Transgender hormones: men and transmasculine

Many transgender people take hormones as part of a gender transition. Trans people must think about their reproductive options before they start hormones. Hormones can change their bodies so they can’t ever make children.

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.

Below is a suggested hormone regimen for transgender men (aka female to male, FTM) and transmasculine people.


Androgen (testosterone)

Oral option:

  • Testosterone undecanoate*     160–240mg/day

Injected option:(aka parenterally, i.m., intramuscular, or subcutaneous)

  • Testosterone enanthate or cypionate     50–200mg/week or 100–200mg/2 weeks
  • Testosterone undecanoate     1000 mg/12 weeks

Transdermal option:

  • Testosterone 1% gel     2.5 – 10 g/day
  • Testosterone patch      2.5 – 7.5 mg/day 

*Not available in the USA.

Monitoring for transgender men (FTM) on hormone therapy:

  • 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

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 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 seized by police at the border
  • Some people order hormones online from foreign pharmacies. This can be an option for those who do not want others to know, but there are a number of risks:
    • Scams that don’t deliver
    • Fake drugs
    • Products seized by customs officials

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’t afford going to the doctor, it’s better to go to a clinic.

References

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