Tip #25: Intro to Testosterone HRTPosted: August 21, 2012
The primary effects of Testosterone have been detailed in countless blogs and articles, including mine. Browsing Tumblr or YouTube you will come across personal stories as people chronicle their journey on their first weeks, months, and years on T. Here’s a brief recap, just in case.
Effects of T
It’s important to remember that there are two types of changes: irreversible, and reversible. The permanent changes will remain even after going off T, and include voice drop, facial and body hair, genital growth, and male-pattern baldness. The non-permanent changes revert once testosterone intake is ceasesd, and among these are acne, oily and coarser skin, menstruation, body odor, and muscle-fat re-distribution namely in the hips, stomachs and thighs, and muscle gain.
So that’s the medical part. What a lot of articles fail to mention is that testosterone, like any hormone, has wide ranging effects that are not visible to the naked eye. These include changes in metabolism, sleep patterns, liver enzymes, appetite and hunger, mood – including varying effects on depression and anxiety – among others. It is crucial to be self-aware and monitor your body, mind, and spirit for any unusual changes. While “unusual” isn’t always bad, these signs can often be easy to miss, or misattribute. Above all, stay healthy.
Types of T
The most common form of T, for a variety of reasons, is injectable testosterone. Popularity begets popularity; doctors prescribing hormones are already familiar with dosages for injectable T, so that’s what they’ll prescribe. While most people never really get over the fact they have to stick a needle in their thigh every week or so, they at least get used to living with it. Moreover, it is the cheapest option – the average cost per month ranges from $19 to $50 – and easier to get covered by insurance.
Gel, Patches and Creams
Other options instead of injectable T are gels, patches, or cream, all of which vary in dosages and prices. These are definitely more costly than injectable, sometimes up to 10x as much. People may opt for one of these as opposed to injectable for many reasons, such as allergies or fear of needles. There is also a marked difference in daily application, compared to the weekly or bi-weekly of injections. For instance, some people report feeling the peaks and troughs of being a 2-week cycle, and a more constant delivery suits them better.
A primary concern for gels, patches, or creams is obviously cost. Secondary is availability, as it may be harder to obtain. Since these are topical, that is, they go on top of your skin, you must be very careful not to rub it onto a partner, pet, or child, making sure to wash your hands thoroughly after applying and covering the area with clothes. Additionally, it washes off when you shower or swim, so it isn’t ideal for people who don’t do this consistently or do this more than once a day.
Other means of administration include subcutaneous pellets and sublingual, and oral. I haven’t heard of anyone use these, but they are detailed in a few of the resources listed at the bottom.
Dosages vary widely, and depend not only on the method of administration, but also on specific type and brand. As well, each individual reacts differently to the same dosage, given different pre-existing hormonal profiles, secondary reactions to absorbtion, metabolism, mood, etc. Lastly, consider that teenagers going through puberty do not suddenly experience a surge of full adult male testosterone levels; usually there is a gradual buildup of many months or even years. Thus it is advisable to start off slowly and increase the dosage as your body adjusts, which also makes it easier to monitor the reactions you’re experiencing and adjust accordingly.
Also note that your dosage will change if your ovaries have been removed, as these are the main source of estrogen in your body. Without ovaries, you no longer need as much testosterone since it will be your primary hormone. However, you will need to be on long term HRT, either on estrogen or testosterone, otherwise your bone health with be adversely affected.
Here are various dosage recommendations form a few sources:
From “Hormones: A Guide for FTMs”, a Booklet by The Transgender Health Program of Vancouver Coastal Health:
Typical starting dose is 50-80 mg every two weeks (or 25-40 mg every week), gradually increased each month until blood testosterone is within the average “male” range or there are visible changes. Typical maintenance dose is 100-200 mg every two weeks (or 50-100 mg every week).
From “Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers”, by Nick Gorton and Dean Spade:
Injected testosterone is started at a range of doses (25 – 125 mg/week depending on the patient and clinician)
costs approximately $100-125 for a 10 cc (2000mg) vial. Depending on dosing a vial may last from 3-10 months making cypionate the least expensive option overall.
From the ever useful “Hudson’s FTM Guide”:
In general, dosages will vary between 50 mg and 300 mg per injection, depending on the ester and the dosing regimen. An average injectable dose is about 200-250 mg every two weeks, though many trans men inject 100 mg every week or every 10 days, or other variations depending on their own bodies’ needs and sensitivities.
From the VCH brochure:
Androgel, Androderm: 5-10 g per day if no physical or mental health concerns; start with 2.5 g per day otherwise.
From Dr. Gorton’s book:
Delivered doses of both patches and gel are generally in the range of 5-10 mg/day. Cost is about $160-210/month in the US Typical dose is 2.5-10g of 1% gel applied daily but must be individualized for each patient. Each gram of the 1% gel contains 10mg of testosterone, of which only 9-14% is absorbed. So if 5 g of gel is applied daily, 9-14% of the 50mg (4.5-7mg) should be systemically available.
From FTM Guide:
The unit dose packets [of Androgel] contain either 25 mg or 50 mg of testosterone. Approximately 10% of the applied testosterone from the packets is absorbed into the system, resulting in an effective dose of 2.5 mg or 5.0 mg, respectively.
Tips for Trans Men already has a great series of comprehensive posts specifically about Androgel, which you should totally check out.
Here’s the tricky part. “There are no brand-name testosterone creams at this time” says FTM Guide, which means you need to get it from a compounding pharmacy. Moreover Creams are “are similar in dosing, application, and precautions to what is described above for Androgel.”
Low Dose Testosterone
Creams and Gels are a lesser known option, yet upon learning about it I latched onto it as the best choice for me. My primary concern was the possibility of a short term low dose; second to that was being able to control that dose, daily. Because when I started testosterone I was still unsure why I was doing it, what I wanted out of it, and most importantly had yet to firmly conclude whether I was truly ready, it was important for me to have total control over my hormone administration.
In the next article we’ll cover more about low-dose testoerone, including reasons for taking a lower dose, either at first or long term, and I will specifically talk about cream dosage.
- “Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers”, by Nick Gorton and Dean Spade. This is an extremely comprehensive guide. If you are scientifically minded, medically curious, or just thorough, this is a must read.
- “Hormones: A Guide for FTMs”, a Booklet by The Transgender Health Program of Vancouver Coastal Health
- “Hudson’s FTM Guide” has long been my go-to guide for any FTM transition related question.