Testosterone-based hormones

Testosterone-based hormones

Some transgender, Two-Spirit and non-binary people benefit from testosterone-based hormone therapy to align physical characteristics with their gender. 

What is testosterone-based therapy?

A note about language

Testosterone-based therapies are also known as “masculinizing hormones.” To be more inclusive of diverse gender identities, we are using language that focuses on anatomy, treatments, goals and presenting concerns, rather than gender.

Testosterone is a hormone that is used to induce secondary sex characteristics Physical traits that develop after sexual maturity (puberty), such as facial hair growth, deepening of the voice or breast development. like beard growth and a deepened voice. It also reduces estrogen-related features, such as a rounder face shape or body fat around the hips and buttocks. 

This page describes the advantages and disadvantages, expected effects, and potential risks of common testosterone therapies. The list of therapies is not exhaustive. Talk to your health care provider to determine the best fit for you.

Common testosterone therapies

 Injectable testosteroneTestosterone gel or creamOral testosterone
Brandtestosterone cypionate or testosterone enanthateAndrogel or compounded in a pharmacyTestosterone undecanoate
DescriptionA medication you inject once a week or once every two weeksA gel or cream applied to your skin at the same time each dayA pill you take twice a day
AdvantagesLower cost ($9–$30 per month) and is widely availableAdministered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosteroneDoes not require an injection, less risk of skin irritation
DisadvantagesMay lead to highs and lows in energy and mood in between doses (becoming worse with every two-week injection) Relatively expensive ($150–$170 per month); it is important to avoid exposing others to the gel or cream by physical contact for two hours after it is appliedNot commonly used because it is expensive (costs $100–$300 per month); hormone levels may fluctuate based on dietary habits and ability to take medication on time twice a day; has more side effects related to liver function

Expected effects of testosterone-based hormone therapies

Increased sex drive

  • Usually starts 1–3 months after beginning therapy
  • Reversible change if you stop taking testosterone

Stopping monthly bleeding

  • Depends on the dose of testosterone (some people on lower doses might still experience monthly bleeding Menstrual bleeding or period. )
  • Cessation usually happens 2–6 months after beginning therapy
  • You may still ovulate and be able to get pregnant even when your monthly bleeding stops (Note: it is not safe to take testosterone while pregnant)
  • Reversible change, if you stop taking testosterone

Enlarging erectile tissue (clitoris) & genital tissue (labia)

  • Usually starts 3–6 months after beginning therapy
  • Reaches full size in 1–2 years
  • Size typically ranges from 1–3 cm
  • Likely a permanent change, even if you stop taking testosterone

Increased facial and body hair

  • Usually starts 3–6 months after beginning therapy
  • Maximum effect in 3–5 years
  • Gradual growth of facial hair
  • More hair and thicker and coarser hairs on abdomen, arms, chest, back and legs
  • Likely a permanent change, even if you stop taking testosterone

Scalp hair loss (balding)

  • Usually starts less than 12 months after beginning therapy
  • Can be more prominent if there is a family predisposition to hair loss
  • Hair loss at temples and along the crown of head
  • Possibility of becoming completely bald
  • Likely a permanent change, even if you stop taking testosterone
  • You can take medications to minimize this

Oily skin and acne

  • Usually starts 1–6 months after beginning therapy
  • Maximum effect in 1–2 years
  • More acne and may permanently scar
  • You can take medications to minimize this
  • Not a permanent change

Increased muscle mass and strength

  • Usually starts 6–12 months after beginning therapy
  • Maximum effect in 2–5 years
  • Not a permanent change

Body fat redistribution 

  • Usually starts 3–6 months after beginning therapy
  • Maximum effect in 2–5 years
  • More abdominal fat
  • Less fat around buttocks, hips and thighs
  • Not a permanent change

Deepened voice

  • Usually starts 3–12 months after beginning therapy
  • Maximum effect in 1–2 years
  • While your voice may deepen, other aspects of the way you speak may not be aligned with your gender goals; you can work with a speech language pathologist to achieve this, if desired
  • Permanent change

Changing the lining of internal genitals (vagina)

  • Usually starts in 3–6 months
  • Maximum effect in 1–2 years
  • Thinning and drying of the lining of the internal genitals (vagina An internal organ located between the legs. A person may be born with a vagina or have one surgically created. When referring to genitals, the Trans Care BC website uses "internal genitals (vagina)" for trans people assigned female at birth (AFAB), and "vagina" or "vagina with vaginoplasty" for trans people assigned male at birth (AMAB), but there are many different terms that individuals may use. )
  • May make certain activities (ranging from walking to having receptive sex) uncomfortable (treatments are available)
  • Not a permanent change

Emotional changes

  • Overall emotional state may or may not change; this varies from person to person
  • Many people experience positive mood changes
  • May experience a narrower range of emotions or feelings
  • May become irritable, frustrated or angry more easily
  • Not a permanent change

Risks associated with testosterone-based hormone therapies

Testosterone is known to increase the chances of polycythemia (increased red blood cells), weight gain, acne, balding and sleep apnea. Testosterone may affect your cardiovascular health by causing changes to cholesterol, blood pressure, blood sugar and weight. Testosterone may also exacerbate certain mental health concerns. There are other potential risks, depending on the specific medication you use and you should discuss these with your provider.

There is either no increased risk of bone density loss or cancer (chest or breast, cervical, ovarian, uterine), or the research is inconclusive.

If you inject testosterone, you may experience fluctuating emotions and energy levels due to variations in testosterone levels throughout the week. You may want to talk to your health care provider about switching to more frequent injections of smaller doses or topical testosterone. Any mood changes that cause you concern should be discussed with your health care provider.

Need support?

Contact our team of experienced health navigators for information about gender-affirming care in B.C.

Community Voices

Read some unique perspectives, stories, and insights from trans, non-binary, and Two-Spirit community members.
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After a few months on testosterone, my voice started to noticeably change. At this point I wasn’t out to everyone in my life and people started asking questions about why I sounded different. I think this moved my ‘coming out’ timeline up a little bit, because people were noticing changes on the outside that I was really excited about and happy with but didn’t quite know how to talk to people about.

—M, on how testosterone affected when they came out