Guide To Testosterone For Trans Men – Part 1 1


Testosterone is the average trans man’s staple. Some take it daily, weekly, bi-weekly, monthly or quarterly. We swallow, dissolve, apply and inject it. But you’re probably reading this because you haven’t started transitioning and you don’t know where to start. Hopefully, this article will tackle most of your questions.

What is testosterone?

Testosterone is an anabolic-androgenic steroid (AAS). Anabolic steroids increase protein within cells and thus was popular among bodybuilders like Arnold Schwarzenegger, but, this is not the main reason that majority of transgender men take it. So why do they? They take it because androgens induce the development of masculine secondary sexual characteristics such as growth of the vocal cords and body hair. Other generally desired effects include male-pattern body fat redistribution and facial hair.

What are the effects of taking testosterone and how long before I see these effects?

In an ideal world, doctors should be able to tell us what effects we can expect, when and how fast they’ll happen, and how to avoid undesired effects. However, that’s not the case and hormone replacement therapy (HRT) or testosterone replacement therapy (TRT) will yield varying results depending on a range of factors such as age, genetics, diet, physical condition, etc. Yes, even your diet and physical condition or fitness can affect your transition.

Below are two tables that give an expected onset of masculinizing effects for people on HRT.

 

wpath-soc-mascunalizing-effects-of-testosteroneSource: WPATH Standards of Care 7th Edition (2012)

endocrine-society-mascunalizing-effects-of-testosterone Source: Endocrine Treatment of Transsexual Persons (2009) by The Endocrine Society

You’ll have noticed that the two tables give slightly different estimates and that’s ok. We’re just at the point where medicine is not an exact science, but an art of probability. They’re still good guides and will give you an idea of what to expect when you do start HRT.

Majority of Filipino doctors still refuse to treat transgender persons for reasons such as, but not limited to, religious beliefs, personal beliefs, lack of knowledge, or a twisted understanding of the creed “First, do no harm.” This has led to mass self-medication in the transgender community. However, there is hope. More and more doctors are starting to treat transgender patients providing services such as hormone level monitoring, and even gender confirmation surgeries (GCS).

Overview of Testosterone Esters and Delivery Methods

Intramuscular and Subcutaneous Injections

The injectable form of testosterone is popular because it is generally cheaper, more effective, less harmful and more convenient to take compared to gels, creams, patches, and pills which are applied or taken daily.

The three (4) most common injectable testosterone solutions are…

Testosterone Enanthate

Testosterone enanthate, as well as cypionate, can be given at intervals of one (1) to four (4) weeks. The half-life when injected intramuscularly is approximately 4.5 days. It is usually sold in 1 ml ampules or 10 ml vials. Vials are better for those who have doses of less than 1 ml. Ampules cannot be stored once opened so it is best to use it right away. However, some say it is ok to store the unused portion in a unused zip-locked and refrigerated syringe.

Brands available locally: Testoviron Depot (Bayer) & Vivrone (Geofman)

Testosterone Cypionate

Testosterone cypionate can be given at intervals of one (1) to four (4) weeks. The half-life when injected intramuscularly is approximately 5 days. Like

Brands available locally: NA
You may find several online stores selling FTM-marketed testosterone cypionate. If you do decide to buy this, use it with caution. The source is questionable.

Testosterone Mix

Sustanon is a mix of testosterone propionate (HL: 0.8 days), phenylpropionate (HL: 1.5 days), isocaproate (HL: 4 days), and decanoate (HL: 7.5 days). The different esters and half-lives result in a supposedly more stable release of testosterone into the body. It can be given at intervals of two (2) to four (4) weeks.

Brands available locally: Sustanon (Organon)

Testosterone Undecanoate

Testosterone undecanoate has a half-life of 20.9 days. It can be given at intervals of ten (10) to fourteen (14) weeks.

Brands available locally: Nebido (Bayer)
You will find that Nebido is both difficult to come by and more expensive in the Philippines than it is elsewhere.

Take note that the half-lives listed here are not definitive. You will find differing information all over the web and even in published works.

Transdermal (creams, gels, patches)

If you’re afraid of needles and want more stable and consistent testosterone levels then transdermal applications are for you. They usually come in pump bottles or sachets and are in the form of gels, creams and patches.

Pros:

  • can be simply applied by rubbing onto skin
  • stable testosterone levels
  • may alleviate hot flashes, irritability, and low energy

Cons:

  • more expensive than injectables
  • can be transferred by direct skin contact with other persons
  • daily or twice-daily application
  • may cause skin irritation or allergies
  • may come off when sweating or swimming

Brands available locally: NA
I have no personal knowledge of these being available anywhere in the Philippines. Androgel (Abbvie), an alcohol-based testosterone gel, is available in Thailand in sachets but it is quite expensive.

Oral

Testosterone undecanoate has been successfully shown to induce masculine secondary sex characteristics when taken orally. The risk of liver toxicity is higher with oral formulations.

Brands available locally: Andriol Testocaps (Organon)

Sublingual

Sublingual delivery works by placing a dissolving tablet under your tongue. It is better than oral delivery because there is less risk of liver toxicity.

Brands available locally: NA

Buccal

Buccal delivery works by placing a dissolving tablet against the gums. It is better than oral delivery because there is less risk of liver toxicity.

Brands available locally: NA

Subcutaneous Pellet Implants

This delivery method involves the implantation of crystalline testosterone pellets beneath the skin, usually, in the buttocks. It’s a quick procedure and only requires replacement every 3-4 months.

Brands available locally: NA
Testopel is the brand name of these testosterone pellets.

Note: I excluded Underground Lab brands. These are widely available but they should be used with caution.

 

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References

Behre HM, Nieschlag E. 1998 Comparative pharmacokinetics of testosterone esters. In: Nieschlag E, Behre HM, eds. Testosterone: Action, Deficiency, Substitution, ed 2. Berlin: Springer-Verlag; 329–348.


About chase

Transman Equality and Awareness Movement Cebu - Founder, Asia Pacific Transgender Network - Regional Steering Committee Secretary


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