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zinniajones · 11 months

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Text of thread at https://kolektiva.social/@zinnia/110418489814171631:

Yes - this is what is happening in Florida due to SB 254, which was signed into law on Tuesday 5/17/2023, taking immediate effect. This immediately cut off 80%+ of adult trans people in Florida from having their HRT refilled, because SB 254 uniquely prohibits only nurse practitioners from prescribing only gender-affirming medications.

This has already been in effect for 7 days now.

Trans adults in Florida have already been cut off from their HRT refills for a week now, including those of us who have been stable on these medications for years or decades.

This is VERY different from the general situation of trans youth care bans in 19 states, many still working their way through the courts.

This has *already* happened, to *all* of us: all trans adults in the third most populous state in the US.

The number of trans adults on HRT massively exceeds the sliver of the population that are under 18 and are prescribed puberty blockers or hormone therapy.

These laws, advanced under the pretext of 'protecting children', are now directly impacting a far larger group of people who are not children and are not subject to those pretextual concerns.

Other arguments about withholding public Medicaid funding for transition treatment also do not apply here: SB 254 does not even allow receiving this care through private insurance or paying cash out of pocket. The care isn't simply not covered - the care itself cannot be provided regardless.

What is happening in Florida requires special attention above the situation of trans youth care bans nationally. This is having a vastly larger impact quantifiably.

It will have worse impacts qualitatively as well: adults are responsible for taking care of and protecting trans kids and making sure they do not hurt themselves.

Whereas as a trans adult, we have no one standing guard at the brink but our own self and the void to which we are accountable.

These are the facts as they stand right now. These are the facts as they have stood for a WEEK and NO ONE nationally is putting any attention on this because there are 19 trans youth care bans all across the country going on, along with everything else targeting trans people and the LGBT community broadly.

This is a specific harm that is happening now and has been happening for 168 hours.

It is not a hypothetical issue to raise awareness of, as if it were at the stage of some proposal that needs to be fought back. This has already happened and is happening right now. Active harm is happening until this law is rolled back.

For all of Florida's history since the inception of the applicable regulatory and licensing bodies, nurse practitioners have been allowed to prescribe hormone therapy, testosterone blockers and other relevant gender-affirming medications.

That has been the case since I moved here in 2011. There was no reason why this wouldn't be the case. It's also the case in every other state.

This new law is a carveout of prescriptions when used for one purpose, gender-affirming care, from nurse practitioners specifically, in a way that has never been done before. It affects all ages.

It has immediately obstructed access to HRT prescription refills for more than 80% of TRANS ADULTS in Florida.

It has also prohibited first appointments for HRT via telehealth with in-state or out-of-state MDs or DOs - first appointments must be in person. This will require expensive and time-consuming travel that is beyond most trans people's means: driving to Georgia from Florida can take 8 hours.

This was an intentional targeting of almost all trans adults in Florida, and the means by which we have received our generic, FDA-approved medications for years. And it included closing every possible door that would let us find another way to keep taking the medications we have taken for...

Well, for me it was 3,891 days when the clock stopped

#tw forced detransition #detransition #Florida #SB 254 #trans care ban #adult trans care ban #transphobia #HRT #transition #transitioning #hormone therapy

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octal-alchemist · 2 months

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Want to go on T but hate needles?

I hesitated to start HRT for a long time because of my paralyzing fear of needles, and the stories I heard about testosterone in pill form. However. I'm now 101 days on testosterone!!

Here's my experience with testosterone gel!! (Spoiler: I highly recommend it.)

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At the start, I was applying one pump of gel to each upper arm and using the back of a spoon to spread and rub the gel in (carefully marked "t spoon" and stored with my testosterone gel). I was advised to only use the unbroken skin of my upper arm, and to carefully wash my hands after applying.

(Most side-effects associated with testosterone gel come from accidentally eating it, because most people rub the gel into their arm using their hands. Gel on hands then transfers to mouth. I try to avoid that by applying with a spoon! I do rinse the spoon and wash my hands anyway to be extra safe.)

After rubbing the gel into my arms w the spoon, I held up my arms and walked around T-posing for like ten minutes so that the gel could dry before I put on a shirt.

Initially I wasn't rubbing it in enough with the spoon, and I would see a white film on my skin after drying. Nowadays I rarely see that. The gel smells strongly of alcohol, similar to hand sanitizer, so that's also unpleasant. I've gotten used to it.

