#hrt changes

Is T life threatening?

ALL medications have the potential to be dangerous or fatal. I don’t consider T to be any more life threatening to a healthy individual than Ibuprofen or Acetaminophen, and most side effects are not dangerous. In some rare cases it can be ill advised to take T or you should take caution when doing so, however.

Things that may PREVENT YOU from taking T due to health risks:

- Pregnancy or breastfeeding, as it can cause defects in the child.

- Currently having or having a personal history of hormone-sensitive cancer such as breast cancer.

- Having problems with blood clots, such as when a blood clot forms in a deep vein (deep vein thrombosis), or there's a blockage in one of the pulmonary arteries of the lungs, (pulmonary embolism).

- Having uncontrolled coronary artery disease.

- Uncontrolled cardiovascular conditions.

- Severe liver or kidney disease.

- Some psychiatric conditions, such as poorly controlled psychosis or other conditions that may impact your ability to consent to the procedure.

Things that should make you stop and talk to a healthcare provider before starting T*:

- Severe acne (T will make this worse or prolong the condition in almost every case)

- a family history of heart disease or breast cancer (for the latter you may consider top surgery before testosterone)

- high levels of cholesterol

- a high red blood cell count

- had a blood clot in your arms, legs, or lungs

*You should be discussing any of the risks/side effects with your provider prior to starting T anyway!

Some notable potential risks include:

- a severe allergic reaction (anaphylaxis) to some methods of T: rare, but most common with the cottonseed oil some injectable methods are suspended in.

- Heart-related risks: unhealthy cholesterol levels, high blood pressure, increased fat around the heart/other organs, excess red blood cells, heart disease

NOTE that all the above can be prevented/the risk can be mitigated by maintaining a healthy weight, be active (exercise!), attend ALL MEDICAL CHECKUPS, and quit smoking/vaping.

- Liver damage

- Cancer (link to cancer is speculative, it is unknown of excess T converted back to estrogen increases the risk of developing certain cancers, but it is a possibility)

- Diabetes

- Headaches

- Emotional changes

- Hair loss (due to male pattern baldness. If a lot of the men in your family are bald, you may end up bald, too).

- Worsening of/Changing of ADHD symptoms

This may seem like a lot, and that may be scary. But remember that most medications have a very long list of possible side effects & risks; There are things you can do to mitigate them.

The following GREATLY REDUCES your risk of complications and/or GREATLY INCREASES the chance that any complications will be caught early:

- Take your medication ONLY AS PRESCRIBED.

- Tell your clinician immediately if you experience any problems with your treatment.

- Follow through with ALL of your follow-ups including physical exams and blood tests, especially early on in your treatment.

- Talk with your clinician if you have or develop any of the conditions that make it risky to take testosterone. Your doctor will be able to advise you with next steps.

- If you decide to stop at any point, discuss this with your clinician first to decide the safest way to do so.

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Below is a list of what changes you can expect on masculinizing HRT, but keep in mind that these are vastly genetic and your mileage may vary. You will experience most of these, if not all, but to what extent & how long it takes depends on genetics, your T dosage, and your method of administration.

THINGS T WILL NOT CHANGE:

- If starting HRT after your growth plates have fused (after you have stopped growing; after puberty) you WILL NOT grow taller.

- Your breast size/density will not change on T, though they may become saggier and easier to bind.

- T WILL NOT prevent pregnancy. I’ve heard conflicting information over whether or not T actually affects fertility, but it seems the general consensus is that it does not. You will have to stop T if you are trying to get pregnant, however.

- T will also not protect against STIs or STDs.

PERMANENT CHANGES:

- Enlargement of the clitoris (bottom growth). This creates a “phallus” of sorts which is usually between 1-2 inches. You will grow foreskin. You will need to wash it.

Bottom growth IS PAINFUL/UNCOMFORTABLE to some when it is growing In. It becomes very sensitive, so touching it can hurt, but this discomfort decreases within 6-8 months. If you’re lucky, like me, you will experience some mild itchiness but no other discomfort.

You can reduce the rate at which bottom growth grows using DHT. This will also slow down other effects, however, such as facial and body hair growth. Discuss with your provider before doing this if it’s something you are interested in.

- Voice drop. The voice dropping is unavoidable on T, and it is an effect that cannot be reversed. Some change happened within the first month for me, with much of it occurring between 2-4 months on T. I’m still experiencing some changes in my voice 11 months in, but it is minimal.

- Thickening of some facial bone structure.

- Hair loss, for the most part.

- Increased body & facial hair growth.

REVERSIBLE CHANGES:

- Increased libido. (When people tell you this is rough, LISTEN. Truly, it was so difficult to get through the roughly 2 week period ~a month in where it was so bad. I could not think about anything else, could not focus—people were right about teenage boys being ravenous).

- Increased appetite, weight gain, and fluid retention.

- Increases muscle mass.

- Fat redistribution. (Decreased fat in breasts, butt, & thighs, increased fat in the abdomen)

- increased sweat and changes in BO

- prominence of veins and coarser/rougher/tougher skin

- Acne (may cause scarring if severe, however)

- Menstruation stopping

- Vaginal atrophy/dryness/itching that may occasionally cause pain w/ vaginal penetration during sex

- changes in mood & emotional stability

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METHODS OF ADMINISTRATION:

Injections:

As the name says. cheapest option & great for keeping your hormone levels relatively stable. Offers very quick changes.

12-weekly shots - an option different from weekly shots, they give a higher dose in one go every 12 weeks. Done by a doctor or other professional licensed to give vaccinations. I wouldn’t recommend this for people just starting HRT as it offers little flexibility with changing your dose, but you absolutely can if you want to.

sub Q - smaller needle that goes into fat reserves in stomach, thighs, or butt. Injected by yourself every week, though your nurse will likely be willing to do it for you if you wish. A partner or other trusted adult may also be able to do it for you. You will get injection training from a professional, don’t worry.

Intramuscular: bigger needle that goes into muscle in your arm. Recommended by the FDA over sub-Q, reaches your bloodstream faster. I believe offers the chance for higher doses at once. Injected once every 1-2 weeks. Usually self-administered/administered at home, but like sub-Q you can get a nurse to do it for you also. You will get training for this as well.

Patches:

don’t know much about these, but they do exist. I’d encourage you to do your own research on them, but to my understanding they are transdermal patches that go on your thighs or stomach and release the hormone over the course of a few days. Replaced 2-3 times a week, I think?

Gel:

What the name says. A gel form of T that you spread over your arm and allow to soak in over the course of a couple hours. This is done DAILY. Generally expensive & not often covered by insurance, but great if you have a fear of needles. You CANNOT allow anyone or any pets to touch this area after application or they will absorb some of the T themselves. This can be toxic to pets as well I believe.

Implants:

a small pellet that goes is implanted into your arm and slowly releases T over the course of a few months. Has to be replaced roughly every 3 months. Like the 12-weekly injections, I wouldn’t recommend this for people just starting HRT as it offers little flexibility with changing your dose, but you absolutely can if you want to.

Pills:

Until recently I was under the impression that pill forms of testosterone were banned in many places because of their toxicity to the liver. I remember hearing however that there are one or two brands that exist and are sold, but you may be hard pressed to find them. Talk to your care provider if interested and do a lot of research, but I would honestly recommend every other method to this one myself.

SOURCES:

Not used as a source, but I do recommend reading the gender dysphoria bible for further information: https://genderdysphoria.fyi/en