This piece is part of In Transit, our series exploring the ins and outs of transitioning and how trans and nonbinary people define it for themselves.
I began my smaller-than-usual dose (i.e., "microdose") of testosterone about eight months ago, in October of 2020. Every day, I choose to schmear a half-packet of testosterone gel on myself. Some days feel momentous and some feel like an unassuming part of my routine. The latter outnumber the former as time goes on.
For years, my suspended and unrealized desire to take testosterone was one I, like so many trans and nonbinary people, had made a home in. The paradox of this home is perfectly satirized in Danny Lavery's The Stages of Not Going On T, which calls out how buried, twisted, and self-exceptional our rationalization can be when we want something we fear. His inner monologue has justification for it all: "If I really wanted to try hormones obviously I wouldn't keep thinking about how I can't try them," or else deflects, "I certainly don't need hormones. See, I've got all these coping strategies instead. Look at how well they're working!"
When I managed to break this mindset, spurts of inspiration always brought me to r/ftm. Each time I got too far into the possibilities, physiological panic would set in, leaving me x'ing everything out, feeling faint, and chaotically texting friends. Entrenched in Lavery's "stages," it felt that the circumstances of my life had, for some reason, made that avenue entirely incompatible for me.
To be the first mover of your gender's future is daunting. It can feel like taking tours at potential colleges, trying to pick a non-corny restaurant in a new city, or starting a big spreadsheet from scratch. This guide aims to be a helpful tool in your understanding of testosterone: While not exhaustive, Allure has talked to experts to describe some of the hormone's physical effects as well as emotional ones, and to offer both professional and real-life perspectives so you know what to expect and when to expect it.
What is testosterone and why might you take it?
While everyone has some testosterone (T), it is the dominant hormone associated with people who have XY chromosomes, who are typically assigned male at birth.
Zil Goldstein (she/her), a family nurse practitioner and associate medical director for TGNB Health at Callen-Lorde Community Health Center based in New York City, explains that "[testosterone] can help grow facial and body hair, causes what we call clitoromegaly (though this is not necessarily how people refer to their bodies), oilier skin, increased muscle mass, and fat redistribution away from the hips and butt and into the gut. Testosterone therapy is available for anyone who wants to achieve these body changes."
Some days feel momentous; some feel like an unassuming part of my routine. In time, the latter outnumbers the former.
People assigned female at birth (or otherwise not male) can be prescribed testosterone, typically in the form of an injection or topical gel, though other methods also exist, like creams and patches. This course of treatment is known as hormone replacement therapy (HRT) or masculinizing hormone therapy. Many transmasculine and nonbinary AFAB people take testosterone, generally to achieve masculinizing effects and usually to quell negative experiences associated with gender dysphoria.
Jesse Schwartz (he/they), a 27-year-old from Philadelphia, started testosterone immediately after having top surgery. He tells Allure that the extent of his deliberations about testosterone informed his attitude toward ultimately making the leap. "People who are comfortable in their gender presentations don't think about going on T for months," he says. "I wish someone had told me not to worry about it and just do it. If it was something I was thinking about [so extensively], that meant it was something I wanted."
As Kasey LeBlanc's guide "How Do I Know If I'm Transmasculine?" assures, your transition does not need to look like anyone else's. My own therapist once asked me whether I would still want top surgery if I were on a desert island alone. I found myself thinking about how nice that would be, even without an audience. Similarly, LeBlanc recommends asking yourself: Would taking a certain step make you happier?
What to expect when you start taking testosterone
Testosterone throws you into the thralls of what many liken to a second puberty. As the body receives increasing amounts of testosterone, a set of physical, emotional, and sexual changes set in, but as Goldstein explains, "it's an individual process for everyone."
Similarly, UCSF's Transgender Care site explains that there isn't a perfect recipe that will yield exact results. Each body metabolizes testosterone differently, and even the same dose will affect the blood levels of different individuals in different ways. UCSF also provides a useful chart on dosing via different methods — injection, gel, patch, cream, and others, ranging from low to high. The World Professional Association for Transgender Health (WPATH) also outlines expected timelines for each change associated with testosterone (see page 37 in the link for a detailed guide).
Despite not being able to "pick and choose what effects testosterone can have on the body," Goldstein is optimistic. She says that most changes that are not desired can be addressed, like cystic acne that crops up or the difficulties of emotional shifts, and that health providers can steer their patients toward solutions to mitigate unwanted effects.
