that you may sweat more overall. You may develop acne, which in some cases can be bothersome or severe, but usually can be managed with good skin care practices and common acne treatments. Some people may require prescription medications to manage acne, please discuss this with your provider. Generally, acne severity peaks during the first year of treatment, and then gradually improves. Acne may be minimized by using an appropriate dosing of testosterone that avoids excessively high levels.

Your chest will not change much in response to testosterone therapy. That said, surgeons often recommend waiting at least 6-12 months after the start of testosterone therapy before having masculinizing chest surgery, otherwise known as top surgery, in order to first allow the contours of the muscles and soft tissues of your chest wall to settle in to their new pattern.

Your body will begin to redistribute your weight. Fat will diminish somewhat around your hips and thighs. Your arms and legs will develop more muscle definition, with more prominent veins and a slightly rougher appearance, as the fat just beneath the skin becomes a bit thinner. You may also gain fat around your abdomen.

Your eyes and face will begin to develop a more angular, male appearance as facial fat decreases and shifts. Please note that it’s not likely your bone structure will change, though some people in their late teens or early twenties may see some subtle bone changes. It may take 2 or more years to see the final result of the facial changes.

Your muscle mass will increase, as will your strength, although this will depend on a variety of factors including diet and exercise. Overall, you may gain or lose weight once you begin hormone therapy, depending on your diet, lifestyle, genetics and muscle mass.

Testosterone will cause a thickening of the vocal chords, which will result in a more male-sounding voice. Not all trans men will experience a full deepening of the pitch of their voice with testosterone, however. Some may find that practicing various vocal techniques or working with a speech therapist may help them develop a voice that feels more comfortable and fitting. Voice changes may begin within just a few weeks of beginning testosterone, first with a scratchy sensation in the throat or feeling like you are hoarse. Next your voice may break a bit as it finds its new tone and quality.

The hair on your body, including your chest, back and arms will increase in thickness, become darker and will grow at a faster rate. You may expect to develop a pattern of body hair similar to other men in your family—just remember, though, that everyone is different and it can take 5 or more years to see the final results.

Regarding the hair on your head: most trans men notice some degree of frontal scalp hair thinning, especially in the area of your temples. Depending on your age and family history, you may develop thinning hair, male pattern baldness or even complete hair loss. Approaches to managing hair loss in trans men is the same as with cisgender men; treatments can include the partial testosterone blocker finasteride, minoxidil, which is also known as Rogaine, applied to the scalp, and hair transplantation. As with cis men, unfortunately there is no way to completely prevent male pattern baldness in those predisposed to develop this condition. Ask your provider for more information on strategies for managing hair loss.

Regarding facial hair, beards vary from person to person. Some people develop a thick beard quite rapidly, others take several years, while some never develop a full, thick beard. Just as with cisgender men, trans men may have varying degrees of facial hair thickness and develop it at varying ages. Those who start testosterone later in life may experience less overall facial hair development than those who start at younger ages.

Lastly, you may notice changes in your perception of the senses. For example, when you touch things, they may “feel different” and you may perceive pain and temperature differently. Your tastes in foods or scents may change.

Emotional state changes

The second area of impact of hormone therapy is on your emotional state.

Puberty is a roller coaster of emotions and the second puberty that you will experience during your transition is no exception. You may find that you have access to a narrower range of emotions or feelings, or have different interests, tastes or pastimes, or behave differently in relationships with other people. For most people, things usually settle down after a period time. Some people experience little or no change in their emotional state. I encourage you to take the time to learn new things about yourself, and sit with new or unfamiliar feelings and emotions while you explore and familiarize yourself with them. While psychotherapy is not for everyone, many people find that working with a therapist while in transition can help you to explore these new thoughts and feelings, get to know your new body and self, and help you with things like coming out to family, friends, or coworkers, and developing a greater level of self-love and acceptance.

Sexual changes

The third area of impact of hormone therapy is on your sexuality

Soon after beginning hormone treatment, you will likely notice a change in your libido. Quite rapidly, your genitals, especially your clitoris, will begin to grow and become even larger when you are aroused. You may find that different sex acts or different parts of your body bring you erotic pleasure. Your orgasms will feel different, with perhaps more peak intensity and a greater focus on your genitals rather than a whole body experience. Some people find that their sexual interests, attractions, or orientation may change when taking testosterone; it is best to explore these new feelings rather than keep them bottled up.

