Masculinizing Hormones

What are the commonly prescribed masculinizing hormone therapies?

There are three options for administering testosterone. You can use the tables below to compare common testosterone therapies. The advantages and disadvantages listed here are not exhaustive. Also included on this page are the expected effects and potential risks associated with masculinizing hormones.  Talk to your health care provider to determine the best fit for you.

Common masculinizing therapies

Option What is it? Advantages Disadvantages
Injectable Testosterone (e.g.testosterone cypionate or testosterone enanthate) A medication you inject once a week or once every two weeks. It’s lower cost (around $10/month).

It’s widely available.

May create highs and lows in energy and mood in between doses.
Testosterone Patch

(e.g.Androderm)

A patch you wear every day on your back, upper arm, thigh or stomach. It’s administered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosterone. It’s relatively expensive (around $130/month).

Some people have a skin reaction to the adhesive.

Testosterone Gel (e.g.Androgel, or compounded testosterone gel/cream) A gel or cream applied to your skin at the same time each day. It’s administered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosterone. Androgel is relatively expensive (around $130/month).

When you are in intimate contact with someone, it can be challenging to avoid exposing them to the gel.

Oral Testosterone (e.g.

testosterone undecanoate)

A pill you take once a day. It’s administered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosterone. Not commonly used because it is less effective at stopping monthly bleeding. Costs $130/month.

 

What are the expected effects of masculinizing hormone therapy?

Effect Notes
Increased sex drive Usually starts in 1-3 months
Monthly bleeding stops Usually happens within 2 – 6 months

You may still 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

Bigger  clitoris*clitoris* (with an asterisk) is used to acknowledge the many different words that are used for this body part Usually starts in 3-6 months

Reaches full size in 1-2 years

Size typically ranges from 1-3cm

Likely permanent, even if you stop taking testosterone

More facial and body hair Usually starts in 3-6 months

Maximum effect in 3-5 years

Gradual growth of mustache and beard

More, thicker and coarser hairs on abdomen, arms, chest, back and legs

Likely permanent, even if you stop taking testosterone

Male pattern baldness Usually starts in less than 12 months

Hair loss at temples and along the crown of head

Possibility of becoming completely bald

Likely permanent, even if you stop taking testosterone

You can take medications to minimize this

Oily skin and acne Usually starts in 1-6 months

Maximum effect in 1-2 years

More acne. May permanently scar

You can take medications to minimize this

Not a permanent change if you stop taking testosterone

Increased muscle mass and strength Usually starts in 6-12 months

Maximum effect in 2-5 years

This is not a permanent change if you stop taking testosterone

Body fat redistribution Usually starts in 3-6 months

Maximum effect in 2-5 years

More abdominal fat

Less fat around buttocks, hips and thighs

Not a permanent change if you stop taking testosterone

Deepened voice Usually starts in 3-12 months

Maximum effect in 1-2 years

While your voice may deepen, other aspects of the way you speak may not sound ‘manlier.’ You can work with a speech language pathologist to achieve this, if desired.

Permanent change

Changes to lining of vagina*vagina* (with an asterisk) is used to acknowledge the many different words that are used for this body part. Usually starts in 3-6 months

Maximum effect in 1-2 years

Thinning and drying of the lining of the vagina*

May make penetration uncomfortable (treatments are available)

Emotional changes Your overall emotional state may or may not change; this varies from person to person. You may find that you have access to a narrower range of emotions or feelings. You may find that you become irritable, frustrated or angry more easily. (If you are injecting testosterone every two weeks, your emotional changes may be the result of your fluctuating testosterone level. You may want to talk to your doctor about switching to weekly injections.)

 

What are the risks associated with hormone therapy?

Effect Notes
Likely increased risk Polycythemia (blood disorder)

Weight gain

Acne

Androgenic alopecia (balding)

Sleep apnea

Likely increased risk with presence of additional risk factors
Possible increased risk Elevated liver enzymes

Hyperlipidemia

Possible increased risk with presence of additional risk factors Destabilization of certain psychiatric disorders (bipolar disorder, psychotic disorders)

Cardiovascular disease

Hypertension (high blood pressure)

Type 2 Diabetes

No increased risk or inconclusive research Loss of bone density

Breast cancer

Cervical cancer

Ovarian cancer

Uterine cancer