What is hormone therapy?
Transgender individuals seeking medical assistance to align with their gender identity often turn to hormone therapy, which is highly effective in easing gender dysphoria and fostering comfort in one's body. This involves administering hormones that correspond to their gender identity, facilitating physiological changes to align with it. For instance, in my case, identifying as male, I undergo testosterone injections as part of hormone replacement therapy. Testosterone, the primary male sex hormone, promotes secondary sex characteristics seen in males, excluding reproductive organs. By integrating testosterone into my body, it functions similarly to how it does in cisgender males: the hormone molecules instruct DNA to activate specific genes, leading to the development of male traits.
Hormone therapy can be administered through pills, creams, or injections. Personally, I have only used injections, which are widely regarded as the most effective and efficient method for hormone integration. In my guide, I will specifically discuss my experience with hormone therapy through injections, noting that results may vary with other methods.
It's important to note that hormone therapy is not mandatory for living according to your gender identity. Some FTM individuals opt not to pursue it, whether due to financial constraints or personal discomfort, and that decision is completely valid because prioritizing your own happiness is paramount.
Starting hormone therapy
I began my journey towards hormone therapy by discussing my transgender identity with my family doctor. She then referred me to a gender therapist, whom I visited for nearly a year. From what I learned online and through conversations with others, therapists typically assess readiness for hormones and refer patients to specialists in gender-affirming care.
While I appreciated my therapist, I felt she didn't fully grasp how urgently I sought hormone replacement and my certainty about it. Luckily, my mother's student, who was also transgender and already undergoing hormone therapy, recommended Dr. Marvin Belzer at Children's Hospital Los Angeles. Upon contacting Dr. Belzer, my mother and I discovered he accepted a different insurance plan. As a result, we switched my insurance to have him become my primary physician.
During my initial appointment with Dr. Belzer, I shared my background and feelings regarding my transgender identity. He confirmed that I identified as male and not non-binary or any other gender identity. Testosterone supplementation promotes masculine traits such as a deeper voice, increased body hair, and muscle growth. For individuals assigned female at birth, testosterone may lead to infertility or affect future fertility; some choose to undergo egg retrieval and freezing, though this can be costly.
Testosterone therapy also carries potential side effects like increased aggression, mood swings, hair loss, and heightened risk of high blood pressure, depending on family history. These factors are among several to consider when contemplating hormone therapy. It's crucial to make a decision that feels right for you; if any aspect of testosterone treatment concerns you, conducting further research or discussing with your doctor is advisable.
Following my blood work, I received an informed consent packet outlining the effects and potential risks of hormone therapy. This included desired changes to develop male characteristics, as well as potential drawbacks such as hair loss and acne. Two weeks later, I returned to Dr. Belzer with the signed forms and received my first testosterone injection.
Giving the shot
A nurse will typically instruct you on self-administering the injection and may allow you to choose the injection site. Injections can be administered subcutaneously (SubQ), into the fat tissue, or intramuscularly (IM), into the muscle tissue. Although my testosterone vial indicates "for IM use only," I have been injecting it SubQ without issues for six years. Therefore, I am unsure of the specific pros and cons between the two methods. However, injecting into muscle, akin to a flu shot, tends to be more painful.
During my first shot, the nurse offered me the option of injecting into the lower abdomen or thigh. Injecting into the thigh positions the needle vertically over the site, which may simplify the process. However, due to the presence of numerous veins, I opted for the abdomen, where there is typically more fat, resulting in less discomfort.
My injection process involves pinching the skin about 1-2 inches away from the belly button, inserting the needle, leaving it in for 10 seconds, and then withdrawing it. It's important to note the injection should not be too close to the belly button, as this can be painful. Wherever you inject, try to avoid visible veins. Whenever I hit a vein, there is pain and bleeding upon withdrawing the needle.
Having never had a fear of needles, I found it relatively easy to adjust to administering weekly shots. Most of the time, I experience minimal pain, with occasional slight discomfort or vein nicks being the only issues.
Effects of taking testosterone
Hormone therapy has brought me immense happiness and fulfillment, significantly enhancing my quality of life. It has been six years since I began hormone replacement, and during this time, numerous positive changes have occurred. I will detail these transformations here:
Voice deepening started about a month into hormone therapy and continued gradually until around seven months, when I felt it had reached its full depth. It took about four months for my voice to consistently sound male; initially, it deepened but could still be perceived as female. The rate and extent of voice changes depend on your individual dosage and body characteristics, influencing the final outcome of your voice transition.
Enhanced muscle mass and strength began to show within a week of starting testosterone. It was thrilling to notice new muscles forming on my shoulders, prompting me to intensify my focus on physical fitness. I invested in a dumbbell set and began regular workouts at home. By six months, my muscles had noticeably developed, bringing me considerable satisfaction. Presently, I continue to strive for further strength and size gains through consistent training and proper nutrition, following a regimen similar to any dedicated fitness enthusiast.
Increased body hair growth was a change I didn't entirely welcome, as it didn't increase as significantly as I had hoped. There was some thickening and darkening, but it wasn't as pronounced as I desired, likely influenced by my Asian genetics. I did notice slight growth in facial hair and eyebrows as well. It's important to note that the extent of body hair growth varies widely among individuals; I've encountered other trans men who developed thick body hair akin to cisgender men.
Heightened aggression and mood swings are recognized as potential side effects of testosterone. This hormone can stimulate aggression in humans, contributing to the perception of increased male aggression. Shortly after starting hormone therapy, I experienced increased irritability and anger, which was particularly challenging as I already had a somewhat moody disposition. However, I've observed that these effects diminished somewhat after about a year or so.
Fat redistribution and changes in facial structure were notable effects for me. While I was never overweight, I did have quite a bit of facial fat which contributed to a more feminine appearance. Testosterone didn't decrease my overall body fat, but it did redistribute it in a more masculine pattern. Some fat moved from my face and thighs to my waist and stomach area. Additionally, my jawline became more angular over time. Comparing before and after pictures, I can see that my face appears more masculine now.
I experienced an increase in acne after starting testosterone. Prior to T, my acne was mild. However, T made my skin oilier, and by the four-month mark, my acne had become quite severe, prompting a visit to my doctor. Initially, Benzyl Peroxide ointment was prescribed, which helped but caused irritation, leading me to discontinue its use. Four months later, I returned to my doctor, who prescribed Minocycline medication, which somewhat alleviated the acne. After a year, I stopped using all acne medications and switched to a nightly facial cleanser routine, avoiding touching my face, which has helped keep my acne under control.
Increased libido. Pretty self-explanatory.
More confidence has been one of the most rewarding outcomes of testosterone therapy for me. While becoming more masculine due to testosterone may have played a role, I also attribute this boost to physiological factors.
