(Originally Aired on 2/2/19)
Please note: I am not a medical professional and this information should not be considered medical advice. This information should not be used to replace consultation with or treatment by a medical professional the listing of medication herein does not imply endorsement by the author.
What the heck is HRT? Testosterone? What what do you mean needles? Welcome to the trans Field Guide.
Hey everyone, today's episode will be focusing on the world of hormone replacement therapy for transmasculine individuals. Quick warning: there will be mention of injections, needles, blood, and medical terminology of body parts. If any of these topics make you uncomfortable, listener discretion is advised.
So to start off, what is HRT? It stands for hormone placement therapy. This is the process through which hormones that your body does not make an adequate amount of is administered to you. In the case of trans men, the hormone being given to you is testosterone. Both testosterone and estrogen are present in everyone, it's just a matter of how much of one or the other is present in your body. For cisgender men (by the way cisgender mean the person who is fine with staying the gender that they were assigned at birth) the normal levels of testosterone a much higher than the levels found in cis women. There are exceptions to this rule: there are some people who were assigned female at birth who have one of a number of conditions that can cause the body to naturally produce a higher level of testosterone then is considered normal. If you feel that this applies to you, I highly recommend talking to a physician or endocrinologist to have your hormone levels tested.
If you are a trans man and want to begin medically transitioning, the first place you may look to is getting testosterone therapy. In order to get prescribed testosterone by a medical professional, which by the way I heavily recommend going to a medical professional to ensure that your hormone levels are within the correct range during this process, you have to have a letter from a psychological professional. This letter is telling the doctor that medically transitioning will be the best thing for your mental health, and that you're not trying to do anything nefarious after getting your mitts on the stuff. What nefarious things someone might be doing with testosterone, I really don't want to know.
When you go in for a consultation with the doctor, either letter in hand or in the doctor’s system, you will likely be asked to read a big packet about what will happen to your body while on testosterone, to make sure that you're not going to sue the doctor's office if something outlined in that packet isn't what you want to happen. This is to protect both you and the doctor. I'll go into the list of the effects towards the end of the episode, as some of the details may not be suitable for all audiences.
First, let's go into how you can get the testosterone into your body. Here's a list from WebMD on the subject:
“Skin patch (transdermal): Androderm is a skin patch worn on the arm or upper body. It's applied once a day.
Gels: AndroGel and Testim come in packets of clear testosterone gel. Testosterone is absorbed directly through the skin when you apply the gel once a day. AndroGel, Axiron, and Fortesta also come in a pump that delivers the amount of testosterone prescribed by your doctor. Natesto is a gel applied inside the nose.
Mouth patch: Striant is a tablet that sticks to the upper gums above the incisor, the tooth just to the right or left of the two front teeth. Applied twice a day, it continuously releases testosterone into the blood through the oral tissues.
Injections and implants: Testosterone can also be injected directly into the muscles, or implanted as pellets in the soft tissues. Your body slowly absorbs the testosterone into the bloodstream.
Why not a simple testosterone pill? Oral testosterone is available. However, some experts believe oral testosterone can have negative effects on the liver. Using other methods, such as skin patches, gels, orally disintegrating tablets, or injections, bypasses the liver and gets testosterone into the blood directly.”
Generally, the most common ways to have testosterone administered is via injection or transdermal gel. There are pros and cons to both: the gel is a good option for people who are afraid of needles, however not all of the gel may be absorbed into your blood, even if you have the patch. also not all insurances cover the non injection ways to get testosterone. in the end the decision should be made with a lot of thought and discussion with your doctor. there is one more step to take before you can receive the prescription, and that is to get your blood labs. This will need to be done regularly even after you start taking the testosterone to ensure that your hormone levels are in the correct range. if your testosterone levels are too high your body can actually start turning that extra testosterone into estrogen, which goes completely against the point of what we're trying to do. This also causes hot flashes and a number of other potential side-effects. your doctor will let you know how often you should get the blood work done, but it will usually aligned with when you need to get your prescription renewed.
