Hello! I was afab and I've been iding as tranmasc for a while. I've had friends and family assume that I'm on testosterone but I never thought much of it I do have solid sideburns, am def hairier than my sister, and my voice reads as p androgynous, but it makes me happy so I never thought much of it. However, I recently started the process to get on hrt and I found out that my testosterone levels are already notably higher than is typical for cis women, if still below the standard male range-- my doctor actually assumed that I'd been diying. He told me that there isn't any point of looking into specific conditions unless I have symptoms that are causing issues, so I don't have any sort of diagnosis. Could I be considered intersex? Is there any point to thinking abt it if I'm abt to start testosterone anyways? (also-- are there any conditions that just cause androgenisation? Bc I don't have any of the other symptoms of pcos)
Hi there! I’ve sorted this ask into sections for organization and easier reading. Since this regards whether being intersex or not, I will make it clear here and several times within the post that I am very inclusive in what intersex is.
Immediately, I’d say yes, you are, fullstop. Hyperandrogenism is an inherently intersex condition (which is an opinion of mine that I believe is true). There is definitely a vocal minority of intersex (and especially perisex people too) who think that you need more “qualifications” to be intersex. However, I don’t think that to be true. There is a large number of people in the intersex community who will welcome and accept you as you are and understand and truly see you as another intersex individual. To those who don’t agree, ignore them the best you can.
I also saw that you mentioned that it’s not something you can self-diagnose which can be true, but one does not necessarily have to go through medical processes to figure out you’re intersex. It’s okay if you decide you aren’t inherently intersex because of your hyperandrogenism or that you don’t want to label that way, but you are absolutely welcome to. If you feel like something additional might make you count as intersex,
Many individuals learn they’re intersex without having gone through any diagnoses or hidden altering of their body by medical professionals and find out on their own time throughout their own life. For example, if someone had ovotestes with a formed vagina and penis, but this was missed throughout their life and they grew up as and were raised as female, they might one day begin to question if they are perisex or intersex, and it would be completely fair of them to decide being intersex describes their life experience without going to a doctor who can test to see if they have ovotestes.
You are experiencing hyperandrogenism, which is an intersex condition of excess androgen hormones. This leads to increased “masculinization” of the body based on traditional views of masculinization vs feminiziation. This is a condition that does not need a diagnosis to know that one has. Hyperandrogenism is not to be confused with the mazculinizing effects of testosterone HRT as many trans+ individuals who go on testosterone HRT develop features that those born with hyperandrogenism already developed without it.
I see that you mentioned LOCAH in your second ask, which is a great start. Before you sent that, I was going to say you could potentially have NCAH/LOCAH as my main recommendation. If you’ve done your own research, you might know this already, but I’m going to explain again just in case.
CAH stands for congenital adrenal hyperplasia and it is a group of genetic disorders affecting the adrenal glands. Adrenal glands control cortisol, mineralocorticoids, and androgens. CAH is split into two categories–classical and nonclassic(al).
The chances of you having classical CAH are extremely low as it can be life threatening and is almost always diagnosed at birth. Classical CAH (usually just referred to as CAH) is split into salt-wasting CAH and simple-virilizing CAH/non-salt wasting CAH, the latter often being less deadly. Both of these produce too little cortisol and produce extra androgen. Salt-wasting CAH has an extremely low aldosterone count, which is necessary for processing sodium, hence “salt-wasting”. Non salt-wasting CAH is like salt-wasting CAH but with a less severe aldosterone count.
The symptoms of classical CAH include but are not limited to:
Ambiguous genitalia for those who were assigned female at birth (often with genitalia looking like a penis but having internal female sex organs)/clitoromegaly
Larger penis at birth for those were assigned male at birth
Androgenization/masculinzation of those who were assigned female at birth (like the things you described, deeper voice, facial hair)
Nonclassic/nonclassical CAH, or NCAH, is a far more likely candidate. NCAH is also less commonly known as LOCAH, the “LO” standing for late onset. The symptoms of NCAH include but are not limited to:
Ambiguous genitalia for those who were assigned female at birth(less frequent and severe than classical)/developed clitoromegaly
Androgenization/masculinzation of those who were assigned female at birth especially during and after puberty
Larger penis with smaller testicles in those who were assigned male at birth
Hormonal disorders/issues with individuals with NCAH are significantly lower but not insignificant. Those with NCAH often have issues with the synthesis of hormones like cortisol that are associated with the adrenal gland are often asymptomatic or unrecognized in tests.
