For an introduction to Testosterone Hormone Replacement Therapy (T HRT), see the first part of the series.
Why Take Low Dose?
Hormones are gradual. This can be very frustrating for people who can’t wait for the changes. But some of us approach the idea of hormones with a bit more trepidation, and would rather take things slow.
Whether it’s because you’re not sure hormones are right for you, or you’re not sure what you want out of hormones, or you just want to be extra careful, taking a low dose is a way of testing the waters, toe by toe.
It’s common to hear of nonbinary trans folk who want certain effects of hormones but not others, and are trying to find the right balance. Others may be struggling to figure out what their identity means to them while undertaking a physical transition, thus trying to reconcile the two.
Other instances in which low dose is recommended is for those who have pre-existing conditions of physical or mental health, such as thyroid disorders or a history of anxiety and depression. While these sorts of conditions do not usually make you ineligible for HRT, it is probably advisable to go low dose, at least at first.
It is actually recommended to start on a low dose, and build your way up to a regular dose. Not only do hormones hit you harder in the first 3-6 months, this also gives your body (and mind) time to adjust. Remember, puberty doesn’t happen in a day!
By slowly ramping up the dose, you can be more in control of the changes you experience. Take it as an opportunity to gauge the effects hormones are having on you. Remember, it’s not just the obvious ones you need to look out for, like “am I finally sprouting chin hair?” Hormones have widespread effects on our bodies, and it’s usually the more subtle, invisible changes we should be watching out for, like “how’s my weight gain/loss?” or “am I suddenly feeling more anxious for no reason?”
(Also: Check out this article for an example of the benefits of low dose for easing into your voice (especially if you are a singer, but also in general)).
Options for Low Dose
Injections, gel, cream, and patch can all be taken low dose.
At first I was under the mis-impression that injectable T was not low-dose friendly, but this isn’t the case.
How Low Can You Go?
If you take too low of a dose, it does nothing. Women are prescribed T to increase libido, and there is a magic low-enough dose where they don’t see the masculinization effects of it, yet do experience the side effect of increased sex drive. If you’re reading this, you probably want some of those masculinization effects, so be wary of taking too little. In some cases, taking too low a dose may even be counterproductive, as it “aromatizes” (converts) into estrogen!
If you take more than a low dose, you might get changes quicker than you expect or want them. That’s okay – you can always lower your dose if the pace is too fast for you. Practice self awareness to have a good sense of how your body is reacting to hormones.
If you take too much – that is, a very high dose – it may end up being detrimental. Normally trans guys attempt to over-dose on T because they want to speed up the process. However, T aromatizes into estrogen, causing the reverse of what you’d want, namely less T and more E. The effects of this can include bloating (water weight), irregular menstrual cycles, weight gain, mood changes, including anxiety and depression, and other health effects, adverse or otherwise. These effects can also happen if you don’t ramp up gradually. So take a dose of patience instead!
Starting & Stopping T
If you are unsure of taking hormones, or of continuing to take them, you can always stop.
Yep, at any time, you can just stop.
You can stop because you are having adverse effects, because you need some extra time to think, or because you’ve just had enough.
If and when you decide to start again, then you can always start again.
It’s advisable to be as consistent as possible, so starting and stopping often is not ideal, but the options are always open.
Dosages for “Low-Dose”
The dosages for being on a “low” dose of T are, well, lower than the regular dose.
This varies widely from person to person, and by method. I’ve gathered some information from articles that lay out standard testosterone dosages, covered in the Introduction to Testosterone HRT post, and compiled it with various personal accounts of those on a self-reported low dose. Another observation from talking to trans patients and their providers is that even “traditional” dosages tend to be higher than what is needed.
Here are some rough estimates (ie, my best guess) on what constitutes a “low dose.”
A standard bi-weekly starting dose is 50-100 mg. Some people take as low a dose as 30 mg bi-weekly.
A standard weekly starting dose is 25-50 mg. Some have taken as low as 20 mg weekly, which is nearly (but not quite) equivalent to the 40 mg/biweekly.
As you may notice, another important factor to consider is the frequency of the injections. Bi-weekly has been the standard for quite some time, but nowadays some people are opting for 10 day or 7 day cycles.
Deciphering the dosage for injectable T can be confusing (it still is for me). Usually the vials come in a formula of 200mg/mL, and you inject a cc amount. Previously, doctors have prescribed trans men 1cc, or 200mg, of bi-weekly injections (every 2 weeks). My doctor recently she most of her trans men patients are on 100mg bi-weekly and they’re usually quite satisfied.