For the first week, (and ONLY the first week), I would see a rash appear on my arms after applying the gel. The rash was sudden and painful, but would disappear after 20 minutes. I also experienced two reynaud's attacks while the gel was drying during that first week. (I often have reynaud's attacks when anxious, and it was winter, so I think that's not the gel's fault.)

After that first week I never rashed again, and there haven't been any more reynaud's attacks during application.

What changes have I seen while using t gel?

Voice: After 4 weeks, my voice was noticeably different. Not so much deep, but sort of? wider? and my voice was cracking a lot. In the last 10 weeks it has been becoming smoother, richer, a bit deeper. I absolutely hated my voice four months ago, but now I get a bit of euphoria everytime I hear myself.

Emotions: From weeks 2 to 8, I experienced frequent fits of anger, irritability, crying, and horniness. Very weird to me because I'm usually levelheaded and have no sex drive. However!! in the last six weeks, even though we raised my dose, ive rarely been angry or horny. I also haven't been getting depressed, and increasingly I feel like I can cope with stress. I haven't cried in about five weeks. I spend most of my time feeling content. Every part of me feels better and healthier.

Muscle: I haven't been working out more than usual (oops), but I can see that my arms are becoming more toned. Won't share the photos because they're goofy but I keep doing the 💪 thing at myself while my t gel is drying.

Periods: I have still continued to menstruate regularly, having 3 periods in the last 101 days. My cycles were already on the long side at 35 days. However, those first two periods on T were painless and incredibly short; I bled for two days the first time and 11 hours the second time, and experienced no cramps, no dizziness, no migraines. (The most recent period was two days long but i did have cramps and a migraine T_T. Doc says it's because I raised my dose right beforehand, and I should stop menstruating entirely soon.)

Hair: I already had a bit of scruff on my neck pre-T, but that was mostly just on one side. I now have thick patches of hair under my chin on both sides and the chin itself is starting to fill in. My longest hairs are 5cm but curl. There are coarse hairs appearing by the edge of my lips. I have also noticed that my leg hair is becoming more coarse, and my right nipple has become a forest. Only my right nipple, for some reason! Very few people in my family are bald, but I was still a little worried so I've been keeping track of hair loss on my scalp; however it has been the same amount as usual. Hair still thick.

Blood test results: My pre-T testosterone level was 56. I was told that 2-70 are normal readings for a cis woman. At my 3 month checkup, my testosterone level was 251!! This is still low for a cis man my age (normal is like 650-800), and I wanted a bit more, so the doctor agreed to increase my dose two weeks ago.

Confidence: I am thrilled to see mirrors lately. My jaw seems more defined with the bit of hair to shadow it; my eyes are happier. I keep flirting with myself, partially to hear my own voice. I talk to my students about transitioning, and although a couple have been a bit transphobic, I've been able to laugh about it. I've gone on a couple dates and actually felt attractive and worthy of attention. I feel alive.

Bottomline -

testosterone gel is working wonders for me. I wish I'd known about this nine years ago, when I first tried to go on HRT. Instead, I injected myself with testosterone twice and took myself to the ER over the panic attack I had 🫠 (I don't miss being 19!)

I'm still a stressy motherfucker, and it feels so much safer and more comfortable to apply medicine externally. I know about the dangers of transference, so I apply the gel with a spoon and wear the same long-sleeved shirt throughout the day, careful not to expose others to the gel.

I have so much farther to go, but it actually feels possible now. Easy, even.

If you want to know anything more about this, please, please ask me!! I have anon on, as well!

#testosterone gel #ftm hrt #hormone therapy #non-binary #nonbinary #idk how to tag but i want people to find this. i want it to help #ftx hrt #transmasc #transgender #ask me anything #101 days on testosterone

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frameacloud · 3 months

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Zinnia Jones (May 31, 2021). "Early use of masculinizing steroid oxandrolone in trans boys can add 2 more inches of height compared to testosterone." Gender Analysis. Live link. Archive.

The above blog post is about a study about looking for more suitable sorts of puberty blocking and hormone therapy for transmasculine youth. It found a treatment that is more effective for letting them grow up to be a couple inches taller, if they start it early, at age thirteen or fourteen. It's about this study:

Grimstad, F. W., Knoll, M. M., & Jacobson, J. D. (2021). "Oxandrolone Use in Trans-Masculine Youth Appears to Increase Adult Height: Preliminary Evidence." LGBT health, 8(4), 300–306. https://doi.org/10.1089/lgbt.2020.0355

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perfidious-prophet · 5 months

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The fucking things they dont tell you when you fucking start Testosterone.

