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Masculinizing Hormone Therapy
Individuals seeking more masculine body features may consider taking testosterone. Testosterone works to increase more masculine secondary sex characteristics, including increased body and facial hair, increased muscle mass, and deepening of the voice. Below is a timeline for the various effects from testosterone for GAHT.Timeline and Expected Effects of Masculinizing GAHT
Types of Testosterone GAHT
Atrius Health supports patients in accessing testosterone GAHT, either through weekly or bi-weekly injections or use of topical gel. Testosterone injections are most commonly self-administered intramuscularly. In this method, a person injects testosterone into a muscular part of their bodies, such as their thigh or buttocks. Testosterone can also be self-administered subcutaneously, injecting the medication into body fat, typically around the stomach. People tend to report decreased injection site pain and increased confidence in self-injection for subcutaneous injections. For either method, our Atrius Health nurses are fully equipped to train you in self-administering injections.Testosterone can also be administered via a topical gel that is applied daily to your skin, typically to your upper arms or thighs. People choosing to use testosterone gel must wait until the gel is completely dry and absorbed into the skin before putting on clothing. Testosterone gel typically takes about6 hours to fully absorb into the skin, so you should avoid showering, exercising, swimming or getting in bodies of water, and applying anything else topically to your skin. People who use testosterone gel must be cautious about contact with others, as the gel can rub off on pets or other people when it is not fully dry. Testosterone gel is a great option for people who may not feel comfortable self-administering injections or who may prefer a more consistent day-to-day hormone level.
Side Effects
Before beginning testosterone GAHT, discuss your medical history with your provider. Testosterone GAHT can increase your risk for high blood pressure, high cholesterol, male-pattern baldness, pelvic pain, blood clots, and infertility. It is important to note that beginning testosterone does not guarantee the cessation of menses or the prevention of pregnancy with penis-in-vagina (PIV) sexual intercourse.Feminizing Hormone Therapy
Individuals seeking more feminine body features may consider taking a combination of estrogen and anti-androgens. Estrogen lowers the amount of testosterone in the body and initiates the development of feminine secondary sex characteristics, such as softer skin, the development of breasts, and thinned/slowed growth of facial hair. Anti-androgens block the effects of testosterone from continuing to occur in the body. Below is a timeline for the effects from estrogen and anti-androgens together.Timeline and Expected Effects of Feminizing GAHT
Types of Estrogen GAHT and Side Effects
Oral estradiol is the most common type of estrogen prescribed for feminizing GAHT. Oral estradiol is taken once or twice a day and recommended to be dissolved under the tongue for safest uptake of the medication.Estrogen can also be delivered via regular intramuscular or subcutaneous injections or a patch changed 1-2 times weekly. Estradiol patches are especially recommended for people who have a higher risk of heart attacks, strokes, or blood clots, and they are a great option for those who find it difficult to adhere to a daily medication regimen or who do not want to self-administer injections.
Studies show that estrogen can increase a person’s risk for blood clots, heart attacks, strokes, infertility, and weight gain. It is important to meet with your provider to discuss your full medical history and the best estrogen GAHT options for your specific history and gender goals.
Types of Anti-androgen GAHT and Side Effects
Anti-androgens come in three main types of medications: testosterone receptor blockers (spironolactone), drugs that block the conversion of testosterone to dihydrotestosterone or DHT for short (finasteride and dutasteride), and drugs that decrease testosterone production by acting on the pituitary gland near the brain (leuprolide). Each has different side effects that require regular monitoring.- Spironolactone is taken orally and can increase urination, raise potassium levels, lower blood pressure, and increase one’s risk for depression and brain fog.
- Finasteride and dutasteride are also taken orally and are very effective at preventing hair loss, but they are less potent anti-androgens than spironolactone or leuprolide.
- Leuprolide is a monthly injectable anti-androgen. It can cause side effects such as fatigue, joint pain, and headaches. It can be difficult to obtain insurance approval for this medication, and even if approved, it may cost more than other anti-androgens.
Low-Dose GAHT
Some individuals may want to begin with a lower-dose GAHT regimen for safety purposes, a more gradual transition, or to better align with their personal gender transition goals. Some individuals may also desire to use GAHT for only a limited time, or they may change their minds about the kinds of medications they want to use. We encourage you to speak with your provider about your gender goals to create a plan that is best for you!GAHT Care and Guidance
As with any medical treatment, we encourage you to speak with your provider about your gender transition goals to find the best options for you. If you are looking for a provider well-versed in GAHT, our Pride+ Care providers have extensive experience and training in working with adults 18 years and older at all stages of their gender journey. Meet our Team and book an appointment with one of our providers. You can also stop by our table at Boston Pride for the People to meet our team in person.