Masculinizing hormone therapy helps gender nonconforming people who are designated female at birth (DFAB), including transgender men and nonbinary individuals, achieve a more traditional masculine appearance. Taking testosterone spurs development of secondary sex characteristics like facial hair, more muscle mass and a deeper voice.
Masculinizing hormone therapy is gender-affirming treatment that produces the secondary sex characteristics associated with being designated male at birth (DMAB). This treatment uses testosterone to spur changes in your body that society associates with masculinity, like a deeper voice, more body hair and increased muscle mass.
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This therapy allows some gender-nonconforming people who are designated female at birth (DFAB) to feel more comfortable in their bodies. For many transgender men and nonbinary DFAB people, masculinizing hormone therapy changes the way they look and sound to better match their understanding of their gender or gender identity.
Masculinizing hormone therapy is just one option for treating gender dysphoria. Gender dysphoria is the medical term for the emotional distress that happens when society’s expectations of your gender don’t match your gender identity. Hormone therapy may allow you to feel more at ease living as your authentic self.
People of all genders produce the hormone testosterone, but your body produces less of it if you’re DFAB. Instead, your body produces more estrogen, the hormone that causes secondary sex characteristics associated with traditional femininity, like rounded breasts and hips.
Masculinizing hormone therapy reduces the amount of estrogen your body makes and boosts your testosterone levels high enough to:
You may notice changes as early as one month after you’ve started taking testosterone, but it may take a little longer to achieve the maximum effects. How quickly your body responds to the therapy depends on individual factors, like your age and genetics. In general, you can expect:
Many of these changes persist even if you stop taking hormones. Others require that you continue taking testosterone regularly. For example, changes related to muscle mass, body fat distribution and menstruation all require that you don’t stop taking testosterone.
Taking testosterone without a healthcare provider’s guidance is dangerous. It can be tempting to bypass an appointment with a healthcare professional to get started on testosterone quickly. This is especially the case if you have friends who are undergoing therapy, who share their prescribed testosterone and dosage recommendations with you. But everyone is different. Getting the dosage wrong can pose long-term risks to your health. Taking testosterone without a prescription isn’t safe.
See your provider to ensure you’re getting treatment that’s safe and optimized to help you achieve your unique treatment goals.
Many healthcare providers can help you, particularly ones specializing in transgender health.
Providers who can help include:
Together, you and your provider can decide the best time to start therapy. Some gender-nonconforming individuals go their entire lives without needing or wanting gender-affirming therapies or surgeries. Others begin therapy as soon as possible.
The Endocrine Society recommends that transgender adolescents start hormone therapy at 16 at the earliest. Earlier than 16, they recommend puberty blockers. The difference is that:
In some instances, transgender youths under 16 and their caregivers may decide that it’s best to begin masculinizing hormone therapy early for the well-being of the child. The right time to start treatment varies on a case-by-case basis.
Your provider will ensure you’re healthy enough for hormone therapy and explain both the benefits and risks of treatment. Preparation may involve:
You will also need to sign an informed consent form stating that you understand the benefits and possible side effects associated with treatment, and choose to begin therapy.
Your provider can tailor your testosterone dose to help you achieve the gender presentation that feels right for you. Many of the changes you’ll notice depend not only on your dosage but also on individual factors that influence your response to treatment, like your age, health and genetics.
You can take testosterone as injectables, pills, pellets, patches and gels. Your healthcare provider can recommend the type, dose and frequency that’s right for you.
To lower the risk of complications and side effects, you may start with a low dose. As your body gets used to the therapy, your healthcare provider may increase your dosage. After achieving the desired results, you’ll take a lower dose for the rest of your life.
Masculinizing hormone therapy can improve your overall well-being by helping to align your physical body with your gender.
Depending on your treatment goals, masculinizing hormone therapy can:
You’ll meet with your provider regularly to monitor your response to treatment. Your provider can adjust your dosage to manage unpleasant side effects.
Side effects include:
Research is still ongoing about the complications that may arise from masculinizing hormone therapy. Testosterone is associated with blood thickening, which can put you at risk of having a high red blood cell count. This may lead to a stroke or a heart attack, especially if your dosage is too high.
Other complications may include:
Steps you can take to stay healthy on masculinizing hormone therapy include:
Follow-up appointments enable your healthcare provider to track your response to treatment. They run tests to check for signs of complications. These often include blood tests. Occasionally, your care may include a bone density test (DEXA (DXA) scan).
You can expect to see your healthcare provider:
Masculinizing hormone therapy can help relieve the negative feelings associated with gender dysphoria. Having physical attributes that match your gender can improve your self-esteem and self-image. These factors contribute to a better quality of life.
Masculinizing hormone therapy may be the only treatment you need. Or, it may be the first step in your gender transition process. Surgery can help you make more changes to your appearance.
Options include the following:
Certain side effects can be a sign of a complication. Some side effects can become severe and require immediate medical attention.
Call your healthcare provider if you experience:
A note from Cleveland Clinic
Masculinizing hormone therapy can change your body so that it’s better aligned with your gender. Before starting any gender-affirming treatment, it’s important to speak to a provider, especially one with expertise in transgender healthcare. They can talk you through both the benefits and potential risks associated with gender-affirming therapy. They can help you safely achieve your treatment goals.
Last reviewed by a Cleveland Clinic medical professional on 02/03/2022.
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