Yeah, everybody knows about the deeper voice and the dreaded asshair, but these were my unfunny little surprises after 3 months on T. Reminder that shit will always vary from person to person because we're not all clones of each other, whatever.

1. Bottom growth fucking hurts. Sometimes I don't want to wear pants. I knew it would happen, didn't know it'd be so uncomfortable. And it starts fast. Like first dose fast.

2. The irritability goes fucking CRAZY it's like I'm constantly PMSing. I get why dudes punch walls. Oh my god. I know how to keep my anger wraps, but holy shit.

3. On the topic of PMSing. I had temporary worsening of menstrual cramps. Jesus fuck. I was having pain before menstruation started for days, and sometimes just randomly. I hope it doesn't flare up, but it seems to be calming down now. I think my body is freaking out over weird hormone levels.

4. Vocal fatigue. Talking hurts. I expected voice cracks, obviously, but why the fuck does this shit hurt? I don't even want to talk that much anymore. My voice just gives out. It's still deepening, so a win is a win, I guess.

5. Apathy, emptiness, anhedonia, and numbness. My motivation has tanked. I don't fucking care anymore. I just want people to leave me alone so I can take a nap. I already had mental issues before starting T, and I don't think T gave this to me, but it's definitely changed how I feel my mental illnesses. I have to like relearn how to cope and shit. I don't recommend starting hormones if you're an emotionally unstable dumbass like myself. This is literally second puberty, mood swings and teen angst included. I am a volatile, angry little man.

6. Anxiety. Like I said, teen angst. My panic attacks now include intense nausea, which is New and Uncool. Dunno why that happened. But I'm just nervous. There's nothing to be nervous about. I consistently feel like I've forgotten to do homework. I am not even in school anymore. Rad!

7. Psychosis? I had my first intense psychotic break at 14. It lasted 6 months, give or take. I've had shorter episodes on and off since then. My symptoms are stress based. The emotional strain is, naturally, pushing me towards the edge again. I am sure I will explode brilliantly and violently within the weeks to come.

8. Male loneliness is real dudes. Have friends.

9. It's harder to mask. I've been periodically going mute again. I'd never really stopped, but it's more frequent now.

Anyway that's my rant I think.

I'm not telling you not to do hormones. I'm not your dad. But it's not fucking easy. Anyway I have no intention of stopping. I am thuggin that shit out. I had a really really tough time during first puberty, and I suspect I'm going to have issues the second time around.

I am happy with the changes I am experiencing physically. I still feel confident and sure of my identity as a trans man. I am just not very happy about losing control over my mental state again. We'll see how it goes. If I'm lucky, I'll get medicated. I can't afford a therapist right now.

Good luck out there, whoever you are.

#testosterone #hrt #ftm #ftm hrt #gaht #gender affirming care #transgender #lgbtq #trans man #trans masculine #rant post #medical transition #hormones #hormone therapy #genderqueer #borderline personality disorder #schizophreniform

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dontmeantobepoliticalbut · 1 year

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It was a mundane, unanimously supported bill on liquor taxation that saw state Sen. Machaela Cavanaugh take to the mic on the Nebraska Legislature floor last week. She offered her support, then spent the next three days discussing everything but the bill, including her favorite Girl Scout cookies, Omaha’s best doughnuts and the plot of the animated movie “Madagascar.”

She also spent that time railing against an unrelated bill that would outlaw gender-affirming therapies for those 18 and younger. It was the advancement of that bill out of committee that led Cavanaugh to promise three weeks ago to filibuster every bill that comes before the Legislature this year — even the ones she supports.

“If this Legislature collectively decides that legislating hate against children is our priority, then I am going to make it painful — painful for everyone,” the Omaha married mother of three said. “I will burn the session to the ground over this bill.”

True to her word, Cavanaugh has slowed the business of passing laws to a crawl by introducing amendment after amendment to every bill that makes it to the state Senate floor and taking up all eight debate hours allowed by the rules — even during the week she was suffering from strep throat. Wednesday marks the halfway point of this year’s 90-day session, and not a single bill will have passed thanks to Cavanaugh’s relentless filibustering.

Clerk of the Legislature Brandon Metzler said a delay like this has happened only a couple of times in the past 10 years.

“But what is really uncommon is the lack of bills that have advanced,” Metzler said. “Usually, we’re a lot further along the line than we’re seeing now.”