Research suggests that gender-affirming hormone use has potentially powerful effects on wellness, reducing anxiety and depression symptoms in transgender individuals, as well as easing social worry and promoting quality of life and self-esteem.
"I mostly felt changes before I saw any. Feeling happier, more at ease, less anxious," explains Schwartz. "And the 'downsides' are so insignificant compared to feeling comfortable in your body and how you present to the world."
As noted in other guides to testosterone, some fear the way T might change their emotions, possibly becoming angrier, a fear which has been fueled by stereotypes of steroids. Goldstein says that she recommends all her patients work with a therapist while starting hormones to help navigate their emotions during such a big time of change. She says that the emotions that arise are, "ever due just to testosterone, but coping with transphobia during the coming-out process is hard, and everyone acts differently. Handling this while testosterone is making some changes about how you feel things can be really challenging, and it's good to have a regular ear to help work things out as they arise."
Though T does shape your emotions, you are still you. "Some people talk about becoming a wholly different person in transition… but it's never just testosterone. Testosterone is only one piece of the puzzle and often gets blamed for things that people do during transition that are just a regular part of becoming the person we want to be," explains Goldstein.
Increased body hair is par for the course with testosterone. Goldstein explains, "There's no way to control where the hair grows when taking testosterone." Even with a smaller dose, it begins to sprout in places you might not otherwise have it, like on your face, thighs, chest, and arms. Texturally, the hair might become coarse as well. UCSF's Transgender Care site suggests looking at men in your family for a sense of how your hair might develop with testosterone.
The hair follicles that become activated don't go away, and even off T, you will still grow hair in these places. If you're fearing hair growth on T, know that hair removal options like waxing, shaving, or laser/electrolysis hair removal are possible. On the flip side, these changes can also be gender euphoric. "I had a noticeable amount of facial hair about six months in. Everything felt good," Schwartz explained.
People on T typically experience some deepening of their voice, albeit at different stages and dependent on dosing. As many resources acknowledge, voice changes are irreversible. Personally, I have felt the change come from within, though without much noticeable difference at present. There are nearly endless videos online across TikTok, YouTube, and other social media. (Personally, I’ve been following TikTok user @shovelbug, since we started T around the same time and it’s been interesting to compare my progress to theirs.)
When it comes to sex and sex drive, T has the ability to change how you feel and where you feel it, but stereotypes about how horny you'll get and how your sexuality might develop are largely dependent on you. Some changes in libido are to be expected. As UCSF's overview of masculinizing hormone therapy states, "you may find that different sex acts or different parts of your body bring you erotic pleasure. 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." It's true that some trans men experience changes in sexual preference, but research suggests, "confusion before and after transitioning, social and self-acceptance, as well as concept of sexual orientation" may explain changes in preference during hormone therapy.
Testosterone promotes physical changes to your genitalia, namely clitoral enlargement, colloquially referred to as "bottom growth." Bottom growth won't reverse after stopping T and is often cited as a fear for those starting out but is actually one of the first marked changes that folks observe. "I was really scared about bottom growth," Schwartz explains, but he says that in hindsight, his fears were "silly and largely products of my internalized transphobia."
Similarly, Cody Corrall (he/they), a Chicago-based 23-year-old, says he thinks people, "have a lot of internalized shame about hormones, like wanting a low voice but not wanting the 'gross' things like bottom growth." Cody says these attitudes are worrisome to him since those sentiments "[were] instrumental to me pushing off my own transition." For Cody, bottom growth ended up being something special. "I love the sensitivity and the intimacy associated with that process and the ways it makes me feel connected in my body," they tell Allure.
Artist and author Chella Man has written candidly on his experiences with testosterone: "I didn't even know that bottom growth was an effect of testosterone until I came across a Tumblr post that mentioned it offhand. I had absolutely no idea what the blogger was referring to. Luckily, I was able to ask my doctor and she explained that the clitoris can grow — usually between one and three inches, but growth can vary — as a result of taking these hormones. I was speechless."
Testosterone also affects menstruation. Many folks on T experience the slowing-down or even stopping of their periods, though, like many aspects of T, this differs based on dosing and timing. In a study published in Transgender Health, researchers observed that of 74 patients taking testosterone intramuscularly (i.e., through injection), more than half had "cessation of menses" within a six-month time frame, while 32 percent of participants experienced cessation by 6 to 12 months, and only 7 percent had not had complete cessation within a year. For those whose periods are uncomfortable or dysphoric, this can be a welcome change. However, anticipating this change might inform any considerations you have about your reproductive future.
