So you’ve decided to take testosterone. Starting T is an exhilarating and highly disorienting experience. Along with much anticipated changes like a lower voice and a squarer jaw, you’re bound for a radically altered social landscape and shifting internal world. You’re coping with the demands of a second adolescence and a gender transition–and you’ve probably got a full plate of regular life stuff, too.
My first year on T was one of the most beautiful, transformative, stressful and challenging passages of my life. Nearly five years later, I feel at home in my body and my social role; gender isn’t on my list of concerns. If transition is right for you, and T is part of that transition, some time on testosterone is likely to give you a similar sense of ease, belonging, and the precious freedom to worry about other things. Testosterone therapy works. The trick is getting through the intensity of transition with your resources and relationships intact. Here are a few suggestions for surviving your first year on T.
Each person is different, so please feel free to take or leave anything here as it is helpful to you. I’ve aimed this post at people taking T with the intention of bringing levels into the male range.
1. Expect chaos. You are diving head first into a storm of transformation–physical, social, emotional and otherwise. So expect stormy conditions for awhile. Your sleep, appetite and libido are all likely to change dramatically (including possibly increasing by an order of magnitude). You may also notice that your moods are all over the map and that people are treating you differently. Know that you are going through an intense period of change. Remind yourself that this does not last forever. Make any accommodations that you can to make this a bit easier on yourself. Eat snacks, take naps, take time to care for yourself. This is not good time to take on any huge new projects. Let transition be your project for awhile.
2. Express yourself. This is an emotional time. Hormones are throwing your moods out of whack. You’re undergoing an important process that you may have brooded over for years. And you’re coming up against the longing, shame, stigma, and hope that characterize the trans experience.
I found that, along with some moodiness associated with my body being in flux, starting T brought up a lot of emotions around being trans. For the first time, I was able to feel my anger at my family and my society for failing to see and accept me. Moving through these feelings is an essential part of the transition process.
Make sure you have plenty of opportunities to vent, share, and connect with other people. See a counselor, talk with friends and family, attend a trans support group, play your favorite sport, keep a journal, create music or artwork, yell as loud as you can from the top of a mountain. Whatever strategies work for you, be sure to create space for your feelings and find ways to express them.
3. Patience is a virtue you probably don’t have. After all the agonizing about transition, after all the hoops and hassles, comes another tremendous challenge–more waiting! You have to wait for your voice to drop, wait for hairs to grow, wait for your body to change shape, wait for others to see you as male. Perhaps you are more patient than I, but this was one of the single hardest parts of transition for me. I was tired of waiting and I had an intense fear that testosterone would somehow not work on me and my body would never change.
But it did work, and it does work. A year from now, you are going to look very different. As much as you’re able, enjoy the ride. Be patient if you can be. At least, be patient with you impatience.
4. Masturbate. Everybody talks about how libido increases with T, and for me, it was totally true. If masturbation is something you enjoy, now is an excellent time to enjoy it. I jerked off a lot during my first year on T. It’s a great way to adjust to any libido changes, and also provides a nice chance to relieve stress and get to know your changing body.
5. Be self-absorbed. Might sound like weird advice. But people in transition are guaranteed to be a bit more self-absorbed than usual. It’s an intensely introspective, self-focused process. After years or decades of living in the closet, our selves need some extra attention. Like the first time around, this adolescence is a process of self-expression and discovery. It’s important to pay attention and try on different ways of moving and being. So don’t fight it–just go with the flow and be self-absorbed for awhile. Trust that by going into this process completely, you will soon enough arrive on the other side.6. Remember to listen. It makes sense to be focused on yourself right now. But don’t neglect the important people in your life, either. Show up for your partner, friends and family by giving them your time and your full attention. Be ready to put the transition stuff down for awhile and hear about what’s going on for other people.
Also be prepared to listen to their feedback for you. At some point, someone is going to tell you that you’ve been a jerk recently, you’re angrier than you used to be, or you’re waving your male privilege around. From one guy to another, they are probably right. Don’t make time for folks who put you down or reject your transition–but be ready to hear challenging feedback from the people who love you. This is just part of being a dude in our society; you’re not going to do it gracefully on your very first try. Listen with patience and openness, and be curious about how your behavior can change.
7. Celebrate small changes. Most of us are focused on the big, exciting changes, like muscles, a beard and being seen as male everywhere you go. But the little changes are just as delicious, and in some ways, it’s the small stuff that really makes your transition. Notice the new hairs sprouting up on your belly, each time your voice cracks, the way people move a little differently around you, the veins just a bit more visible on your arms, even the pimples. It’s all these tiny signals that sooner or later come together and present a new side of you to the world. Enjoy them.
Readers–what advice would give to someone just starting T? If you’ve started T recently, how are things going so far?