In fact, only 26 bills have advanced from the first of three rounds of debate required to pass a bill in Nebraska. There would normally be two to three times that number by mid-March, Metzler said. In the last three weeks since Cavanaugh began her bill blockade, only three bills have advanced.

The Nebraska bill and another that would ban trans people from using bathrooms and locker rooms or playing on sports teams that don’t align with the gender listed on their birth certificates are among roughly 150 bills targeting transgender people that have been introduced in state legislatures this year. Bans on gender-affirming care for minors have already been enacted this year in some Republican-led states, including South Dakota and Utah, and Republican Governors in Tennessee and Mississippi are expected to sign similar bans into law. And Arkansas and Alabama have bans that were temporarily blocked by federal judges.

Cavanaugh’s effort has drawn the gratitude of the LGBTQ community, said Abbi Swatsworth, executive director of LGBTQ advocacy group OutNebraska. The organization has been encouraging members and others to inundate state lawmakers with calls and emails to support Cavanaugh’s effort and oppose bills targeting transgender people.

“We really see it as a heroic effort,” Swatsworth said of the filibuster. “It is extremely meaningful when an ally does more than pay lip service to allyship. She really is leading this charge.”

Both Cavanaugh and the conservative Omaha lawmaker who introduced the trans bill, state Sen. Kathleen Kauth, said they’re seeking to protect children. Cavanaugh cited a 2021 survey by The Trevor Project, a nonprofit focused on suicide prevention efforts among LGBTQ youth, that found that 58% of transgender and nonbinary youth in Nebraska seriously considered suicide in the previous year, and more than 1 in 5 reported that they had attempted it.

“This is a bill that attacks trans children,” Cavanaugh said. “It is legislating hate. It is legislating meanness. The children of Nebraska deserve to have somebody stand up and fight for them.”

Kauth said she’s trying to protect children from undertaking gender-affirming treatments that they might later regret as adults. She has characterized treatments such as hormone therapy and gender reassignment surgery as medically unproven and potentially dangerous in the long term — although the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association all support gender-affirming care for youths.

Cavanaugh and other lawmakers who support her filibuster effort “don’t want to acknowledge the support I have for this bill,” Kauth said.

“We should be allowed to debate this,” she said. “What this is doing is taking the ball and going home.”

Nebraska’s unique single-chamber Legislature is officially nonpartisan, but it is dominated by members who are registered Republicans. Although bills can win approval with a simple majority in the 49-seat body, it takes 33 votes to overcome a filibuster. The Legislature is currently made up of 32 registered Republicans and 17 registered Democrats, but the slim margin means that the defection of a single Democrat could allow Republicans to pass whatever laws they want.

Democrats have had some success in using filibusters, which burn valuable time from the session, delay votes on other issues and force lawmakers to work longer days. Last year, conservative lawmakers were unable to overcome Democratic filibusters to pass an abortion ban or a law that would have allowed people to carry concealed guns without a permit.

Cavanaugh said she has taken a page from the playbook of Ernie Chambers — a left-leaning former legislator from Omaha who was the longest-serving lawmaker in state history. He mastered the use of the filibuster to try to tank bills he opposed and force support for bills he backed.

“But I’m not aware of anyone carrying out a filibuster to this extent,” Cavanaugh said. “I know it’s frustrating. It’s frustrating for me. But there is a way to put an end to — just put a stop to this hateful bill.”

Chambers praised Cavanaugh’s “perseverance, gumption and stamina to fight as hard as she can using the rules” to stand up for the marginalized, adding, “I would be right there fighting with her if I were still there.”

Speaker John Arch has taken steps to try to speed the process, such as sometimes scheduling the Legislature to work through lunch to tick off another hour on the debate clock. And he noted that the Legislature will soon be moving to all-day debate once committee hearings on bills come to an end later this month.

But even with frustration growing over the hobbled process, the Republican speaker defended Cavanaugh’s use of the filibuster.

“The rules allow her to do this, and those rules are there to protect the voice of the minority,” Arch said. “We may find that we’re passing fewer bills, but the bills we do pass will be bigger bills we care about.”

Chambers said this is a sign that Cavanaugh’s efforts are working. Typically, the Speaker will step in and seek to postpone the bill causing the delay to allow more pressing legislation such as tax cuts or budget items to move forward.

“I think you’re going to start to see some of that happen,” Chambers said. “I think if (Cavanaugh) has the physical stamina, she can do it. I don’t think she shoots blanks.”

