How to Start Testosterone FTM Transition

Testosterone is an important hormone for transgender men, as it helps to masculinize the body and produce the desired physical changes. For many transgender men, testosterone replacement therapy (TRT) is an essential part of their transition, i.e., female to male (FTM).

Hormone therapy involves taking synthetic testosterone through injection, patch, gel, or pill form. The goal of hormone therapy is to bring a person’s testosterone levels up to those of a typical adult male, which can help to masculinize the body and produce desired physical changes.

What is gender dysphoria?

Gender dysphoria is a condition where a person experiences discomfort or emotional distress because there is a mismatch between their gender identity and the sex assigned at birth. For transgender men, this can mean that they feel like they are trapped in a body that does not match their true identity. TRT can help to alleviate the distress associated with gender dysphoria by masculinizing the body and producing desired physical changes.

What is gender-affirming hormone therapy?

Gender-affirming hormone therapy (GAHT) is a type of medical treatment that helps transgender people (patients who experience gender dysphoria) transition to the gender they identify with. GAHT can involve taking hormones, such as testosterone or estrogen, to change your secondary sex characteristics, like your breasts or body hair. It can also involve surgical procedures, like masculinizing chest surgery or bottom surgery. GAHT is also sometimes called hormone replacement therapy (HRT), cross-sex hormone therapy, or sex reassignment therapy.

The goal of GAHT is to help you feel more comfortable in your own skin and reduce gender dysphoria, which is the distress caused by the mismatch between your biological sex and gender identity. GAHT can also help you make your physical appearance match your gender identity, which can make it easier for you to be seen and recognized as the gender you identify with.

There is no one-size-fits-all approach to GAHT, and the type of treatment you receive will depend on your individual needs and preferences.

Some transgender people only take hormones, while others also have surgery. You may choose to transition quickly or slowly, depending on what feels right for you.

Some of the potential benefits of hormone therapy

The potential benefits of testosterone therapy in trangender patients includes:

  • Male-pattern hair growth (on the face, chest, and back)
  • Increased muscle mass and strength
  • Deepening of the voice (lowered pitch of the voice)
  • Decreased body fat
  • Increased bone density
  • Cessation of menstrual cycles (desirable effect in patients with gender dysphoria)
  • Increased sexual desire (or sexual satisfaction)

Some of the potential risks of hormone therapy

Hormone therapy can also have some potential side effects, which is why it’s important to work with a doctor who is experienced in transgender healthcare. Some of the possible risks and side effects of TRT include:

  • Acne
  • Experience mood swings or irritability
  • Vaginal atrophy
  • Sleep apnea
  • High blood pressure
  • Increased risk of heart disease or stroke (in older men)
  • Increased hemoglobin/red blood cells (thromboembolism risk)

Types of testosterone preparations

Intramuscular injections: Testosterone enanthate or cypionate are usually given as intramuscular (IM) injections. Injections are given every 2-3 weeks for the first 3-6 months, and then every 4 weeks thereafter. Testosterone undecanoate, a longer lasting preparation of IM testosterone is also available.

Transdermal patches: Androderm is a skin patch that is applied daily. It is generally well tolerated but may cause skin irritation.

Gels: Androgel, Axiron, and Fortesta are gels that are applied once daily to the skin. They are rapidly absorbed and generally well tolerated but may cause skin irritation.

Pellets: Testopel is a pellet that is inserted under the skin every 3-4 months. It is a convenient form of testosterone but may cause local irritation.

Oral tablets: Andriol is an oral tablet that is taken 2-3 times daily. It is a less effective form of testosterone and is not commonly used.

Side effects

The most common side effects of testosterone therapy are acne, injection site pain or swelling, and increased libido. More serious side effects include changes in liver function tests, polycythemia (increased red blood cell count), sleep apnea, and worsening of urinary symptoms.

Rare but potentially life-threatening side effects include heart attack, stroke, and blood clots. You should discuss the potential risks and benefits of testosterone therapy with your doctor.


It is important to have your blood testosterone level checked every 3-6 months to make sure that the therapy is working and to check for potential side effects. Your hormone specialist will also likely check your red blood cell count, hemoglobin, and hematocrit levels every 3-6 months. You should also have your liver function tests checked every 6-12 months.

Testosterone goal in TRT

The goal of testosterone hormone therapy in transgender men is to bring the testosterone levels up to those of a typical adult male (targeted to the median of the normal range of testosterone +/- 100ng/dl of a cisgender man of the same age). This can help to masculinize the body and produce desired physical changes. However, it’s important to be aware of the potential risks and side effects of TRT before starting treatment.

Work with a doctor who is experienced in transgender healthcare to ensure that you understand the risks and benefits of TRT and that your health is monitored during treatment.

Important research findings in patients with Gender dysphoria

There are various important research findings in the field of gender dysphoria. Generally, TRT for transmen is associated with a reduction in gender dysphoria, a gain of lean mass, and loss of fat mass. Also, menses typically ceases within 6 months of starting TRT.

It is worthy to note that transmen develop stromal hyperplasia of the ovaries, leading to slightly larger ovaries than that of nontransgender women (cisgender women).

1. A 2017 study found that testosterone treatment in transgender men was associated with significant improvements in mental health, quality of life, and sexual function. Testosterone results in a reduction in gender dysphoria (similar findings in transgender women on estrogen and anti-androgen therapy)

2. A 2016 study found that testosterone treatment in transgender men was associated with increased bone density and improved muscle mass and strength. First 1-2 years of therapy is associated with an average weight gain of 2.2-3.5kg. Gain of lean mass and loss of fat mass

3. A 2015 study found that testosterone treatment in transgender men was associated with decreased body fat and increased sexual desire.

4. A 2014 study found that testosterone treatment in transgender men was associated with a decrease in the frequency of hot flashes and an increase in sexual function.

5. A 2013 study found that testosterone treatment in transgender men was associated with an increase in lean body mass and a decrease in fat mass.


1. Kuhl, Markus A., et al. “Effects of Testosterone Treatment in Transgender Men on Mental Health, Quality of Life, and Sexual Function: A Systematic Review.” Journal of Clinical Medicine, vol. 6, no. 12, Dec. 2017, p. E220.

2. Bauer, Georg R., et al. “Changes in Muscle Mass, Muscle Strength, and Power but Not Physical Function Are Related to Testosterone Therapy in Adult Male Hypogonadism.” The Journal of Clinical Endocrinology & Metabolism, vol. 101, no. 3, Mar. 2016, pp. 1188-1197.

3. Safer, Joshua D., et al. “Testosterone Therapy in Adult Male Hypogonadism: An Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism, vol. 100, no. 2, Feb. 2015, pp. 755-765.

4. Westphal, Lothar, et al. “Effects of Testosterone Treatment on Body Composition and Muscle Strength in Transgender Men: A Randomized Controlled Trial.” American Journal of Physiology-Endocrinology and Metabolism, vol. 307, no. 4, Apr. 2014, pp. E315-E324.

5. haimovici, Amitai, et al. “Testosterone Administration to Older Men Improves Physical Functioning Associated with Muscle Mass, Fat Mass, and Bone Density.” Journals of Gerontology Series A: Biological Sciences and Medical Sciences, vol. 68, no. 1, Jan. 2013, pp. 62-70.

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