Many people take hormones as part of a gender transition. You must think about your reproductive options before you start hormones. Hormones may change your body so you can not make children. You need to know the other risks and side effects that can happen before you start taking hormones.
In the case of hormones, talk to your healthcare provider about your goals. You can start and stop hormones if you want to try them for a while. Some people try them for a few weeks or a few months to see how they feel. You can stop and restart anytime, but it’s a good idea to do it under a doctor’s care.
These are what experts say are good hormones to take for people who want to masculinize how they look, like transgender men (aka female to male, FTM), transmasculine people, and other gender diverse people.
Androgen (testosterone)
Oral option – pills you swallow
- Testosterone undecanoate*: 160 to 240 milligrams a day
Injected option – drugs put in through your skin with a needle (parenterally, i.m., intramuscular, or subcutaneous)
- Testosterone enanthate or cypionate: 50 to 200 milligrams a week, or 100 to 200 milligrams every 2 weeks
- Testosterone undecanoate: 1000 milligrams every 12 weeks
Transdermal option – a gel or sticky patch that sends drugs through your skin
- Testosterone 1% gel: 2.5 to 10 grams a day
- Testosterone patch: 2.5 to 7.5 milligrams a day
*Not available in the USA.
Things your doctor will watch for:
- Monitor for virilizing and adverse effects every 3 months for first year and then every 6 – 12 months.
- Monitor serum testosterone at follow-up visits with a practical target in the male range (300 – 1000 ng/dl). Peak levels for patients taking parenteral testosterone can be measured 24 – 48 h after injection. Trough levels can be measured immediately before injection.
- Monitor hematocrit and lipid profile before starting hormones and at follow-up visits.
- A hematocrit measures the number of red blood cells present in your blood. The normal range for transmasculine people prior to hormone use is 4.2 to 5.4 million cells per microliter (mcL). Normal range after hormones is 4.7 to 6.1 mcL.
- A blood lipid profile measures the levels of each type of fat in your blood: total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and others. Cleveland Clinic has a good overview.
- Bone mineral density (BMD) screening before starting hormones for patients at risk for osteo- porosis. Otherwise, screening can start at age 60 or earlier if sex hormone levels are consistently low.
- FTM patients with cervixes or breasts should be screened appropriately.
Where to get hormones
This information is for adults. For younger people, see how to get hormones as a minor.
From your doctor
- Most people get hormones from their healthcare provider. Tell them you want to start hormones. They will probably give you a physical exam that includes blood tests. In some cases, they may ask you to take other steps before prescribing them, like speak with a therapist.
From a clinic
- Many larger cities have clinics that serve our community. See the resources section for options near you.
- Planned Parenthood offers hormones for our community at many locations and is throughout the US: (plannedparenthood.org/health-center)
Online (less recommended)
- Some people order hormones online from foreign pharmacies.
- This can be an option for those who do not want others to know about their hormone use.
- Buying and importing prescription drugs without a prescription is probably against the law where you live.
- Because it is against the law, you might lose the money you paid:
- No delivery sent
- Fake drugs sent
- Drugs taken by police at the border
- If you want to use this option, here is how to order hormones online.
From someone you know (not recommended)
- This used to be common, but there are cheaper and safer ways now. If you do not have insurance or can not afford to go to the doctor, it is better to go to a clinic.
References
UCSF Transgender Care (transcare.ucsf.edu)
Gardner IH, Safer JD (2013). Progress on the road to better medical care for transgender patients. Current Opinion in Endocrinology, Diabetes and Obesity. 2013 Dec;20(6):553-8. https://doi.org/10.1097/01.med.0000436188.95351.4d