The Tea on T
The who, what, when, where, and why on testosterone
What is Testosterone?
Testosterone is a hormone produced naturally by every person that aids in the everyday functions of the body. However, in the case of testosterone for HRT, testosterone is an injectable, topical, or implantable medication used to raise the testosterone levels in an individual and masculinize the body. Testosterone aids in the formation of typical male secondary sex characteristics like a lowered voice and increased body/facial hair.
Testosterone is not only used for trans men/mascs going through HRT, but it is also used by cisgender people for a variety of reasons. Most commonly, it’s used to help correct low testosterone levels in cisgender men.
Besides folks that choose to take testosterone for a set period of time and then go off of it, testosterone will be a lifelong medication for a lot of trans men/mascs. This is especially true if the individual has had a full hysterectomy at which point either testosterone or estrogen will need to be taken to make sure the body continues to function correctly.
Types of Testosterone
The two main types of testosterone for injectable medication is testosterone cypionate and testosterone ethanate. Both are oil-based esters that differ mainly in the duration of their activity. T cypionate has a longer half-life (the time it takes for the drug’s active substance in the body to reduce to half) due to an extra carbon atom while T ethanate is shorter which means it has to be injected on a more frequent schedule. Despite this, the difference in time is small with T cypionate lasting about eight days and T ethanate seven days. You and your doctor will pick one that works best with your personal medical history if you are going the injectable route and will help with picking the frequency of dosing.
Outside of injectable medications there are testosterone gels, patches, and pellets. Both gel and patches are applied daily, usually in the morning or at night. Testosterone pellets are implanted in the hip or butt area and last on average about 2-6 months and dissolve over the course of that time.
Methods of Delivery
Injections: Injectable testosterone is given on a weekly to biweekly base on average and are self-administered at home. These shots can be either subcutaneous or intramuscular. Subcutaneous injections are injected into fat, so you will typically use your thighs, butt, or stomach for injection. Intramuscular injections are injected into muscle, typically a thigh or hip muscle (vastis lateralis or ventrogluteal muscle).
Gel: Testosterone gel is an alcohol-based substance applied topically to the skin. It will be applied daily either in the morning or before going to bed, but can be applied at any point throughout the day.
Patches: Like testosterone gel, patches are applied daily either in the morning or before going to bed. These seem to be used less often for HRT, but are an option nonetheless.
Pellet: Testosterone pellets are inserted surgically underneath the skin typically in the butt and hip region of the body. These pellets release testosterone slowly over the course of several months. On average one pellet will last anywhere from two to six months although, most will be implanted every three months for consistency. The previous pellet fully dissolves so there is no need for removal when going to implant the next pellet.
Injectable T and T Gel are widely considered the most common, affordable, and accessible forms of testosterone so you will see most people on one of those as opposed to patches and pellets.
Injections 101
As I said before, injections are done via intramuscular or subcutaneous shots. The key difference is where you inject the testosterone into, but they do have several other key differences.
Subcutaneous (SubQ)
Injected into fat tissue
Needle size typically ranges from 23-25 gauge, needle is shorter
Slower to disperse throughout the body; Not as many hormone spikes
Subcutaneous injections are one of two forms of injection for testosterone. These injections are administered into the fatty areas of the body like the thighs, stomach or butt as there is a larger quantity of fat in these areas than other areas of the body. This injection makes its way throughout your system a little slower due to the lesser amount of blood vessels present in fat.
Intramuscular (IM)
Injected into muscle
Needle size typically ranges from 22-25 gauge, needle is longer
More likely to cause bruising
More readily accessible to your body due to higher amount of blood vessels in muscles
Intramuscular injections are the second form of injectable testosterone. Like the name suggests, these are injected into muscle as opposed to fat. The two most common muscles to inject into are the vastis lateralis or ventrogluteal muscle. These injections act slightly faster compared to SubQ due to their close proximity to blood vessels.
I have attached a good guide on the how-to’s of injection, but here are some of my personal tricks to make injection days run smoother:
Play music: Having something to listen to will help calm your nerves (especially if it’s your first shot)
Keep a stock of your injection supplies on hand: This includes alcohol wipes, sharps container, and band aids.
Clean your injection site thoroughly with the alcohol wipe before and after injection. Wiping again afterwards helps stop the injection site from itching.
Rub the injection site with the heel of your hand afterwards to help ease the initial shot pain (although most shots are painless!).
Gel 101
Testosterone gel is a method of applying testosterone topically to various parts of your body. Some common application sites include the upper arms, stomach, and thighs. Unlike injections, gel is applied daily either in the morning or at night.
Gel has grown increasingly popular due to it having a steadier supply of T without the hills and valleys of hormone levels some folks get with injections. This also means that you have to schedule it into your day and set aside time to apply it.
A few things to be cautious of with gel:
Gel can rub off on others so make sure to apply it, wash your hands right away, and throw on a t shirt or hoodie for a few hours after application.
