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SearchDonatelocation: Transition > Frequently Asked Questions (FAQ) > Transitioning Process > Testosterone Questions
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1. How long did you have to be in therapy before you could start testosterone? 2. What does the letter from my therapist need to say so I can start testosterone? 3. Why did you go to Massachusetts for an endocrinologist? 4. Do I have to go to an endocrinologist to get testosterone, or can I get it from my primary care family doctor? 5. Can I buy testosterone online, without going to a therapist/getting a letter or without doctor supervision? 6. What are the health risks to taking testosterone / Is testosterone safe? 7. What blood tests did you need to have done before/while on starting testosterone? 8. What is “standard dose” or “half dose”? / How do I calculate how much testosterone I am taking? 9. Did taking testosterone by itself make you stronger/more muscular? 10. Did your hands/feet get bigger on testosterone? 11. Did you grow taller on testosterone? 12. Is there a way to predict how deep my voice will go while on testosterone? 13. Did you grow an adam’s apple from being on testosterone? 14. Do you sweat more or smell worse after starting testosterone? 15. Did you find that your tastebuds changed after you started taking T? 16. Does testosterone change your personality or make you moody? 17. How much genital growth did you have from testosterone? 18. How long do you have to be on testosterone before you can get any surgeries? 1. How long did you have to be in therapy before you could start testosterone? The WPATH/Harry Benjamin Standards of Care, which many therapists follow, suggest a minimum of three months in therapy before the therapist can write the recommendation letter for testosterone. I had many problems with my therapist, specifically that she was admittedly transphobic herself, which resulted in me receiving my letter after about five months in therapy. 2. What does the letter from my therapist need to say so I can start testosterone? There are specific guidelines in the WPATH/Harry Benjamin Standards of Care as to what is recommended to be in therapist’s letters; however, these are only guidelines and don’t necessarily need to be followed word-for-word. Check with your doctor who will be prescribing the testosterone to find out what they would like to be in the letter. A copy of my letter for testosterone is here. 3. Why did you go to Massachusetts for an endocrinologist? I was living in Vermont at the time, and an endocrinologist in Northampton, MA was the closest trans-friendly endocrinologist I could find. 4. Do I have to go to an endocrinologist to get testosterone, or can I get it from my primary care family doctor? You do not need to go to an endocrinologist to get testosterone. Many people end up going to endocrinologists, because often their primary care family doctor doesn’t know enough about cross-sex hormone use to be comfortable prescribing testosterone for the intent of transitioning. However, if your family doctor feels comfortable and knowledgeable enough about it, they certainly can prescribe it for you. 5. Can I buy testosterone online, without going to a therapist/getting a letter or without doctor supervision? It’s probably possible to buy testosterone online without a prescription, but that is not a good idea. Like all other prescription drugs, being on testosterone without doctor supervision is illegal and potentially dangerous. 6. What are the health risks to taking testosterone / Is testosterone safe? When prescribed by and used under the supervision of a doctor, being on testosterone can be very safe. There are certain blood tests that should be performed before starting testosterone as well as repeated every 3 months during the first year of hormone therapy, every 6 months during the second year of hormone therapy, then yearly thereafter. The most common medical side effects of testosterone include polycythemia (increased RBC mass), increased liver enzymes, and/or increased cholesterol levels. See here for a more in-depth explanation of these side effects. 7. What blood tests did you need to have done before/while on starting testosterone? Blood tests run before starting testosterone vary among doctors, but it is a good idea to run a complete blood count (CBC), complete metabolic panel, triglycerides, cholesterol, and lipid levels before starting testosterone in order to establish a baseline. Testosterone can sometimes increase red blood cell mass (seen in a CBC), liver enzymes, and/or cholesterol levels so having these baseline lab values is beneficial long-term. Blood tests should also be run while on testosterone therapy, and it is generally recommended to have them done every 3 months during the first year of hormone therapy, every 6 months during the second year of hormone therapy, then yearly thereafter. These tests also vary among doctors. My doctor does a CBC, triglycerides/cholesterol, total testosterone, and free testosterone (and sometimes LH). Amount of testosterone to be injected is determined by these test results – total and free testosterone values should be within the normal male range, generally accepted to be 300-960 ng/dl for total testosterone and 9-30 ng/dl for free testosterone. 