A common misconception is that testosterone is a perfect method of birth control, but those on T can still become pregnant and face other fertility issues. In light of the potential fertility risks and impact of HRT, some folks who want to permanently avoid becoming pregnant consider a hysterectomy as either a preventative method or else as a gender-affirming treatment. Alternatively, as UCSF outlines, if pregnancy is desired, you will need to pause testosterone and work with a healthcare provider to determine when it is best to both conceive and resume testosterone after giving birth.
Because testosterone tends to make a person's face more oily, you may be fearful of the likelihood of acne. Goldstein notes that cystic acne is highly treatable through topical antibiotics. "Sometimes it needs oral antibiotics or isotretinoin to fully resolve, but it can easily be treated on both the face and body," she explains.
Corrall recalls that they noticed their skin changing and feeling rougher after starting HRT, but that this actually encouraged adopting a healthy skin-care routine. WPATH timelines project the onset of skin changes between one and six months of beginning testosterone, so planning to see a dermatologist to learn more about your skin can be helpful to establish the best skin-care practices. If you choose to go off T, your skin may clear up. If you remain on T, evidence suggests that acne is often at its worst within the first year and gradually improves thereafter. In evaluating the pros and cons, Schwartz pointed out that for him the benefits outweighed the costs. "No amount of acne will make taking T not worth it," he explains.
Testosterone can increase the ability to gain and retain muscle mass. However, it should be noted that any new gain isn't solely reliant on testosterone and is influenced by other factors like nutrition, exercise, and genetics. In other words, if bulking up is your goal, hormones aren't everything. You will need to put in the work!
According to UCSF, face shape and body fat do reconfigure and redistribute in response to the change in hormones. You can expect some fat to be lost in your hips and perhaps some to relocate around the stomach.
Many people also feel changes in appetite. Corrall "absolutely got hungrier early on," likening the experience to "big, stereotypical teenage boy energy." Still, he says this feeling has leveled out and has offered a way to reevaluate their relationship to food. "I feel that I'm able to identify what my body needs much more easily and actually listen to it."
Going on T doesn’t necessitate social transition or imply that your journey is linear. "Some people only transition socially and never take testosterone, and some people never transition socially but like the effects the medication has on their body. The most important thing with social transition is to set your own pace and not let other people pressure you into doing things before you are ready," explains Goldstein.
Still, it can be a bit complex. "Sometimes medical treatment can necessitate some social transition, or at least coming out to people who notice changes in the body," she explains. That said, you may want to consider how you want to discuss possible changes with those in your life. Goldstein also points out that those changes are not solely due to the T, but "usually paired with other aspects of social transition, like dressing differently or getting a different haircut," and together, help a person transition socially if they have a desire to.
A note on "micro-dosing" T
If the rapidity of testosterone's effects worries you or your gender feels more aligned to a lighter version of some of these effects, you can talk to your doctor about taking less T, often called micro-dosing. Micro-dosing means taking less testosterone to minimize how quickly changes set in.
This particular application of taking T has become a more widely talked-about option for trans and nonbinary AFAB people over the last few years. Alyza Enriquez was one of the first to document their experience with micro-dosing, which showed many transmasculine people there was a way to consider testosterone without the potential fear.
Despite the phenomenon of micro-dosing entering our consciousness, Goldstein explains, "I don't know when 'micro-dosing' started to come up as something different than testosterone therapy, but people choose low doses of testosterone all the time. When people want minimal effects, or to have them happen slowly, we use lower doses of testosterone. Everyone should talk to their medical provider honestly about what their goals are in starting testosterone and come up with a plan that is most likely to meet those goals."
Where to find more information
Scanning the whole of the internet can be tough, especially when so many unique experiences exist around T. Corrall says that their early research on T was mainly on social media, and while they acknowledge its downsides, they feel it was important to see "trans people talk about their experiences in real-time." They give the following advice: "If you want to try testosterone and you have the resources to do so, I think you should try it. See how you feel. It doesn't have to be permanent and your transition doesn't have to be linear. But it's a much easier way of finding what you want instead of going in circles in your own head."
Goldstein says that she "always recommend[s] going right to the medical sources," such as the much-cited UCSF Transgender Care site as well as the Endocrine Society. If you are seeking gender-affirming care, consider Callen-Lorde (NYC-based), the WPATH’s provider search tool, or GLMA’s provider search tool.
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