Don’t be afraid to explore and experiment with your new sexuality through masturbation and with sex toys. If you have a sex partner or partners, involve them in your explorations..

Reproductive system changes

The fourth area of impact of hormone therapy is on the reproductive system.

You may notice at first that your periods become lighter, arrive later, or are shorter in duration, though some may notice heavier or longer lasting periods for a few cycles before they stop altogether.

Testosterone may reduce your ability to become pregnant but it does not completely eliminate the risk of pregnancy. Transgender men can become pregnant while on testosterone, so if you remain sexually active with someone who is capable of producing sperm, you should always use a method of birth control to prevent unwanted pregnancy. Transgender men may use any form of contraception, including the numerous options available that do not contain estrogen, and some that contain no hormones at all. There are many contraception options that are long acting and do not require taking a daily pill. Transgender men may also use emergency contraception, also known as the “morning after pill”. Ask your medical provider for more information on the contraceptive and family planning options available to you.

If you suspect you may have become pregnant or have a positive pregnancy test while taking testosterone, speak with you provider as soon as possible, as testosterone can endanger the fetus.

If you do want to have a pregnancy, you’ll have to stop testosterone treatment and wait until your provider tells you that it’s okay to begin trying to conceive.

It’s also important to know that, depending on how long you’ve been on testosterone therapy, it may become difficult for your ovaries to release eggs, and you may need to consult with a fertility specialist and use special medications or techniques, such as in vitro fertilization, to become pregnant. These treatments are not always covered by insurance, and can be expensive. Uncommonly, testosterone therapy may cause you to completely lose the ability to create fertile eggs or become pregnant.

Risks

While cisgender men do have higher rates of cholesterol related disorders and heart disease than cisgender women, the available research on transgender men taking testosterone has generally not found these differences. Most of the research on risk of heart disease and strokes in transgender men suggests that risk does not increase once testosterone is begun. However, longer term, definitive studies are lacking. It has been suggested that the risk of other conditions such as diabetes or being overweight is increased by masculinizing testosterone therapy, however actual research supporting these claims are limited.

One known risk is that testosterone can make your blood become too thick, otherwise known as a high hematocrit count, which can cause a stroke, heart attack or other conditions. This can be a particular problem if you are taking a dose that is too high for your body’s metabolism. This can be prevented by maintaining an appropriate dose and through blood tests to monitor blood and hormone levels.

While available data are limited, it does not appear that testosterone increases the risk of cancer to the uterus, ovaries, or breasts. Because not all breast tissue is removed during masculinizing chest surgery, otherwise known as top surgery, there is a theoretical risk that breast cancer could develop in the remaining tissue. However, it can be difficult to screen for breast cancer in this tissue, and there are risks of a false positive test result. Your provider can give you more information about breast cancer screening after top surgery.

Cervical cancer is caused by an infection with the human papillomavirus, or HPV. HPV is transmitted sexually, more commonly by having sexual contact with someone who has a penis. However, people who have never had sexual contact with a penis may still contract an HPV infection. The HPV vaccine can greatly reduce your risk of cervical cancer, and you may want to discuss this with your provider. Pap smears are used to detect cervical cancer or precancer conditions, as well as an HPV infection. Your provider will make a recommendation as to how often you should have a pap smear. It is unclear if testosterone therapy plays any role in HPV infection or cervical cancer.

If your periods have stopped because of testosterone treatment, be sure to report any return of bleeding or spotting to your provider, who may request an ultrasound or other tests to be certain the bleeding isn’t a symptom of an imbalance of the lining of the uterus. Sometimes such an imbalance could lead to a precancerous condition, although this is rare in transgender men. Missing a dose or changing your dose can sometimes result in return of bleeding or spotting. Some men may experience a return of spotting or heavier bleeding after months or even years of testosterone treatment. In most cases this represents changes in the body’s metabolism over time. To be safe, always discuss any new or changes to bleeding patterns with your doctor.