8. What is “standard dose” or “half dose”? / How do I calculate how much testosterone I am taking? Typical “standard dose” is 100 mg/week, which is the same as 200 mg every 2 weeks. “Half dose” is considered 50 mg/week, which is the same as 100 mg every 2 weeks. To figure out how much testosterone to put into the syringe, you need to know the concentration of your testosterone; this information is located on the testosterone vial. For example, my vial looks like this, indicating its concentration is 200 mg/ml. My dose is 80 mg/week so I do the following calculation:  Since 80 divided by 200 equals 0.4, I inject 0.4 ml per week of testosterone. Before you leave your doctor’s office, be sure to double check with them about how much to fill your syringe with testosterone, based on your testosterone’s concentration. Injectable testosterone is labeled for intramuscular (IM) injection. Some doctors have instructed their patients to do subcutaneous (SQ) injections, and this has been anecdotally reported to work as effectively as IM administration, but SQ use of the product is not yet FDA-approved. As always, check with your doctor before changing your dose or method of administration. There are also oral testosterone tablets (testosterone undecanoate, brand name Andriol) that are not currently available in the United States as well as testosterone gel/cream (brand names Androgel and Testim) that is applied topically every day. 9. Did taking testosterone by itself make you stronger/more muscular? Yes. I developed some lean body mass (muscle) just from being on testosterone and without going to the gym. Also, once going to the gym, I developed more muscle much more quickly than before being on testosterone. 10. Did your hands/feet get bigger on testosterone? No. 11. Did you grow taller on testosterone? No. 12. Is there a way to predict how deep my voice will go while on testosterone? No, there is no way to predict how low it will go while on testosterone. Voice deepening will eventually settle into a new (deeper) range, but how fast it reaches this new range is determined by testosterone dosage. However, the end result does not depend on the dosage of testosterone. Someone on a higher dose will reach their fully hormonally-transitioned state earlier/faster than someone on a lower dose, but the end result is determined by genetics. 13. Did you grow an adam’s apple from being on testosterone? Yes. An adam’s apple is formed when testosterone causes thickening of the thyroid cartilage in the neck; this thickening is also part of the voice changing process. 14. Do you sweat more or smell worse after starting testosterone? I definitely sweat more now than I did pre-testosterone. As far as smelling worse, I’m not sure; I guess you’d have to ask my friends! 15. Did you find that your tastebuds changed after you started taking T? No. 16. Does testosterone change your personality or make you moody? I don’t think it directly changes your personality, but I experienced an increase in self confidence that allowed me to stand up for myself more frequently. Because I was suddenly more vocal about what I believed in, it appeared as if I was more “aggressive.” Testosterone is rumored to make someone more angry or cause rage, but I personally think this is often (but not always) used as an excuse for people who are having difficulty adjusting to the physical and mental changes. I most definitely felt a change in learning style and, as cliché as it sounds, a vastly decreased ability to multi-task after starting testosterone. Over the course of three months or so, I went from being someone who could listen in class, take notes, make my to-do list, and plan my dinner all at the same time to someone who could barely listen and take notes simultaneously. 17. How much genital growth did you have from testosterone? Pre-testosterone, my clitoris was always a little more pronounced than on the women I've dated, although I don't think that necessarily means I was "bigger" than an average female, because who am I to say what's average. Though it definitely had "length" before I started T, and it was about 1 cm long. At three years on testosterone it was about 5.5 cm long. Most, if not all, of that growth happened within the first eight months so I didn’t expect it to get any bigger, solely due to testosterone. In addition to length, it also increased in width/diameter, but I don't have any specific measurements on that. If you want to see some photos (not of me, but someone has a collection of photos of a bunch of other people), visit this site. BE CAREFUL though because this site is very graphic (i.e. NOT work safe). 18. How long do you have to be on testosterone before you can get any surgeries? Every doctor has their own requirements or recommendations. Some surgeons will perform chest surgery without requiring you to be on testosterone at all. Most surgeons recommend you be on testosterone for at least two years before bottom surgery. |