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arboreal-hiding · 11 months

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Trans Schmidt uses testosterone gel instead of injections bc he passed out in the office when the doctor even mentioned the possibility of needles

#hot guy p.i.#Schmidt #schmando #trans schmidt #trans man #testosterone #hormone therapy #hot guy p.i. headcanons #drawfee #karina farek

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craycraybluejay · 4 months

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Something no one ever talks about but we SHOULD:

Certain sex hormones can greatly excaberate the symptoms of already debilitating illnesses and health problems.

To my knowledge so far:

-estrogen greatly adds to ibs symptoms (personal experience between diy t and no t)

-estrogen can make seizures more common on average in epilepsy patients

-testosterone is more vulnerable to further raise high cholesterol

-etc. Will do more research from primary and secondary sources.

HRT should be more readily available to ALL. And I believe that in cases of low supply, people with physical disabilities and chronic illnesses that rely on hormone therapy should get it first whether cis or trans. Listen. Do you know how much better being disabled was for me on HRT? I hope to get back on it soon. But seriously y'all. Research any illnesses both that you have and are genetically preexposed to and how both the hormones you have and the hormones you want affect these illnesses. Do this in order to go into any hormone therapy with both eyes open. Also medical professionals should more readily prescribe high doses of birth control (generally progesterone) for menstruation related illnesses like endometriosis. We MUST fight for the right to hormone therapy, not only for our right to present as who we are as trans people, but also for disability rights, for patient rights. For several different versions of human rights. Everyone deserves the ability to make informed decisions about their hormones.

#hrt #hormone therapy #sex hormones #birth control #estrogen #testosterone #progesterone #chronic illness #disabilities #human rights #patient rights #disability rights #trans rights #the intersection between trans rights and disabled rights is actually very big when you realize both are tied to #medicine and politics #and are often negatively affected by the same restrictions and similar discriminations #intersectionality

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lou-needs-help · 2 years

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Ftm hormone therapy: the changes testosterone causes to AFAB bodies.

I start T soon so here's some changes to AFAB bodies when you take T

Increased thickness and growth of body hair

Bottom growth (clitoris grows)

Hair on crown starts to thin (depending on genes you may or may not have male pattern baldness)

Shoulders broaden

Fat redistributes. Less around hips, more around stomach.

Menstrual cycle lessens/stops

Skin becomes coarser/greasier

Change in body odor (you'll probably stink more)

Less fat around body which makes muscles look more defined

Easier to gain muscle mass

Don't expect a full beard right away, you're gonna get back hair tho

Stronger libido

Mood swings lean towards anger as opposed to estrogen based mood swings that lean towards sadness

Vaginal dryness

Voice deepens (be prepared for voice cracks)

These things will take time, let your body figure itself out.

#trans dude #trans guy #transmasc #trans help #gender affirming #transgender #gay pride #happy pride 🌈#ftm tips #testosterone #hormone therapy #tw afab anatomy #transgernderism #pride month bitches

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drafthorsemath · 5 months

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Life update on me and Hudson

Hudson is nearing the end of his treatment for Lymes and he's going to be done his treatment for EPM just before Christmas. The worrying thing is that he can start to get worse again once the drugs stop and then we need to figure out what else to do. There's one other drug we could try. I hope that he will at least maintain where he's at now. We're trying a supplement that may or may not help, but we think it at least won't hurt.

I am waiting to hear back from my doctor about scheduling a biopsy, and was told the biopsy itself may not happen until after the new year. I've started having worse and more frequent pain, but other symptoms are a little more bearable and closer to my "normal" simply by stopping the progesterone.

If you find me reblogging things from way back on your blog, it's because it's a great distraction and makes me happy. I'm also trying to get a fic written on the better days when I have energy. I really want to get it finished. Crosshair deserves it.

#about me #medical #biopsy #horse #epm #lyme disease #hormone therapy

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answersfromzestual · 9 months

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Information on Testosterone Hormone Therapy:

As you prepare to begin treatment, now is a great time to think through what your goals are, as the approach to hormone therapy is definitely not one-size-fits-all.

Do you want to get started right away on a path to the maximum safe effects? Or, do you want to begin at a lower dose and allow things to progress more slowly? Perhaps your long term goal is to seek less-than-maximal effects and you would like to remain on a low dose for the long term. Thinking about your goals will help you communicate more effectively with your medical provider (an endocrinologist is the best way) as you work together to map out your care plan.