So what exactly will testosterone do to you? This is a little tricky, because everyone will have a little bit different experiences, But we have a good idea on what commonly happens.
Increase of facial and body hair. A lot of this has to do with your personal genetics, but commonly you will see at least some increase of facial hair and an increase in body hair. Everyone will experience different amounts of hair growth in different places at different rates.
There's thickening of the vocal cords and a deeper voice. Change with this is different but at first you may sound like you have a cold, and then sound like you're a prepubescent teen with a cracking voice, and potentially other super fun vocal changes before it stabilizes. You can supplement this with vocal training with a professional in the field, which is something you can start before the testosterone, and even with that you're not guaranteed to suddenly become Frank Sinatra. Do people still know who he is? Look him up if you don't know.
Potential loss of head hair. Yes my friends, you heard me right. Hair thinning, receding hairlines, and male pattern baldness are things you may or may not experience. Again this is partially dependent on your genetics, but at least some hair loss is a common side effect that people have reported. That said, a receding of the hairline a little bit can really help make your face look more masculine, as the hairline is generally considered to be male tends to involve a lot more forehead then does for women.
Increased red blood cell count. This is a fairly common side effect of testosterone treatment, and can usually be alleviated just by donating blood. Your doctor will see this during regular blood tests throughout the process, and will let you know how often you should give blood, if at all.
Testosterone can change your cholesterol too, which is just another important reason to have a medical professional helping you out through this process.
Skin changes. Your skin will probably become more oily and you may have more acne. It sucks, but we live in a world with a lot of options for acne and skincare. Make sure to take good care of your skin, which will look completely different from person to person, and you may want to talk to a dermatologist and get the best plan for your skin type. All that should help with the annoyance of acne.
Next one may come across as weird, but your body and urine may smell different. Deodorant is your friend my guys.
There are other changes that some guys have reported experiencing, like increase energy, hunger and changes to the size of feet and other things. However, since we currently don't have a medical source for these changes, I'm not going to go in-depth about these in this episode.
These next bullet points will be talking about private areas so listener discretion is advised. Decreased the mamarian mass. Good news, you lose some moobs. However, you probably won't be ready to burn the bra without the help of a skilled surgeon, unless you were blessed with a small chest from the get-go. Even then you'll very likely need to supplement with some body sculpting workouts to be able to really get away with going shirtless at the beach. Most reports from guys on testosterone have been that while their breasts lose mass, the skin does not shrink, and instead they tend to end up with something that looks a little deflated and is easier to bind down, but is not gone completely.
Bottom growth. while you're upstairs is shrinking your downstairs is growing. While on testosterone, the clitoral area can grow up to a few inches. Unfortunately you will not be able to sport the length of an average cis man. However, some trans men have reportedly been able to utilize the size that they have gained in the bedroom to varying degrees of complexity. This is also coupled with an increase of sensitivity in the area and a more noticeable ability to achieve erection.
Ovarian changes. Your period will slow and very likely stop. Hooray! Some trans men still get some occasional periods, but they're usually much lighter than they got before starting testosterone. You might also experience ovarian atrophy, which means that your ovaries will shrink and just kind of stop working. Now the second one takes much longer and is not a guaranteed thing. Remember that you still have a chance of getting pregnant even on testosterone, even after your period stops. If you are having vaginal intercourse with someone who produces semen, the only way that you will completely stop 100% the chance of getting pregnant is if you have a hysterectomy.
And finally, increase the libido. Yes, you are now a randy teenage boy, I'm sorry.
That was lengthy. Even so, this may not be a complete list, but will give you a general idea of what you can expect to potentially experience. Special thanks to you Hudson's FTM research guide, which I reference to catch some of the things I missed on my first draft of this episode. You can find this resource at FTMguide.org. What did you think? Did I still miss something? Is there anything listed that you want to know more about? Send us an email at Transfield email@example.com. Also make sure to subscribe to keep up with new episodes, and remember I am proud of you.