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.
[This post includes frank discussion of my body.]
Growing up trans created a catastrophic rift between my mind and my body. Years into transition, I can recognize myself in the mirror, but I’m still healing the split. Little bridge over a great chasm, I cross it slowly, slowly, over and over. Someday I will actually trust it to hold.
An important and intimate part of this reconnection is my relationship with my junk. As I’ve written before, I have no plans for bottom surgery. I have a dick and I am quite content with it.
For years, I was told that I didn’t have a penis, never would or could have a penis, except maybe through (expensive, painful) surgery, and even then, I was told, it wouldn’t really count. I still encounter content on a routine basis that states that trans men who have not had bottom surgery don’t have dicks, which really bugs me. I’m realizing how deeply this psychological castration has affected me. And I’m learning about how my miraculous reverse castration (if you will) changes the way I inhabit the world.
It’s weird to have atypical genitals, a body that doesn’t fit perfectly in either box. I’m not thrilled about sitting down to pee. But I really don’t care that much, because what I’ve got now is such an improvement in terms of my comfort, identity, ability to be naked without vomiting, etc. And I am able to recognize and experience my body as male.
It occurred to me recently that, were I a woman, my body would create intense dysphoria. I’ve been aware that my voice, face, body shape, etc. are clearly male. But I’d held out on acknowledging how clearly male my junk is. My junk is a bit surprising for a man, sure. But, cissexism being what it is, my junk would be way more surprising for a woman. This was a weirdly comforting realization, a confirmation of how far I’ve come.
My doctor remarked on the changes in my genitals after a recent physical. Several years ago, while I was in a storm of changes from testosterone, she asked me how much my “clitoris” had grown. I felt pretty irked by the language–that’s my penis, thanks–but I answered, holding my fingers a couple inches apart. This recent check-up was the first time she’d seen me naked since I started hormones, and afterwards she made a rather confused comment, “There’s been a lot of growth in your, uh. Whatever you call it.” She couldn’t bring herself to describe my junk with female words any longer; it just doesn’t fit. I felt pretty delighted by this. Doctors are so often the arbiters of what words “really” describe our bodies, and mine had just acknowledged that it’s impossible to examine my groin and use female terms with a straight face. I felt like my dick was finally official.
People make a lot of noise about size, but personally, I just don’t give a shit. I’m happy with myself, and I have a partner who loves me and is attracted to me the way I am. So my dick is more like a baby carrot than a regular carrot, more like a baby zucchini than a large zucchini, more like a baby dill pickle than one of those giant pickles they sell at the movie theater…you get the idea.
Edible metaphors aside, the growth I’ve experienced surprised me. It’s tough to find reliable information on this sort of thing, but I had the impression I would grow a lot less. I don’t know if I’m bigger than the typical trans guy, or if I just got the wrong idea, or if I didn’t want to get my hopes up. Probably nobody knows; again, lack of information. For any trans guys who are wondering what to expect: I noticed growth in the first month or two, and it continued through the first two years. Today, my dick is similar in size and shape to my thumb; it ranges between about 1″ and 3″ (I haven’t actually measured, ha) depending on the temperature, whether I have a hard-on, etc. Most importantly for me, my dick is the most, er, prominent feature of that part of my body.
What’s really surprised me is how much the growth has shifted my sense of my body. I lived for more than 20 years with the constant pain of a phantom limb I didn’t know I had. I really feel like I’m slowly healing some deep wound as I relate to my penis. It’s not so much through sexual stuff–though I very much enjoy that–but more through ordinary experiences of my body. Changing clothes, taking a shower, crossing my legs–just seeing and experiencing myself. It’s important to me on personal, emotional, and sexual levels. But what strikes me most is this other, primal level, which feels like it’s rooted very deeply in a subconscious level of my mind. Beyond my wishes, transition goals, sexual desires, etc., is a preverbal part of me that knew what my body was supposed to look and feel like. A part of me that wanted to be whole.
To T or not to T? It’s a tough question. Testosterone is a powerful hormone that can radically alter your body and your internal landscape. For many trans guys and some nonbinary people, testosterone is a ticket to a new world in which body, mind, spirit, and social perception finally align. But how can you know in advance whether that new world is really right for you? And what if the ticket is one-way?
I have been on testosterone for 4 years, and I’ll probably continue for the rest of my life. I spent several years desperately agonizing about whether to take T, and today I can say it was one of the best decisions I have ever made. Here is the advice I wish someone had given me back when I was wrestling with this question.
1. Do your research. In my experience, trans people turn into veritable internet librarians when it comes to our transitions. If you’re reading this post, chances are you’ve read dozens of articles on the physical effects of testosterone, plus sought out hundreds of blogs, videos and photo timelines documenting others’ experiences on T. But if you haven’t done all that yet, do it.