Many people are eager for hormonal changes to take place rapidly- understandably so. But it's very important to remember that the extent of, and rate at which your changes take place, depend on many factors. These factors include your genetics, the age at which you start taking hormones, and your overall state of health.

Consider the effects of hormone therapy as a second puberty, and puberty normally takes years for the full effects to be seen. Taking higher doses of hormones will not necessarily bring about faster changes, but it could endanger your health. And because everyone is different, your medicines or dosages may vary widely from those of your friends, or what you may have read in books or in online forums. Use caution when reading about hormone regimens that promise specific, rapid, or drastic effects. While it is possible to make adjustments in medications and dosing to achieve certain specific goals, in large part the way your body changes in response to hormones is more dependent on genetics and the age at which you start, rather than the specific dose, route, frequency, or types of medications you are taking.

While I will speak about the approach to hormone therapy in transgender men, my comments are also applicable to non-binary people who were assigned female at birth and are seeking masculinizing hormone therapy.

There are four areas where you can expect changes to occur as your hormone therapy progresses: Physical, emotional, sexual, and reproductive.

Physical

The first physical changes you will probably notice are that your skin will become a bit thicker and more oily. Your pores will become larger and there will be more oil production. You’ll also notice that the odors of your sweat and urine will change and that you may sweat more overall. You may develop acne, which in some cases can be bothersome or severe, but usually can be managed with good skin care practices and common acne treatments. Some people may require prescription medications to manage acne, please discuss this with your provider. Generally, acne severity peaks during the first year of treatment, and then gradually improves. Acne may be minimized by using an appropriate dosing of testosterone that avoids excessively high levels.

Your chest will not change much in response to testosterone therapy. That said, surgeons often recommend waiting at least 6-12 months after the start of testosterone therapy before having masculinizing chest surgery, otherwise known as top surgery, in order to first allow the contours of the muscles and soft tissues of your chest wall to settle in to their new pattern.

Your body will begin to redistribute your weight. Fat will diminish somewhat around your hips and thighs. Your arms and legs will develop more muscle definition, with more prominent veins and a slightly rougher appearance, as the fat just beneath the skin becomes a bit thinner. You may also gain fat around your abdomen.

Your eyes and face will begin to develop a more angular, male appearance as facial fat decreases and shifts. Please note that it’s not likely your bone structure will change, though some people in their late teens or early twenties may see some subtle bone changes. It may take 2 or more years to see the final result of the facial changes.

Your muscle mass will increase, as will your strength, although this will depend on a variety of factors including diet and exercise. Overall, you may gain or lose weight once you begin hormone therapy, depending on your diet, lifestyle, genetics and muscle mass.

Testosterone will cause a thickening of the vocal chords, which will result in a more male-sounding voice. Not all trans men will experience a full deepening of the pitch of their voice with testosterone, however. Some may find that practicing various vocal techniques or working with a speech therapist may help them develop a voice that feels more comfortable and fitting. Voice changes may begin within just a few weeks of beginning testosterone, first with a scratchy sensation in the throat or feeling like you are hoarse. Next your voice may break a bit as it finds its new tone and quality.

The hair on your body, including your chest, back and arms will increase in thickness, become darker and will grow at a faster rate. You may expect to develop a pattern of body hair similar to other men in your family—just remember, though, that everyone is different and it can take 5 or more years to see the final results.

Regarding the hair on your head: most trans men notice some degree of frontal scalp hair thinning, especially in the area of your temples. Depending on your age and family history, you may develop thinning hair, male pattern baldness or even complete hair loss. Approaches to managing hair loss in trans men is the same as with cisgender men; treatments can include the partial testosterone blocker finasteride, minoxidil, which is also known as Rogaine, applied to the scalp, and hair transplantation. As with cis men, unfortunately there is no way to completely prevent male pattern baldness in those predisposed to develop this condition. Ask your provider for more information on strategies for managing hair loss.

Regarding facial hair, beards vary from person to person. Some people develop a thick beard quite rapidly, others take several years, while some never develop a full, thick beard. Just as with cisgender men, trans men may have varying degrees of facial hair thickness and develop it at varying ages. Those who start testosterone later in life may experience less overall facial hair development than those who start at younger ages.

Lastly, you may notice changes in your perception of the senses. For example, when you touch things, they may “feel different” and you may perceive pain and temperature differently. Your tastes in foods or scents may change.

Emotional state changes

The second area of impact of hormone therapy is on your emotional state.

