FTM Hormone Replacement Therapy — How Does HTR Work?

The information below is for educational and entertainment purposes only and should not be used as medical advice. It does not replace or represent the advice of a medical professional.

When transitioning from female to male, hormone replacement therapy (HRT) is an important part of this transition process. For trans men that were born into a female body, it helps a great deal with the masculinization process. Eventually, HRT also helps to maintain the masculine characteristics throughout the rest of their lives. But how does HRT for trans men exactly work? How do trans men get access to it? And how much does it cost? In this article, we’ll discuss everything you need to know about FTM hormone replacement therapy.

What is hormone replacement therapy?

Hormone replacement therapy (HTR) is a medication treatment to adjust the hormone balance in a body. Menopausal, postmenopausal, or transgender people use it to treat hormonal imbalances or depletion. However, in FTM HRT specifically, it consists of inserting testosterone into the body to cause and maintain the body’s masculinization. The administration of “T” can be done in several ways.

The most common way is the injection of testosterone with a syringe and needle. Make sure to check out our blog post about injecting testosterone to learn more about this specific method. Other methods include transdermal administration through gel, cream, or patches on the skin, oral administration, or a pellet under the skin. The choice of administration depends on the country, body and health of the person, and personal preference. Here you can read more about the various types of testosterone and administration options.

What changes will FTM HRT bring?

When starting female to male HRT, certain bodily changes can be expected to happen. It will be like a second puberty in which secondary masculine sex characteristics will develop. Just as during puberty, the changes will be gradual, will occur after a couple of months of continuous testosterone administration, and will take a couple of years to fully develop. The following changes can be expected:

• Voice — Because of the vocal cords thinking, the voice will become deeper.
• Facial hair — Over time, facial hair will develop. How much and in what areas depends on the individual.
• Body hair — Over time, there will be more hair on various parts of the body, including arms, legs, chest, belly, and back. The amount and distribution depend on the individual.
• Body shape — Muscle mass will increase, and fat distribution will be more masculine, causing an overall more masculine appearance of the body.
• Face — Becomes more angular in shape, causing a more masculine appearance.
• Clitoris — The clitoris will grow in size. Many often consider it to be a small (FTM) penis.
• Menstruation — The testosterone will over time completely block the monthly periods.
• Skin — Due to the increased activity of the oil glands, the skin becomes more oily, sometimes causing acne. But there are various ways in which you can treat the acne. Additionally, the skin might become rougher in feeling and appearance.
• Scent — Body and urine scent might change.
• Sex drive — Testosterone usually increases the person’s sex drive.
• Red blood cells — The amount of red blood cells increases.
• Cholesterol — Good cholesterol goes down; bad cholesterol goes up. Therefore it’s important to eat healthy.
• Appetite — Will increase.
• Mental/emotional changes — Some trans men report a shorter temper and/or feeling down on various cycles or their testosterone administration. At the same time, others have reported the opposite, feeling calmer and even-tempered. As with many aspects of the FTM transition, the changes depend on the individual, and it’s always important to closely observe the emotional changes happening. Many recommend writing in a journal to keep track of the changes. Check out our list with FTM essentials.

As you can see, there are many (exciting) changes that can be expected from HRT for trans men. However, it’s important to keep in mind that the person’s personality or identity will remain the same. That’s one of the many misconceptions surrounding testosterone. They’ll stay the same person on the inside and if any, will even show more of their (true) selves!

How much does HRT cost?

One of the questions that come to mind when thinking about starting FTM HRT is the costs. Our answer here is based on self-administered testosterone by injection and only serves as a (very) rough indication. Keep in mind that other methods might have different costs related to it. Additionally, the price might (significantly) differ depending on the country you live in and the availability of the “T”.

You can basically divide the HRT cost into three parts; the testosterone itself, the needles and syringes, and medical visits.

1. Testosterone — ~$90 for a 10 ml vial of 200 mg/ml solution. Depending on your dosage, this might last you for several months.
2. Draw needles — $4 for a pack of 100.
3. Injection needles — $4 for a pack of 100.
4. Syringes — $5 for a pack of 100.
5. Medical visits — $150 for each visit, includes blood checks and prescription, usually taking place twice a year.