It’s totally possible you could have another intersex condition, or not this at all. Regardless of why you experience hyperandrogenism, you do, and that alone makes you intersex.
You could also have PCOS. Ironically, you can have PCOS without having cysts. Symptoms of PCOS include:
Hyperandrogenism can be a symptom of an adrenal gland disorder, those of which include but are not limited to:
Diagnosis advice and testing/screening
Whether or not seeking a diagnosis is worth it is up to you. Because you have to outward health concerns because of your hyperandrogenism, it can be hard to qualify for testing. Being diagnosed with an intersex condition can lead to medical mistreatment, malpractice, and abuse, as well as difficulty in transitioning. I don’t want to say what you should do because I don’t want you to make your decision based off of anyone but yourself.
It can be difficult to test for NCAH once you have gone on HRT as tests for NCAH are usually done via checking the hormone levels in your body. I was actually in a nearly identical situation to yours when I was questioning if I was intersex, so I totally relate to you on pretty much everything! I was already on T by the time I was questioning if I was intersex, which meant testing would involve me going off of T (which triggers my dysphoria) and could be difficult because of the effects T had on my body.
Based on my knowledge, there IS a genetic test for NCAH, but I’m not sure how easy it is to get. If you want to be screened for NCAH, ask your doctor about it.
You could also be screened for PCOS, but the screening for PCOS can be very dysphoria inducing if things regarding your genitals or genitalia being inspected triggers that if you have dysphoria, as well as the fact that many gynecologists aren’t trans+ friendly or intersex friendly. Gynecologists can also be tough because many gynecologists aren’t required or refuse to give patients things that reduce pain during procedures or inspections. It can be tough to find one, but don’t be discouraged!
Any trans+ patients starting testosterone should be starting with microdosing and have various things in their blood checked before they start HRT (things such as red blood cell count, bone density, testosterone count), etc. After you start, especially since you have hyperandrogenism, it’s really important to have your blood drawn at least once a month to check various levels. (Or modified based on doctor recommendation.) Starting HRT must be closely monitored in order to know and ensure your body is healthy and to figure out if you should increase or decrease a T dosage.
When I started T HRT, my testosterone wasn’t checked before hand or the records of it were inaccessible to my doctors, so I went from having an above average T count for a person who was assigned female at birth to a person with a T count ABOVE the average for cis men regardless of body size. And you must consider I am a tiny person (I was 4’11 and ~95 lbs at the time). My doctors ALSO thought I was dying, haha. They called all freaked out! Turns out I was fine.
Trans+ health doctors don’t usually think to check for potential intersex conditions that could affect HRT in my experience.
Make sure you advocate for yourself during your transition. It can be difficut but it is necessary!
I saw you mentioned that you’ve been IDing as transmasc and the phrasing sorta makes it sound like you’ve been questioning that, so just in case–if you’re are questioning if you’re transmasc or not because you’re potentially intersex, you can still be transmasc! Generally speaking, transmasc is used to be synonymous with FTM and means someone who was assigned female at birth and then later identifies as/realizes they’re masculine-aligned or male*. I’d also like to say just, gender wise, label wise, you can do whatever you want, always. It doesn’t matter what people think. If not, ignore me and my little soapbox because I just wanted to make sure you know that!
And thank you for the kind words about this blog, I hope I can reach more and more intersex people on Tumblr and help as many people out as I can. And don't worry about "spamming", you didn't spam but even if you did I love spam so no worries. If you want to chat further you can DM me on here or on my Discord (which I can give via DM or via an ask off of anonymous and then I'll answer you privately)
If you have any other thoughts, questions, comments, concerns, etc., please let me know! Even if it’s just that this helped! I love getting to answer asks and help people out.
If I accidentally skimmed past any of your questions or concerns, let me know and I’ll edit this post to include any information.
And to anyone, if you see any false information, typos, grammar mistakes, formatting issues, etc., please let me know and I will change it.
*I’d like to make it clear that I fully support people who use this term otherwise. There is a significant number of intersex people who identify as transmasc because it describes part of their experience even if they were assigned female at birth. The terms transmasc/fem/neu(tral), FTM, MTF, FTNB, and MTNB are often used differently or used in a way that doesn’t fit the traditional expectations of many other queer people by groups such as: intersex people, bigender, multigender people, genderfluid people, genderflux people, genderqueer people, genderfucked people, and more. I absolutely support genderfuckery but also acknowledge that understanding of the term in how it’s usually used is necessary for understanding many individuals or conversations when the term is used.