1. My insurance company covers my Androgel prescription, allowing me to afford the medication.
2. I refill my prescription as usual. Suddenly, a new form is required to process the refill. The new form just so happens to ask whether the medication is for female-to-male transsexualism.
3. Poof! My medication is no longer covered. I cannot pay for it without coverage.
4. This is just the most recent time my insurance has denied me coverage; I already know how to get afforable prescription testosterone when paying out of pocket. So I’ll be okay.
5. But it still hurts to be told my healthcare doesn’t matter and isn’t worth paying for, just because I’m trans.
I recently switched up my testosterone prescription. I am now using Androgel, after nearly 4 years of injections. I am really pleased with the change and thought I’d compare and contrast the two experiences.
I initially started with injections for two reasons. First, the cost–it’s generally much cheaper. (If you’re paying for testosterone cypionate out of pocket, you might want to look into Strohecker’s Pharmacy. Affordable and awesome.) Second, my doctor informed me that people usually see faster changes with injections, and fast changes were my no. 1 priority at the time.
I’m a rather anxious person, and over the last few years I developed a very negative relationship with my shots. In the beginning, I was highly motivated to get T into my system, so I didn’t really care. Once hormones changed from a matter of urgency to plain old health maintenance, I found it harder and harder to do the shots. I also found the shots got a lot more painful as I shed fat and gained muscle. Alma dutifully did every single one of my injections, despite my frequent complaining about them. (Thank you!!!) I kept thinking things would improve with time, but in fact, they got worse and worse. A couple months ago, I finally decided I’d had enough.
With some effort, I found an affordable way to get the gel. My insurance covers it at a great price if I get it through a special home delivery pharmacy, and it works out to be only slightly more expensive than the injections ($160/year vs $120/year). I’ll be aging off my dad’s insurance plan in a year; hopefully I will be able to continue to get the gel at a reasonable price after that. We’ll see.
Some things I love about switching to Androgel:
- No needles!
- No pain!
- I can do everything myself (never worked up the nerve to do my own injections)
- Levels feel more even (used to get breakouts & feel low-energy at the end of my shot cycle)
A few things I don’t like about Androgel:
- Volume of gel I have to apply. I am on a lower dose (3 pumps/day, similar to 75mg/week in injection terms) and it’s still so. much. gel.
- Worrying about accidentally exposing someone else to T (namely Alma)
- Skin is a bit dry and itchy where I apply the gel
The few downsides are minor inconveniences. I’ve switched my showers from morning to night, so that takes care of the accidental exposure issue. Lotion is helping with the skin irritation. I will get my levels checked in a few months to make sure the gel is doing its job. All in all I’m really pleased with the switch.
Readers who take hormones–what method do you use?
Last month, I visited my doctor and asked her for a prescription for amitriptyline. I took this medication for several years, from the time I was about 16 to age 21, to help me cope with depression, anxiety and migraines. Three years ago, delighted with the way testosterone had improved my mood, I stopped taking it.
I’m still not sure exactly why. I was doing much better–but what made me think I didn’t need it anymore? Maybe I just didn’t want to take two medications. More than that, I didn’t want to be someone who had to take two medications.
Testosterone has improved my quality of life tremendously. But after three years, I had to admit that my anxiety had reared its ugly head again. I got sick of being debilitated by spirals of worries, irrational and bottomless. I got sick of feeling like shit when nothing was wrong.
I realized I had two entirely separate conditions: I am transgender, and I am prone to depression and anxiety. To be more specific, I have obsessive compulsive disorder, in my own semi-educated opinion. These conditions certainly interact with one another, but they are basically separate. A lot of people in my family have the same depression and anxiety problems, but not a one is trans.
It’s amazing how difficult it is to admit you could benefit from mood-altering medication. I am a staunch supporter of mental health treatment–I’m becoming a counselor, for goodness sake–but I felt a major twinge of shame at asking for help.
There’s the idea that having a mental health condition makes you crazy, sick, inferior, or broken. There’s the idea that if you’re functioning and surviving, you shouldn’t seek treatment just to make your life a bit better.
Life is precious. We get one shot. There is truly no good reason not to get the most we can from it–to be our fullest and healthiest selves, to be as alive and awake as possible. For some people, medication is one important tool for making contact with reality.
I am so glad I bit the bullet and asked for the prescription. I still have obsessive thoughts, but they are fewer, and it is much easier to recognize them for what they are. My default mood, when nothing is especially right and nothing is especially wrong, has gone from agitation and uneasiness to quiet contentment. I look forward to starting the day in the morning, and I look forward to coming home at night.
At this point, I couldn’t care less about needing a couple of medications to be healthy. The thought seems preposterous now, and more than a little ungrateful, given my overall good health. I am just so glad I have them.