Some health insurance providers cover the various aspects of the HTR. Make sure to talk to your insurance provider to discuss your options. This can save you a lot of money!

Is HRT safe?

One of the main concerns about HTR is if testosterone can damage the body in any way. We’re here to deliver the good news! The short answer is, no, HTR doesn’t cause any damage to the body! Researchers in Italy have concluded the following:

Testosterone administration in FtM subjects has a good safety profile” after finding “no significant serious adverse effects, and no clinically relevant changes” in 45 FTM patients treated for at least ten years with testosterone.

Other studies report similar conclusions, and in many cases, the conclusion states that FTM HRT has a positive effect on trans men’s health. These positive health effects can be attributed to a decrease of depression, anxiety, anger, and even suicidal thoughts. In that sense, HTR is literally saving lives!

Source: Meier, C., Fitzgerald, K., Pardo, S., & Babcock, J. (2011). The effects of hormonal gender affirmation treatment on mental health in female-to-male transsexuals. Journal of Gay and Lesbian Mental Health, 15(3), 281–299.

Another common question concerning FTM HRT is if (trans)men can get pregnant while on “T.” The short answer is, yes. The testosterone will decrease the possibility of getting pregnant, but it will not completely eliminate them. Therefore, when having sex with someone that is able to produce sperm and there is no desire to become pregnant, it’s strongly advised to use a form of birth control. If you do wish to become pregnant, you should discuss this with your provider. You’ll likely have to stop taking testosterone, but it might be worth it. Read the story about a trans dad here.

Can you stop HRT?

In most cases, trans men stay on testosterone even after the masculinization process is completed, basically, for the rest of their lives. There are two reasons for this. First, in cases where the ovaries and uterus are still in place, the estrogen production will take over again, and a feminization process will occur (including monthly periods). In cases where the ovaries have been removed, the body will not produce a healthy amount of either testosterone or estrogen by itself anymore, causing a menopause-like state, including hot flashes, bone density loss, and other health issues. Second, to remain emotionally balanced and comfortable in the body, a balanced testosterone level might be advisable.

Still, the decision to stop the HTR is up to each individual, and could be related to health or emotional reasons. There are certain aspects to consider when making that decision, and it’s paramount to discuss this with a medical professional as it’s a big (re-)adjustment for the body. Nevertheless, certain changes are non-reversible;

• Voice — will stay at the pitch level it’s at when HRT is stopped
• Hair — the amount of hair that has developed on the face, and the body will continue to grow. No new patches of hair will develop. It might slightly change in appearance or texture.
• Clitoris — Will stay at the length/thickness it’s at when HRT is stopped.

Conclusion

As you can see, many of the FTM changes that occur because of testosterone administration will be profound and some non-reversible. Therefore, it’s important to discuss HTR’s decision with a (healthcare) professional if possible. However, for those certain they about being transgender, HTR can be a lifechanging and lifesaving experience! In those cases, it can be an incredible journey towards finding their true selves and living life in a way that feels (at least a little bit) more authentic.

Sources

• Author Unknown, year unknown. FTM Testosterone Therapy Basics. [online] FTM Guide. Available at: http://www.ftmguide.org/ttherapybasics.html
• Author Unknown, 2016, November 21. Hormone Replacement Therapy for Men. [online] Healthline. Available at: https://www.healthline.com/health/hormone-replacement-therapy-for-men
• Ballard, J.R., 2019. FAQs About Transitioning With Hormone Replacement Therapy (HRT). [online] FTM Magazine. Available at: https://www.ftmmagazine.com/faq-about-transitioning-with-hormone-replacement-therapy-hrt/
• Deutsch, M., 2020, July. Information on Testosterone Hormone Therapy. [online] UCSF Transgender Care. Available at: https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy
• Riverdale, J., 2018, December 29. Is Long-term Testosterone Treatment Safe? [online] Transguys.com Available at: https://transguys.com/ref/research/is-long-term-testosterone-treatment-safe