Personal Update: I’ve been on a 50mg (.25cc of 200mg/mL) injectable dose, going on 5+ years now. I recently switched from a 15 to a 12 day cycle. I still see slow, consistent masculinization. I would not recommend going much lower than this in most cases, but you could. My doctor even recommended I use a 100mg/mL vial to make a lower dose easier to measure.
See more of my long-term progress in my Transition Timeline.
Gel is normally applied daily. According to the articles, a regular dose is between 2.5g and 10g per day of 1% gel, with a starting dose at around 2.5g/day.
It has taken me a while to figure this out (see below), so my best guess of a low dose would be anywhere between 2.5g and 7.5g, with the amount T in a 1% gel being 25-75 mg.
For an in-depth personal account on long-term low dose gel, I recommend Kameron’s blog at janitorqueer.com. He’s seen minimal to no masculinization and has been on gel for 4 or 5 years now.
If you notice, none of the articles specify cream dosage, though some mention it is the same as for gel. That’s what I initially assumed; however, it was a little more complicated than that to decipher… My guess for a low-dose cream would be between 50 and 75mg. From my experience, I would not go lower than 50 mg, and would call 100mg a “regular” dose.
Gel and Cream Dosage, De-mystified
When I opened my package of compounded T cream from Stroheckers, the conundrum I faced was – how much? You see, the cream came in two big tubs, akin to body lotion. My prescription said “2.5mg/g, 5g/day.” The label on the cream said “5% CRM” with instructions to “apply 2 grams (1/2 teaspoonful daily).” Not only was I not sure which dose was accurate (as my doctor usually prescribed injections), I had no clue how much either 2.5mg/g or 5% or 2 grams or even 1/2 teaspoon was!
Dosage for gels and creams is trickier to figure out, because there’s a lot more numbers to crunch. There is the base amount of testosterone the cream has, say 50mg. That’s usually the number you ultimately care about.
The label indicates the amount you apply in grams, and then what % of that is testosterone, or the concentration; a 1% gel contains 10 mg of testosterone per 1 gram of total gel (10 mg/g). (About 10% of those 10 mg is actually absorbed, so the “effective” amount comes down to 1 mg of T (1mg/10mg/g). Since the “effective” absorbed amount is variable, it’s usually ignored.) So going back to the 10mg, if you apply 5 grams of 1% gel daily, you’re getting 50mg of T daily (10mg/g x 5g = 50mg).
Confused? Don’t worry, this tripped me up too. Let’s try and do the math.
My T dosage
My prescription said 2.5mg/g, so if 10mg/g is 1%, this would be a .25% gel. Taken at 5g/day, it would amount to 12.5mg/day (2.5mg/g x 5g). If you consider the standard dose of 5g at 1% = 50mg, a fourth of this would be 5g at 0.25mg = 12.5mg.
But this was for gel; the cream I got has a different concentration, and cream is also absorbed differently. Right now I’ve been taking roughly 1 gram daily of the 5% cream. One gram of 1% cream is 10 mg of T, so 1 gram of 5% is five times as much, or 50 mg. (I’ve recently raised it 1.3g, so at 5% it’s 1,300mg x 0.05 = 65 mg).
(Trust me, it took me quite a while to go back and forth between the articles, my prescription, my current dosage, and my calculator, and even then I’m not entirely sure this is accurate. If it makes anybody feel any better…)
Finally, I met with my now-current physician, who also mentioned one very important thing: above all, try to get the same dose every day. It doesn’t matter if it’s absorbed differently every day, just try to be as consistent as possible. In order to do this, I had to get a small digital scale, and measure out 1 gram every morning. (I zero out the scale with the lid of the cream container, then put some cream on the lid.) Alternatively others have mentioned using a syringe, which also works.
If you do get a gel or a cream, make sure you understand the dosages. Look at how much you’re applying (grams) and multiply that by the concentration (%) to get the amount of T (in mg). And when using cream or gel, don’t forget to wash your hands thoroughly and cover the area with clothing so as not to rub it off on a partner, child, or even pet!
Me on T
If you’re interested in learning more about my personal journey with hormones, you can read a few articles on my blog. I have yet to give an update on the newest developments; just know that the story doesn’t end there.