2. Talk to a doctor. A lot of people–including me–make talking to a doctor the last step of this quest. In retrospect, talking to my doctor early on would have greatly simplified the whole process. Ask whether it would be safe for you to take T based on your other medical conditions, what the process would be to get a prescription, and whether you’ll need any referrals. This gives you a timeline and clear series of steps if/when you decide to move forward with testosterone. If your country uses a structured clinic system, find out what is required to qualify for treatment and how long it takes to access hormones. This info will clear up a lot of the stressful questions that make this process such a challenge, such as, Will I be able to get a prescription? What tests will I need? How long will it take? How much will it cost? Do I need a new doctor? With that out of the way, you can focus on figuring out what you want and need.
3. What will you regret? Suppose you start testosterone tomorrow. Imagine yourself in 10 years. What might that person regret? Now, suppose you never take testosterone. Again, 10 years down the line, what might you regret? Nobody knows the future, but I found this a very helpful exercise. I realized that my greatest fear was never taking this opportunity, looking back and wishing I’d started T as a young guy. On the other hand, I couldn’t muster any real fear about, say, being perceived as a boring straight guy or not trying harder to live as a butch. (I tried as hard as I could.) Look into your heart; there may be helpful answers waiting there for you.
4. Do you want the whole package? Testosterone is a gamble. Each person responds differently based on dosage, genetics, length of treatment, and possibly magic. Think carefully about the effects of T, and ask yourself whether you are open to the whole range of possibilities or really only want some of the outcomes. The changes can happen to varying degrees and in different combinations. You might go in imagining yourself with a deep voice, toned muscles, and smooth skin, and wind up a chubby tenor covered in hair from head to toe–or vise versa. A lower dose will cause subtler and slower shifts, maybe no visible changes at all. But basically there are no guarantees, except that you’ll generally move towards more male-typical traits. Are you looking for the whole experience, external and internal? Or are there just a few specific changes that you want? If, for example, you want a more masculine physique and voice, and are wary of any other changes, you might want to experiment with diet, exercise and voice coaching before you try hormone therapy.
5. Seek guidance from a higher power. With a decision this big, it’s a good idea to turn to whatever sources of wisdom you find meaningful. Does your culture have traditions for gaining insight, beginning a journey or making a hard decision? Do you find meaning in prayer or meditation? Some places you might turn include scripture, religious leaders, faith healers, wise friends or family members, mentors and mental health professionals. This could take many forms depending on your beliefs and culture. A few ideas to get you thinking: get your Tarot cards read, set aside a day to meditate on the question, ask God for help, ask for the answer to come in a dream, create visual art exploring your feelings, go hiking or camping alone. The point is, you probably need to get outside of your mind to find a real answer. Find a way to access higher wisdom or deeper insight that works for you. Whatever resources you have, call on them now.
6. Whatever you do, do it for you. You’re probably facing opinions and pressure everywhere you look. Transitioning is taboo, so you’re probably feeling some pressure not to modify your body, to make it work in your assigned gender (possibly for the sake of feminism, the children, or something), and/or not to do something “artificial” or “unnatural.” On the flip-side, there’s also a strong norm that if you’re going to transition, you better transition to be a normative man or woman, including hormones and surgery. So you’re probably also feeling some pressure to follow a certain path through transition, including a dose of testosterone that will put you in the typical male range. It’s almost impossible to think clearly in this hurricane of social sanction. But, as much as you’re able, try to sort out your own needs and preferences, and make your choices from a place of self-love. Whether you decide to take testosterone or not, do it for you.
7. Go for it. At some point, you have to take a leap of faith and go with your best guess. You may find that you’ve taken plenty of time to think, done thorough research, and reflected deeply on the question, and you’re still not sure what you want. Make an educated guess and move forward, knowing you can change course if needed. If you’ve spent a year or five reflecting and you just can’t stop thinking about testosterone, you’re probably going to have to try it yourself to be satisfied. Let your fears slow you down and make you careful. But don’t let your fears paralyze or stifle you. It’s okay to venture into the unknown. In fact, it’s wonderful.
What questions do you have about testosterone therapy? For those who have been on T, how did you make your decision? What do you know now that you wish you had known then?
Hairs decorate my chin, dark and delicate. My mustache is a gentle brush across my upper lip. Sandpaper scratch of stubble on my sideburns and neck.
I have been on testosterone for 4 years. Testosterone continues to shape the body across the lifespan, but I’m told that after 5 years, the puberty stage is complete. I figure at this point, what I see is what I get, more or less.
When I first began to contemplate transition, I was 19 years old and still waiting for my mustache. I squinted my eyes at the tiny hairs, sure that any day now, they would multiply and darken. The hairs didn’t come. Something was very wrong.