Gel can be toxic to pets so similarly to my last point, make sure to keep your pets away from the application site as well as the actual gel itself.
Some people report gel drying out their skin or causing acne/pimples.
HOWEVER, there are simple solutions to these problems.
Apply your gel using a spatula or nitrile gloves which will limit it’s contact with your hands/what your hands touch.
Get a hydrating lotion to apply to the application site.
When on gel, it is important to avoid getting water on the application site for a few hours after application. This includes pools, showers, and other bodies of water. The reason being is that water can wash away the gel and give you a weaker dose.
Where Can I Get Testosterone?
There are several places you can get testosterone, each with their own unique processes. Below is a brief overview of the different places T is available, but this does vary place to place so make sure to do additional research.
Your general practitioner
Your GP will either be able to prescribe T to you or refer you to a doctor who is able to prescribe it to you.
Informed consent clinics
The biggest informed consent clinic in the USA is Planned Parenthood.
Endocrinologist
An endocrinologist is a specialist that specifically works with the endocrine system, which includes hormones.
This is the doctor your GP may refer you to.
Online prescription sites
These include Hims, Plume, and FOLX, among others.
What Can I Expect on Testosterone?
Testosterone works slowly. You are basically going through a second puberty when you begin your HRT journey. It should also be noted that every person is different and testosterone will have different effects at different levels for everyone and some people may not get some of the effects.
One thing I see people not fully understanding in regards to taking T is that you can’t pick and choose what effects you get, it’s essentially all or nothing. If you don’t want facial hair, too bad you may get it on T. You don’t want bottom growth? Well, it happens to the overwhelming majority who take T so it’s unavoidable. DHT, which is responsible for male pattern baldness, can be slowed or stopped by taking finasteride. It has also been shown that finasteride can also slow or stop bottom growth so don’t think you have to rule out testosterone entirely if you’re worried about these things. Above all else, consult with your doctor.
If you aren’t sure about going on T, take your time thinking it over! It’s not a decision to be made lightly and you can’t control what effects you will and will not get.
Mental and emotional changes
Crying can become more difficult
The way you process emotions can change
Tiredness can increase
Mood stabilizes
Many trans men/mascs report feeling more relaxed, calm, level-headed and chill on testosterone.
Libido changes
While this is not strictly mental/emotional, libido can increase drastically on testosterone, especially in the first few years.
Increase in energy
Can be described as “Zoomies”
Gender euphoria
Physical changes
Increase in body/facial hair
Hairline receding/changing
This can include hair texture changing
Increased sweat production
Hunger increases
Causes vascularity in hands and arms
Muscle becomes easier to gain
Bottom growth
Libido changes from more thought based to visual based
Fat redistribution
Stopped/slowed period
This can include a slowing or stopping of PMS and PMDD
Skin texture gets rougher
Increased chance of acne/pimples
Oilier skin
Body smell can change
Not everyone who goes on T will experience all of these changes, and people will experience these effects to varying degrees. The reason for this is…
Genetics and Their Role
As with most things that deal with the human body, genetics plays a huge role in shaping the outcome of testosterone. The big question I see everyone ask is “What will testosterone do to me?” Well, look at your dad, brothers, uncles, cousins, and grandpas. What you will experience on testosterone will rely heavily on what your genetic makeup is, and your family members can give you a rough idea as to what to expect. Now this doesn’t always work if you’re, like me, adopted, but this should not be a deterrent for starting T. You’ll just have some fun surprises along the way!
If you feel comfortable, ask your male family members about their experiences going through puberty, what age they started experiencing balding/heart issues/joint problems/etc as that may be the course you take as well. If your grandpa is 98 years old with a full head of hair and no heart issues, you very well may end up running a similar course.
Unfortunately, other people can’t always make predictions for you (especially people on the internet). This is why it’s so important to work with your doctor to make sure you are staying in the best shape possible and managing any other health conditions while taking testosterone.
Testosterone Myths
Testosterone will make you ugly/gross/violent/a bad person
No it won’t! This is a myth peddled by TERFs and transphobes to keep people from transitioning.
Testosterone will make you pass quickly
It can, again genetics play a huge role in this, but for most people it takes months to years of being on T for passability to be achieved.
Testosterone gives you health problems
Testosterone can make you more susceptible to illness at the same rate as another person with a testosterone dominant endocrine system (like cisgender men). It also decreases the risk of illnesses that typically affect people with an estrogen dominant endocrine system (like cisgender women).
Testosterone makes you an angrier
Yet another lie peddled by TERFs and transphobes to make folks scared to transition.
Testosterone gel works slower than injections
False! T gel and injections both work similarly.
Testosterone really is a wonder drug, and something that has personally helped me mentally, physically, and emotionally. I hope this guide was helpful and enlightening and as always, keep researching!
