Testosterone-based hormones

What is testosterone-based therapy?

A note about language

Testosterone-based therapies are also known as “masculinizing hormones.” To be more inclusive of diverse gender identities, we are using language that focuses on anatomy, treatments, goals and presenting concerns, rather than gender.

Testosterone is a hormone that is used to induce secondary sex characteristics like beard growth and a deepened voice. It also reduces estrogen-related features, such as a rounder face shape or body fat around the hips and buttocks.

This page describes the advantages and disadvantages, expected effects, and potential risks of common testosterone therapies. The list of therapies is not exhaustive. Talk to your health care provider to determine the best fit for you.

Common testosterone therapies

	Injectable testosterone	Testosterone gel or cream	Oral testosterone
Brand	testosterone cypionate or testosterone enanthate	Androgel or compounded in a pharmacy	Testosterone undecanoate
Description	A medication you inject once a week or once every two weeks	A gel or cream applied to your skin at the same time each day	A pill you take twice a day
Advantages	Lower cost ($9–$30 per month) and is widely available	Administered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosterone	Does not require an injection, less risk of skin irritation
Disadvantages	May lead to highs and lows in energy and mood in between doses (becoming worse with every two-week injection)	Relatively expensive ($150–$170 per month); it is important to avoid exposing others to the gel or cream by physical contact for two hours after it is applied	Not commonly used because it is expensive (costs $100–$300 per month); hormone levels may fluctuate based on dietary habits and ability to take medication on time twice a day; has more side effects related to liver function

Expected effects of testosterone-based hormone therapies

Increased sex drive

Usually starts 1–3 months after beginning therapy
Reversible change if you stop taking testosterone

Stopping monthly bleeding

Depends on the dose of testosterone (some people on lower doses might still experience monthly bleeding)
Cessation usually happens 1–6 months after beginning therapy
You may still ovulate and be able to get pregnant even when your monthly bleeding stops (Note: it is not safe to take testosterone while pregnant)
Reversible change, if you stop taking testosterone

Enlarging erectile tissue (clitoris) & genital tissue (labia)

Usually starts 1–6 months after beginning therapy
Reaches full size in 1–2 years
Size typically ranges from 1–3 cm
Likely a permanent change, even if you stop taking testosterone

Increased facial and body hair

Usually starts 6–12 months after beginning therapy
Maximum effect in 5+ years
Gradual growth of facial hair
More hair and thicker and coarser hairs on abdomen, arms, chest, back and legs
Likely a permanent change, even if you stop taking testosterone

Scalp hair loss (balding)

Usually starts less than 12 months after beginning therapy
Can be more prominent if there is a family predisposition to hair loss
Hair loss at temples and along the crown of head
Possibility of becoming completely bald
Likely a permanent change, even if you stop taking testosterone
You can take medications to minimize this

Oily skin and acne

Usually starts 1–6 months after beginning therapy
Maximum effect in 1–2 years
More acne and may permanently scar
You can take medications to minimize this
Not a permanent change

Increased muscle mass and strength

Usually starts 6–12 months after beginning therapy
Maximum effect in 2–5 years
Not a permanent change

Body fat redistribution

Usually starts 1–6 months after beginning therapy
Maximum effect in 2–5 years
More abdominal fat
Less fat around buttocks, hips and thighs
Not a permanent change

Deepened voice

Usually starts 1–6 months after beginning therapy
Maximum effect in 1–2 years
While your voice may deepen, other aspects of the way you speak may not be aligned with your gender goals; you can work with a speech language pathologist to achieve this, if desired
Permanent change

Changing the lining of internal genitals (vagina)

Usually starts in 1–6 months
Maximum effect in 1–2 years
Thinning and drying of the lining of the internal genitals (vagina)
May make certain activities (ranging from walking to having receptive sex) uncomfortable (treatments are available)
Not a permanent change

Emotional changes

Overall emotional state may or may not change; this varies from person to person
Many people experience positive mood changes
May experience a narrower range of emotions or feelings
May become irritable, frustrated or angry more easily
Not a permanent change

Risks associated with testosterone-based hormone therapies

Testosterone is known to increase the chances of polycythemia (increased red blood cells), weight gain, acne, balding and sleep apnea. Testosterone may affect your cardiovascular health by causing changes to cholesterol, blood pressure, blood sugar and weight. Testosterone may also exacerbate certain mental health concerns. There are other potential risks, depending on the specific medication you use and you should discuss these with your provider.

There is either no increased risk of bone density loss or cancer (chest or breast, cervical, ovarian, uterine), or the research is inconclusive.

If you inject testosterone, you may experience fluctuating emotions and energy levels due to variations in testosterone levels throughout the week. You may want to talk to your health care provider about switching to more frequent injections of smaller doses or topical testosterone. Any mood changes that cause you concern should be discussed with your health care provider.