Intro to Testosterone HRT

The primary effects of Testosterone have been detailed in countless blogs and articles, including mine. Browsing Tumblr or YouTube you will come across personal stories as people chronicle their journey on their first weeks, months, and years on T. Here’s a brief recap, just in case.

In the second part of the series, I go into more detail on Low Dose Testosterone.

testosterone-vial

Two Types of Effects

It’s important to remember that there are two types of changes: irreversible, and reversible.

The permanent changes will remain even after going off T, and include: voice drop, facial and body hair, genital growth, and male-pattern baldness.

The non-permanent changes revert once testosterone intake is ceased, and among these are: acne, oily and coarser skin, menstruation, body odor, and muscle-fat re-distribution namely in the hips, stomachs and thighs, and muscle gain.

So that’s the medical part. What a lot of articles fail to mention is that testosterone, like any hormone, has wide ranging effects that are not visible to the naked eye. These include changes in metabolism, sleep patterns, liver enzymes, appetite and hunger, mood – varying effects on depression and anxiety – among others. It is crucial to be self-aware and monitor your body, mind, and spirit for any unusual changes. While “unusual” isn’t always bad, these signs can often be easy to miss, or misattribute. Above all, stay healthy.

Types of T

Injectable Testosterone

The most common form of T, for a variety of reasons, is injectable testosterone. Popularity begets popularity; doctors prescribing hormones are already familiar with dosages for injectable T, so that’s what they’ll prescribe. While most people never really get over the fact they have to stick a needle in their thigh every week or so, they at least get used to living with it. Moreover, it is the cheapest option – the average cost per month ranges from $10 to $50 – and it’s easier to get it covered by insurance.

Subcutaneous Injections

Update! The newest method for injectable testosterone is called “sub-q” injections. It is just as safe and effective as the traditional IM (intramuscular), but it is much less painful.

You can read more about it on TransGuys.com.

Pro-Tip!

Use 2 different needles – I use an 18g for drawing, and 25g for injecting.

This is because injectable T comes in a dense, viscous oil, which makes it very hard to draw out of the vial. Using a higher gauge needle makes it easier to draw the liquid into the syringe. However, this would result in a very painful injection (take it from me!). So you switch the needle and inject with a very thin one instead. Nearly pain free!

testosterone-injection-transgender

Every other week

Gel, Patches and Creams

Other options instead of injectable T are gels, patches, or cream, all of which vary in dosages and prices. These are definitely more costly than injectable, sometimes up to 10x as much (from. People may opt for one of these as opposed to injectable for many reasons, such as allergies or fear of needles. There is also a marked difference in daily application, compared to the weekly or bi-weekly of injections. For instance, some people report feeling the peaks and troughs of being a 2-week cycle, and a more constant delivery suits them better.

A primary concern for gels, patches, or creams is obviously cost. Secondary is availability, as it may be harder to obtain. Since these are topical, that is, they go on top of your skin, you must be very careful not to rub it onto a partner, pet, or child, making sure to wash your hands thoroughly after applying and covering the area with clothes. Additionally, it washes off when you shower or swim, so it isn’t ideal for people who don’t do this consistently or do this more than once a day.

Other

Other means of administration include subcutaneous pellets and sublingual, and oral. I haven’t heard of anyone use these, but they are detailed in a few of the resources listed at the bottom.

Dosages

Dosages vary widely, and depend not only on the method of administration, but also on specific type and brand. As well, each individual reacts differently to the same dosage, given different pre-existing hormonal profiles, secondary reactions to absorbtion, metabolism, mood, etc. Lastly, consider that teenagers going through puberty do not suddenly experience a surge of full adult male testosterone levels; usually there is a gradual buildup of many months or even years. Thus it is advisable to start off slowly and increase the dosage as your body adjusts, which also makes it easier to monitor the reactions you’re experiencing and adjust accordingly.

Also note that your dosage will change if your ovaries have been removed, as these are the main source of estrogen in your body. Without ovaries, you no longer need as much testosterone since it will be your primary hormone. However, you will need to be on long term HRT, either on estrogen or testosterone, otherwise your bone health with be adversely affected.

Here are various dosage recommendations form a few sources:

Injectable Testosterone

From “Hormones: A Guide for FTMs”, a Booklet by The Transgender Health Program of Vancouver Coastal Health:

Typical starting dose is 50-80 mg every two weeks (or 25-40 mg every week), gradually increased each month until blood testosterone is within the average “male” range or there are visible changes. Typical maintenance dose is 100-200 mg every two weeks (or 50-100 mg every week).

From “Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers”, by Nick Gorton and Dean Spade:

Injected testosterone is started at a range of doses (25 – 125 mg/week depending on the patient and clinician)
costs approximately $100-125 for a 10 cc (2000mg) vial. Depending on dosing a vial may last from 3-10 months making cypionate the least expensive option overall.

From the ever useful “Hudson’s FTM Guide”:

In general, dosages will vary between 50 mg and 300 mg per injection, depending on the ester and the dosing regimen. An average injectable dose is about 200-250 mg every two weeks, though many trans men inject 100 mg every week or every 10 days, or other variations depending on their own bodies’ needs and sensitivities.

Update

In my own experience, from talking to trans patients and their providers, traditional dosages tend to be higher than what is needed. Most regular doses used to be in the 200mg range every 2 weeks; now many providers have switched to 100mg every 2 weeks and have found that is enough for “full” masculinization. It’s also become more common to reduce the cycle to 7 or 10 days.

I’ve been on “low dose” of 50mg (25cc of 200mg) every 12-15 for a few years, and I still see slow, consistent masculinization – meaning I could still go lower.

Gel

From the VCH brochure:

Androgel, Androderm: 5-10 g per day if no physical or mental health concerns; start with 2.5 g per day otherwise.

From Dr. Gorton’s book:

Delivered doses of both patches and gel are generally in the range of 5-10 mg/day. Cost is about $160-210/month in the US. Typical dose is 2.5-10g of 1% gel applied daily but must be individualized for each patient. Each gram of the 1% gel contains 10mg of testosterone, of which only 9-14% is absorbed. So if 5 g of gel is applied daily, 9-14% of the 50mg (4.5-7mg) should be systemically available.

From FTM Guide:

The unit dose packets [of Androgel] contain either 25 mg or 50 mg of testosterone. Approximately 10% of the applied testosterone from the packets is absorbed into the system, resulting in an effective dose of 2.5 mg or 5.0 mg, respectively.

Cream

Here’s the tricky part. “There are no brand-name testosterone creams at this time” says FTM Guide, which means you need to get it from a compounding pharmacy. Moreover Creams are “are similar in dosing, application, and precautions to what is described above for Androgel.”

Creams is a lesser known option; initially, I decided it was best choice for me (because insurance didn’t cover gel back then). When I started testosterone I was still unsure why I was doing it, what I wanted out of it, and most importantly had yet to firmly conclude whether I was truly ready, so it was important for me to have total control over my hormone administration.

In my own experience, I would not recommend cream because it was messy to apply difficult to measure the dose. Most people now use Androgel or injections.

Low Dose Testosterone

In the next article I will talk more about low-dose testosterone, including reasons for taking a lower dose, either at first or long term.

Resources

5 responses to “Intro to Testosterone HRT

  1. Pingback: Intro to Testosterone HRT | Neutrois Nonsense·

  2. Hello Micah,

    I would love to read this. The link seems broken.

    Thank you, Jane

    Jane Harlan-Simmons

  3. Pingback: Featured Voices: One Year on T | Neutrois Nonsense·

  4. Pingback: Patients & Providers: Top 5 Questions About Hormones | genderqueer.me·

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