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.
Expected effects
Onset of effect: Begins within first year; may take further time to be noticeable
Full result: The rate and extent of hair thinning vary widely, may slow down after few years and stabilize but progressive loss possible
Reversibility: Irreversible
Changes to expect
- Hair loss occurs at temples and along the crown of the head
- It can be more prominent if there is a family predisposition to hair loss
- There is a possibility of becoming completely bald
- There are medications available to minimize hair loss
Onset of effect: 6–12 months
Full result: 4–5 years
Reversibility: Irreversible
Changes to expect
- Gradual hair growth on the face
- Thicker, coarser hair on abdomen, arms, chest, back and legs
- The degree and rate of physical change is dependent on the dose and method of administration, as well as other factors such as genetics
Onset of effect: 1–6 months
Full result: 1–2 years
Reversibility: Irreversible
Changes to expect
- Thickened vocal cords cause the voice to deepen
- Some people experience a scratchy throat or feeling hoarse early on in their treatment
- Singers who take testosterone may need to retrain their voice
- Speech therapists and vocal coaches can help individuals achieve the voice and speech they desire
Onset of effect: 1–6 months
Full result: 1–2 years
Reversibility: Reversible; however, acne scars may be permanent
Changes to expect
- Some people may experience an increase in overall skin oiliness and in the incidence of acne on face and body
- Acne can permanently scar
- There are medications available to reduce acne
Onset of effect: 1–6 months
Full result: 2–5 years
Reversibility: Reversible
Changes to expect
- Fat decreases around hips and thighs, and increases around the abdomen
- Facial fat decreases and shifts, giving the eyes and face a more angular, masculine appearance
Onset of effect: 6–12 months
Full result: 2–5 years
Reversibility: Reversible
Changes to expect
- Muscle mass and strength will increase, but these are also influenced by diet and exercise
- The arms and legs may develop more muscle definition, with more prominent veins
Onset of effect: Variable
Full result: Variable
Reversibility: Reversible; although long-term effects on fertility are unknown
Changes to expect
- Monthly bleeding Menstrual bleeding or period. (menstruation) can become lighter, shorter, or less frequent, and may stop entirely. These changes depend on the dose of testosterone.
- The long-term impact on fertility remains uncertain. Some individuals may still ovulate even if regular bleeding has stopped, so pregnancy is still possible.
- Testosterone should not be used during pregnancy, as it may pose risks to fetal development.
- If someone with ovaries and a uterus is on testosterone and is sexually active with someone who makes sperm, it is advisable to use contraception (condoms or progesterone-based methods which will not interfere with testosterone).
Onset of effect: 1–6 months
Full result: Will vary depending on individual factors
Reversibility: Reversible
Changes to expect
- Libido may increase significantly at first and then gradually stabilizes over time
- Orgasms may feel different, with more intensity and greater focus on the genitals
- Erectile tissue Tissue that is capable of stiffening or engorging with blood, which typically occurs during sexual arousal. (clitoris An erogenous and erectile organ located above the urethral opening that consists of a complex network of erectile tissue and nerves, with parts located inside and outside the body. A person may be born with a clitoris or have one surgically created. When referring to genitals, the Trans Care BC website uses "erectile tissue (clitoris)" for trans people assigned female at birth (AFAB), and "clitoris" for trans people assigned male at birth (AMAB), but there are many different terms that individuals may use. ) may become larger when aroused
- Sexual interests, attractions, or orientation may change
Check out Demystifying Sex Drive & Sexual Response (interactive video) for an exploration of the ways that hormones can affect desire and sexual response.
Onset of effect: 1–6 months
Full result: 1–2 years
Reversibility: Irreversible
Changes to expect
- Most people experience growth of erectile tissue Tissue that is capable of stiffening or engorging with blood, which typically occurs during sexual arousal. (clitoris An erogenous and erectile organ located above the urethral opening that consists of a complex network of erectile tissue and nerves, with parts located inside and outside the body. A person may be born with a clitoris or have one surgically created. When referring to genitals, the Trans Care BC website uses "erectile tissue (clitoris)" for trans people assigned female at birth (AFAB), and "clitoris" for trans people assigned male at birth (AMAB), but there are many different terms that individuals may use. ) with possible thickening of outer labia The external genitals (folds of skin) around the vaginal opening. though this can be subtle
- Eventual size of the erectile tissue typically ranges from 1–3 cm
- The erectile tissue may grow with arousal (erections)
- Some people may experience increased sensitivity
- Orgasms may feel different, with more intensity and greater focus on the genitals
Onset of effect: 1–6 months
Full result: 1–2 years
Reversibility: Reversible
Changes to expect
- Some people may experience thinning and drying of the internal lining. This can make certain activities uncomfortable, such as urination or having receptive sex.
- These changes can make a person more prone to urinary tract infections (UTIs)
- These changes to the internal canal can increase the risk of contracting STIs. They can also increase susceptibility to bacterial vaginosis, which causes a strong-smelling discharge.
- There are treatments available to address discomfort in the genital area that do not interfere with testosterone levels or transition.
- The uterus lining may also thin and decrease in size. This is often accompanied by an end to monthly bleeding Menstrual bleeding or period. .
Onset of effect: Timing variable
Full result: Timing variable
Reversibility: Reversible
Changes to expect
- Emotional changes vary from person to person
- Many people experience positive mood changes
- Some may experience a narrower range of emotions or feelings
- Some may become irritable, frustrated or angry more easily
- People are encouraged to seek mental health support and speak with their health care provider if emotional changes are disruptive or causing distress
Common testosterone therapies
| Injectable testosterone | Testosterone gel or cream | Oral testosterone | |
|---|---|---|---|
| Brand | testosterone cypionate or testosterone enanthate | Androgel or compounded in a pharmacy | Testosterone undecanoate |
| Description | A medication you inject once a week or once every two weeks | A gel or cream applied to your skin at the same time each day | A pill you take twice a day |
| Advantages | Lower cost ($9–$30 per month) and is widely available | Administered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosterone | Does not require an injection, less risk of skin irritation |
| Disadvantages | May 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 applied | Not 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 |
Risks
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.
Contact our team of experienced health navigators for information about gender-affirming care in B.C.
Community Voices
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.