Puberty is a roller coaster of emotions and the second puberty that you will experience during your transition is no exception. You may find that you have access to a narrower range of emotions or feelings, or have different interests, tastes or pastimes, or behave differently in relationships with other people. For most people, things usually settle down after a period time. Some people experience little or no change in their emotional state. I encourage you to take the time to learn new things about yourself, and sit with new or unfamiliar feelings and emotions while you explore and familiarize yourself with them. While psychotherapy is not for everyone, many people find that working with a therapist while in transition can help you to explore these new thoughts and feelings, get to know your new body and self, and help you with things like coming out to family, friends, or coworkers, and developing a greater level of self-love and acceptance.

Sexual changes

The third area of impact of hormone therapy is on your sexuality

Soon after beginning hormone treatment, you will likely notice a change in your libido. Quite rapidly, your genitals, especially your clitoris, will begin to grow and become even larger when you are aroused. You may find that different sex acts or different parts of your body bring you erotic pleasure. Your orgasms will feel different, with perhaps more peak intensity and a greater focus on your genitals rather than a whole body experience. Some people find that their sexual interests, attractions, or orientation may change when taking testosterone; it is best to explore these new feelings rather than keep them bottled up.

Don’t be afraid to explore and experiment with your new sexuality through masturbation and with sex toys. If you have a sex partner or partners, involve them in your explorations..

Reproductive system changes

The fourth area of impact of hormone therapy is on the reproductive system.

You may notice at first that your periods become lighter, arrive later, or are shorter in duration, though some may notice heavier or longer lasting periods for a few cycles before they stop altogether.

Testosterone may reduce your ability to become pregnant but it does not completely eliminate the risk of pregnancy. Transgender men can become pregnant while on testosterone, so if you remain sexually active with someone who is capable of producing sperm, you should always use a method of birth control to prevent unwanted pregnancy. Transgender men may use any form of contraception, including the numerous options available that do not contain estrogen, and some that contain no hormones at all. There are many contraception options that are long acting and do not require taking a daily pill. Transgender men may also use emergency contraception, also known as the “morning after pill”. Ask your medical provider for more information on the contraceptive and family planning options available to you.

If you suspect you may have become pregnant or have a positive pregnancy test while taking testosterone, speak with you provider as soon as possible, as testosterone can endanger the fetus.

If you do want to have a pregnancy, you’ll have to stop testosterone treatment and wait until your provider tells you that it’s okay to begin trying to conceive.

It’s also important to know that, depending on how long you’ve been on testosterone therapy, it may become difficult for your ovaries to release eggs, and you may need to consult with a fertility specialist and use special medications or techniques, such as in vitro fertilization, to become pregnant. These treatments are not always covered by insurance, and can be expensive. Uncommonly, testosterone therapy may cause you to completely lose the ability to create fertile eggs or become pregnant.

Risks

While cisgender men do have higher rates of cholesterol related disorders and heart disease than cisgender women, the available research on transgender men taking testosterone has generally not found these differences. Most of the research on risk of heart disease and strokes in transgender men suggests that risk does not increase once testosterone is begun. However, longer term, definitive studies are lacking. It has been suggested that the risk of other conditions such as diabetes or being overweight is increased by masculinizing testosterone therapy, however actual research supporting these claims are limited.

One known risk is that testosterone can make your blood become too thick, otherwise known as a high hematocrit count, which can cause a stroke, heart attack or other conditions. This can be a particular problem if you are taking a dose that is too high for your body’s metabolism. This can be prevented by maintaining an appropriate dose and through blood tests to monitor blood and hormone levels.

While available data are limited, it does not appear that testosterone increases the risk of cancer to the uterus, ovaries, or breasts. Because not all breast tissue is removed during masculinizing chest surgery, otherwise known as top surgery, there is a theoretical risk that breast cancer could develop in the remaining tissue. However, it can be difficult to screen for breast cancer in this tissue, and there are risks of a false positive test result. Your provider can give you more information about breast cancer screening after top surgery.

Cervical cancer is caused by an infection with the human papillomavirus, or HPV. HPV is transmitted sexually, more commonly by having sexual contact with someone who has a penis. However, people who have never had sexual contact with a penis may still contract an HPV infection. The HPV vaccine can greatly reduce your risk of cervical cancer, and you may want to discuss this with your provider. Pap smears are used to detect cervical cancer or precancer conditions, as well as an HPV infection. Your provider will make a recommendation as to how often you should have a pap smear. It is unclear if testosterone therapy plays any role in HPV infection or cervical cancer.