Life continued; two years passed. I got my first shot of testosterone. Somewhere along the way, I picked up the idea that I needed to grow a beard. My mustache dream receded.
It’s a beard moment. My friends have them; the hip guys on the street have them. I was disappointed when my facial hair began growing in slowly, slowly.
I told my mom about my hirsute aspirations. “A beard?” she said. “I don’t know. We’re not a very hairy family.”
I look into eyes of my grandfather and great-grandfather, their perfectly smooth faces suspended in gelatin silver. No beards in sight. Just the occasional shadow of stubble in a candid shot of my saba.
I was extremely embarrassed to grow in my mustache. I couldn’t resist it; I liked the sight of that fuzzy shadow far too much. But who has a mustache like mine? I was afraid to look foolish.
I think it was Alma who finally put the idea in my head. I’d been looking at white guys’ facial hair, bushy beards in sandy brown. The image of “man” in my mind was dripping with racism. Nice beaner stache, my brother told me, teasing. I don’t think he had any clue how racist that sounded.
My eyes were opened. Suddenly, mustaches like mine were everywhere. Thin, perfectly formed mustaches crowning the upper lips of brown guys of all varieties. Strolling around the university on a sunny day, I see facial hair like mine on Latino, Asian, Native and Middle Eastern guys.
My legs are a forest of brown hairs. My arms are smooth, haloed in delicate gold fuzz. My mom touches my arms and says it’s a Sephardic thing. Staring in the mirror, I laugh when I remember that they used to call us Oriental.*
My people spent 500 years in the place where the Middle East collides with Eastern Europe. It’s a place of varied features, of thick black hair and soft fair locks, where gazes may be the darkest brown or silver-green as a still lake. Complexions come in rich shades of olive, brown and gold. Some men have long, thick beards; some have bushy, carefully groomed mustaches; some have a slender frame of hair at the edges of mouth and face; and some men don’t grow facial hair at all. I have always known this, but somehow in the rush of my American youth culture, I forgot. I have to look outside the mainstream if I want to see a person who resembles myself.
So I like my little mustache. There’s something slightly counter-cultural about it. I like that it’s a little unusual–and I like who I share it with. I’m not waiting for a white man’s beard anymore.
* Until the mid-20th century, it was common for white people to call the Jews of the Middle East “Oriental Jews.” It was not a term of affection. We had our own words. My people have always called ourselves Sephardim.
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.
This post includes frank discussion of sexuality and my body.
It recently occurred to me that, although I have not had genital surgery, in a lot of ways, I no longer feel like someone who has not had genital surgery. I have had surgery once as part of my transition (chest reconstruction) and plan to have surgery once more (hysterectomy, at my doctor’s recommendation). If you had asked me early in my transition, I would have said I wanted to have bottom surgery (probably metoidioplasty) as soon as possible.
What’s changed? Going into this journey, I underestimated two things: how much other transition steps would affect my relationship with my whole body, and how much surgery sucks.
Let’s take the unpleasantness of surgery first. Chest surgery was a great experience–if I had to, I would make that decision again in a heartbeat. It was also a reality check. Pain, recovery time, needing help while healing, taking medications, going under anesthesia, numbness and scarring–all these things real to me now. I have also felt the impact of the financial costs. If genital surgery procedures were comparable to chest surgery in terms of risks and costs–including healing time, dangers of any surgery, possible loss of sensation, dollar cost, etc.–I might consider it. But that’s not the case. Bottom surgery is more dangerous and much more expensive, healing times are much longer, and I would likely need multiple procedures. Considering the price-tag, healing time, and other risks of bottom surgery, it’s just not worth it to me.
It probably would be worth it to me, though, if I still experienced acute dysphoria. That brings me to the other thing I underestimated–how big a difference all the other aspects of my transition have made.
I am now able to move through the world as a man with ease. I am able to feel comfortable during sex. I still have some dysphoria, and it’s not pleasant, but I think it’s now within the range of ordinary body image insecurity that many people experience. I’d say I’ve gone from a 10 to a 2 on a 10-point gender dysphoria scale.
I also underestimated, quite literally, the changes testosterone would cause when it comes to my dick. I had extreme dysphoria around my genitals pre-T. I considered myself stone and always used a strap-on during sex. This has totally reversed–today, using any kind of prosthesis would induce dysphoria, not alleviate it. Though my genital configuration is definitely not average, I am able recognize what I have as male. I have a dick, plain and simple. I still experience dysphoria around that part of my body, but it is manageable.
I also have a partner who perceives my body as male, and I am able to engage sexually in a way that feels right to me–to have intercourse and do all the other fun stuff straight dudes tend to do. I did not know that would happen, and I did not know how much it would mean to me.
Pretty much the only thing I can’t do is pee standing up in a convenient, splash-free fashion. From my observations in public restrooms, it appears that a large proportion of men have this problem.