Testosterone is a widely misunderstood hormone. Often viewed through cultural cliches and misused to ponder social problems with a lack of evidence-based explanations, all human bodies have some Testosterone. As more and more positive experiences have occurred for individuals on their own Testosterone-based Gender-Affirming Hormone Therapy journey, Equal Health strives to uphold safe access to telehealth for the trans and gender-diverse community. Following our previous post about Estrogen and Hormone Replacement Therapy (HRT), we will be exploring the same category of changes for Testosterone: physical, reproductive, sexual and emotional.
While it is true that emotional changes occur for anyone who is prescribed and processing HRT, patients working with Testosterone do not have one (or even two or three) common emotional shift(s). Individuals experience a range of reactions and feelings while becoming accustomed to HRT. The narrative that Testosterone alone drives aggressive behavior is not only lacking in evidence, but additionally feeds a negative stereotype harmful to the ways in which “masculinity” can evolve and heal in the social sphere. Testosterone’s role in Gender-Affirming Hormone Therapy tends to contribute to a feeling of well-being and balance as expressed by Morehouse Medical Student, Transgender Health Advocate and Health Disparities Researcher Ben Haseen:
"People often think hormones like testosterone dictate how people behave which reinforces gendered stereotypes. Before I started T, people used to tell me that I would get more assertive and get angry quicker. Starting testosterone ended up having the exact opposite effect. I became a much calmer person, more in tune with my emotions. In medical school during my endocrinology lecture, I remember my professor saying to stop associating anger and aggression with testosterone because there is no correlation between the two. In the end, it wasn't the hormones that changed my mood. Being comfortable in my skin has allowed me to feel and acknowledge the emotions that I have and address them in healthier ways. And that's how HRT can be powerful."
Education and research are very helpful to manage expectations going into Gender-Affirming Hormone Therapy, though it is important to remember all bodies are different and timelines are always individual. Chest size is one aspect that Testosterone HRT does not change, and masculinizing chest surgery, known as “top surgery”, is not recommended until 6-12 months of an active HRT Testosterone plan. Generally, risks with Testosterone HRT are low, though higher rates of cholesterol and heart-disease are possible. According to research, various types of cancers are not known to increase due to Testosterone HRT.
Initial changes with Testosterone HRT often begin with our largest organ as humans: the skin. Oil production increases, pores become larger, and acne may result from the first year of Testosterone treatment. Topical skin care or additional medication can help manage acne Testosterone adjustment. Over time skin will thicken and facial fat decreases, redistributing for a more angular appearance. A decrease of fat from hips and thighs with more muscle definition follows; exercise routines can further personal physique goals. Just like Estrogen HRT, weight loss or gain may happen depending on the individual. Additionally, the odors of sweat and urine change and the sense of touch regarding pain and temperature may alter. For some individuals, voice changes with a deepened pitch are likely to occur within the first few weeks of treatment as Testosterone thickens vocal chords.
Testosterone notably affects hair growth. Facial hair can appear quickly as thickness of facial and/or body hair may increase, though timelines may depend on age and genetics. However, thinning around the temples and general frontal scalp thinning are a very common effect of Testosterone HRT, which may be managed by minoxidil treatments. The degree of hair changes, whether it be facial, body or frontal scalp thinning will vary from person to person due to family history and genetics.
In the reproductive realm, Testosterone HRT decreases the menstrual cycle, becoming lighter and less frequent, before no longer having periods altogether. While pregnancy is still a possibility, Testosterone reduces the ability to become pregnant; however, contraception remains valuable for those not wanting to become pregnant. If planning to become pregnant, Testosterone treatment will need to pause for some time while trying to conceive. Regarding sexual changes, libido increases along with growth of the clitoris (especially when aroused), commonly referred to as “bottom growth”. Sexual interests and attractions may change while going through transition. Though there have been studies as to why this aspect shifts, the reasons remain unknown, though this interesting article from Them explores some possibilities.
Unfortunately, the DEA is currently strategizing to restrict the prescription of “controlled substances” without an initial in-person appointment first and Testosterone is categorized as a Schedule III controlled substance. Testosterone is technically a steroid and has been speculated to be abused by athletes. However, this proposal would gravely affect gender-affirming care that includes Testosterone and create an immense challenge for telehealth providers and the individuals who benefit from telehealth services. Unlike Estrogen, which we discussed in our previous post, Testosterone is targeted through the DEA’s proposed rule, which is still in the process of being evaluated and has made no headway on a decision. However, we know that it will affect thousands of individuals across the United States and make access much more difficult for Testosterone-based HRT.
"Our mission at Equal Health is to provide safe and inclusive, affirming health care to our patients. We will continue to support our patients through these potential DEA regulatory changes and will assist in connecting patients to providers for in-person visits. We will continue to provide testosterone HRT virtually to our patients and will strive to ensure no interruptions in their gender affirming care." - Dr. Avantika Varma
Gender-Affirming Hormone Therapy is a membership service Equal Health offers to the LGBTQIA+ community. Equal Health continues to strive towards protecting the rights to safe and accessible telehealth for the transgender, non-binary and gender-diverse community. As of the time of posting, Estrogen and Testosterone Memberships are available to the public for individuals 18 years or older.
“Information on Testosterone Therapy”, University of California