If your periods have stopped because of testosterone treatment, be sure to report any return of bleeding or spotting to your provider, who may request an ultrasound or other tests to be certain the bleeding isn’t a symptom of an imbalance of the lining of the uterus. Sometimes such an imbalance could lead to a precancerous condition, although this is rare in transgender men. Missing a dose or changing your dose can sometimes result in return of bleeding or spotting. Some men may experience a return of spotting or heavier bleeding after months or even years of testosterone treatment. In most cases this represents changes in the body’s metabolism over time. To be safe, always discuss any new or changes to bleeding patterns with your doctor.

Fortunately, since you do not have a prostate, you have no risk of prostate cancer and there is no need to screen for this condition.

If you have had your ovaries removed, it is important to remain on at least a low dose of hormones post-op until at minimum age 50. This will help prevent a weakening of the bones, otherwise known as osteoporosis, , which can result in serious and disabling bone fractures.

Most people using masculinizing testosterone therapy will experience at least a small amount of acne. Some may experience more advanced acne. Often this acne responds to typical over-the-counter treatments, but in some cases prescription medication may be required. Acne usually peaks within the first year of treatment and then begins to improve.

While gender affirming hormone therapy usually results in an improvement in mood, some people may experience mood swings or a worsening of anxiety, depression, or other mental health conditions as a result of the shifts associated with starting a second puberty. If you have any mental health conditions it is recommended you remain in discussion with a mental health providers as you begin hormone therapy.

Other medical conditions may be impacted by gender affirming hormone therapy, though research is lacking. These include autoimmune conditions, which can sometimes improve or worsen with hormone shifts, and migraines, which often have a hormonal component. Ask your medical provider if you have further questions about the risks, health monitoring needs, and other long term considerations when taking hormone therapy.

Some of the effects of hormone therapy are reversible, if you stop taking them. The degree to which they can be reversed depends on how long you have been taking testosterone. Clitoral growth, facial hair growth, voice changes and male-pattern baldness are not reversible.

Testosterone treatment approaches

Testosterone comes in several forms. Injections are usually best given weekly to maintain even levels of testosterone in the blood. Studies have shown that using a smaller needle and injection by the subcutaneous, or under the skin, approach, is just as effective as the intramuscular approach, which involves a larger needle injecting deeper into the muscle. In addition to injections, there are gel and patches that can be applied to the skin daily. The gel is applied to skin and once dry, you can swim, shower, and have contact with others. The patch also allows swimming, showering, exercise, and contact with others. All of these forms work equally well when the dosing is adjusted to achieve the desired hormone levels, and the decision about which form to use should be based mostly on your preference.

Another option for testosterone is the use of pellets under the skin. These are inserted every few months via a minor in-office procedure. Ask your medical provider for more information about this approach.

Recently, an oral form of testosterone, taken as a pill twice daily, has been approved for use. There are potential risks of high blood pressure when taking this medication, so extra steps need to be taken to monitor your health if you choose to use this form of your testosterone. Ask your medical provider for more information about this approach.

Regardless of the type of testosterone you are taking, it’s important to know that taking more testosterone will not make your changes progress more quickly, but could cause serious side effects or complications. Excess testosterone can result in mood symptoms or irritability, bloating, pelvic cramping, or even a return of menstruation. High levels of testosterone also result in increased estrogen levels, as a percentage of all testosterone in the body is converted to estrogen. In general estrogen blocking medicines are not used as a part of masculinizing hormone therapy.

Other medications that may be used include progestagens, which are hormones similar to or identical to those made by the body to maintain a balance in the lining of the uterus. These hormones can be used in cases where periods continue after testosterone levels have been optimized. These hormones can cause mood swings, bloating, and other side effects, so it is recommended that you discuss these medications further with you provider if they are to be used.

Final thoughts

And finally, please remember that all of the changes associated with the puberty you’re about to experience can take years to develop. Starting hormone therapy in your 40s, 50s, or beyond may bring less drastic changes than one might see when beginning transition at a younger age, due to the accumulated lifetime exposure to estrogen, and declining responsiveness to hormone effects as one approaches the age of menopause. Once you have achieved male-range testosterone levels, taking higher doses won’t result in faster or more dramatic changes, however they can result in more side effects or complications.

Now that you have learned about the effects of masculinizing hormone therapy, as well as risks and specific medication options, the next step will be to speak with your provider about what approach is best for you.

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