Fortunately, since you do not have a prostate, you have no risk of prostate cancer and there is no need to screen for this condition.

If you have had your ovaries removed, it is important to remain on at least a low dose of hormones post-op until at minimum age 50. This will help prevent a weakening of the bones, otherwise known as osteoporosis, , which can result in serious and disabling bone fractures.

Most people using masculinizing testosterone therapy will experience at least a small amount of acne. Some may experience more advanced acne. Often this acne responds to typical over-the-counter treatments, but in some cases prescription medication may be required. Acne usually peaks within the first year of treatment and then begins to improve.

While gender affirming hormone therapy usually results in an improvement in mood, some people may experience mood swings or a worsening of anxiety, depression, or other mental health conditions as a result of the shifts associated with starting a second puberty. If you have any mental health conditions it is recommended you remain in discussion with a mental health providers as you begin hormone therapy.

Other medical conditions may be impacted by gender affirming hormone therapy, though research is lacking. These include autoimmune conditions, which can sometimes improve or worsen with hormone shifts, and migraines, which often have a hormonal component. Ask your medical provider if you have further questions about the risks, health monitoring needs, and other long term considerations when taking hormone therapy.

Some of the effects of hormone therapy are reversible, if you stop taking them. The degree to which they can be reversed depends on how long you have been taking testosterone. Clitoral growth, facial hair growth, voice changes and male-pattern baldness are not reversible.

Testosterone treatment approaches

Testosterone comes in several forms. Injections are usually best given weekly to maintain even levels of testosterone in the blood. Studies have shown that using a smaller needle and injection by the subcutaneous, or under the skin, approach, is just as effective as the intramuscular approach, which involves a larger needle injecting deeper into the muscle. In addition to injections, there are gel and patches that can be applied to the skin daily. The gel is applied to skin and once dry, you can swim, shower, and have contact with others. The patch also allows swimming, showering, exercise, and contact with others. All of these forms work equally well when the dosing is adjusted to achieve the desired hormone levels, and the decision about which form to use should be based mostly on your preference.

Another option for testosterone is the use of pellets under the skin. These are inserted every few months via a minor in-office procedure. Ask your medical provider for more information about this approach.

Recently, an oral form of testosterone, taken as a pill twice daily, has been approved for use. There are potential risks of high blood pressure when taking this medication, so extra steps need to be taken to monitor your health if you choose to use this form of your testosterone. Ask your medical provider for more information about this approach.

Regardless of the type of testosterone you are taking, it’s important to know that taking more testosterone will not make your changes progress more quickly, but could cause serious side effects or complications. Excess testosterone can result in mood symptoms or irritability, bloating, pelvic cramping, or even a return of menstruation. High levels of testosterone also result in increased estrogen levels, as a percentage of all testosterone in the body is converted to estrogen. In general estrogen blocking medicines are not used as a part of masculinizing hormone therapy.

Other medications that may be used include progestagens, which are hormones similar to or identical to those made by the body to maintain a balance in the lining of the uterus. These hormones can be used in cases where periods continue after testosterone levels have been optimized. These hormones can cause mood swings, bloating, and other side effects, so it is recommended that you discuss these medications further with you provider if they are to be used.

Final thoughts

And finally, please remember that all of the changes associated with the puberty you’re about to experience can take years to develop. Starting hormone therapy in your 40s, 50s, or beyond may bring less drastic changes than one might see when beginning transition at a younger age, due to the accumulated lifetime exposure to estrogen, and declining responsiveness to hormone effects as one approaches the age of menopause. Once you have achieved male-range testosterone levels, taking higher doses won’t result in faster or more dramatic changes, however they can result in more side effects or complications.

Now that you have learned about the effects of masculinizing hormone therapy, as well as risks and specific medication options, the next step will be to speak with your provider about what approach is best for you.

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[groovinrightalong]

Hot take! Telling someone that going off of hormone therapy (for whatever reason, which is not your business) is the same as detransitioning is, in fact, just as trans-medicalist as telling someone they aren’t trans unless they’ve taken hormones/gotten surgery. Other people’s transitions, medical situations, and lives AREN’T your business!