What Physical Changes to Expect on Testosterone Hormone Replacement Therapy, Explained by FOLX
Learn what expectations to maintain regarding physical changes can you expect on transgender testosterone hormone replacement therapy.
Looking for the estrogen version of this article? Click here to learn about the physical changes of estrogen hormone replacement therapy.
Each person’s gender affirmation goals and plan may be different. Much like other medications and treatments, each body is unique and responds to testosterone hormone replacement therapy differently. While there are some general changes that you can expect, how fast or to what degree these changes take place will vary from person to person. Generally, lower doses of testosterone correlate to slower, more gradual changes or a more androgynous appearance. Higher doses that are taken regularly as directed are associated with faster changes. Some transgender men, for instance, may prefer a higher, masculinizing dose while other non-binary or trans masculine people prefer to micro-dose testosterone. There is no one-size-fits-all for gender identities and dosages.
Many people report feeling more relaxed and at ease in their bodies after starting HRT. Testosterone therapy can greatly alleviate gender dysphoria, affirm your identity, and help you feel more joyous in your experience of yourself and the world. We know that many people’s first question is what physical changes to their body they can expect to see on testosterone HRT. With that in mind, we’ve mapped out a generalized timeline for the secondary sex characteristics you might see and when. There are some fairly common changes expected with changing T levels on testosterone hormone therapy. Here are a few:
There are 3 permanent changes that occur over time if you are taking testosterone:
- Lower, deepened voice in tone
- Facial hair and body hair growth
- Clitoris enlargement/bottom growth (by one to two centimeters)
Other changes require regular administration of testosterone in order to maintain:
- Increased muscle mass/strength
- Body fat redistribution from hips and thighs, which may increase around the abdominal area/gut
- Changes to monthly bleeding/menses
- Increased sex drive/libido
With that being said, how these secondary sex characteristics change can vary greatly from person to person and genetics, similarly to adolescents undergoing puberty. For instance, some trans men and other gender-variant people on testosterone GAHT/HRT grow full-length beards while others can’t. Some trans masculine people’s voices will drop super low, while others will drop just an octave or two. Likewise, you may notice that body fat distribution doesn’t turn out the way you initially expected. All of this said it’s important to remember that many hormonal changes aren’t linear and it can take years to see the full effect.
Changing hormone levels impacts everybody differently.
Some other common side effects of testosterone GAHT/HRT may include increased skin oiliness or acne as well as possible male pattern baldness or hair thinning. Other changes that may occur without well-defined time expectations can include increased libido, coarser skin, increased sweating, increased appetite, chest tissue atrophy, weakening of tendons relative to increased muscle mass, and facial masculinization. Additionally, you may experience front hole irritation or vaginal atrophy, which is common and easy to treat.
While each and everybody is different, these changes won’t map exactly the same from person to person. How slowly or quickly these changes occur depends greatly on genetics, dosing, and your levels via gel or subcutaneous or muscular injections.
See the chart below for a general timeline of what changes you can expect to see on testosterone HRT.
This chart is by no means comprehensive, as some changes don’t happen as planned and every person’s medical transition is different. For more frequently asked questions about testosterone, read reading.
Can testosterone change your voice? If so, is the voice change permanent?
Yes, taking testosterone GAHT can lead to a deeper voice. In addition to testosterone HRT, many transgender and non-binary people seek out gender-affirming voice lessons (with a trans competent provider) to learn how to achieve a deeper voice. There are also vocalists out there who can help musicians find their new singing range and navigate the vocal changes that occur when transitioning.
What are some common emotional changes on testosterone?
Since our culture is so cis-centric and heteronormative, many confuse testosterone with toxic masculinity. Particularly, testosterone can be falsely equated with male anger and violence, which is a dangerous combination (i.e. domestic and sexual violence) under patriarchy. Despite what you may have heard about testosterone, understand that T doesn’t make anyone inherently angry or violent, just in the same way estrogen doesn’t make someone “crazy” or “hysterical.”
While there are many myths out there about testosterone, there are legitimate expectations of the emotional impact of testosterone HRT. When you first start, you may experience changes in appetite or metabolism. Some people gain weight in the first three to six months while others might lose weight due to being more active and changes to muscle in the body.
Some people also notice that they are able to access a full range of emotions more easily, and are less angry. Additionally, some people do find that increased testosterone in their bodies might impact their ability to cry or produce tears easily. This might be a relief if you found yourself crying too often or it could be challenging if you wish you could access your tears more frequently.
If you’re hurting, we strongly encourage you to tap into your support networks; seek out the chosen family and community around you or consider seeking professional help from an LGBTQ+ competent therapist.
Will my face change on testosterone?
Testosterone face changes, especially for those on higher doses, can look like the restructuring of facial structure. Since body fat also redistributes, you might have less fat on your cheeks, which can also alter how your face looks. Muscle redistribution and facial hair changes can also make your face appear more masculine.
What happens when you stop taking testosterone?
It’s fairly common for those on GAHT/HRT to take breaks from taking their hormones or stopping altogether due to insurance or financial hardships, having trouble finding providers, concerns, or side effects. We recommend you reach out to your healthcare provider for guidance before pausing or stopping hormone therapy.
With that said, if you’ve already consulted your FOLX clinician or healthcare provider, you can expect some changes if you pause or stop testosterone. Though we acknowledge all bodies respond differently to short-term hormonal changes, some changes to look for can include the return of menstruation/bleeding, changes in mood and energy, muscle loss, and fat redistribution. The coarseness of your body and facial hair might change as well. You can also consider changing your route and dosage of testosterone if the one you are on isn’t working for you. If you’d like to do so, please reach out to your healthcare provider.
For those interested in signing up for testosterone GAHRT with FOLX, the process begins here. For existing FOLX members with testosterone-related questions, don't hesitate to schedule time with your clinician. For non-members with more curiosity, read up on testosterone here; you can also reach us directly at email@example.com.