Some quick important information for transmasculine people & trans men looking to start testosterone HRT:
hello, i'm a transmasculine nonbinary person who's been taking testosterone HRT since 2015. i've also worked in a pharmacy and i've seen a lot of the roadblocks that comes with transmasculine people trying to start HRT. nobody really explains how difficult it can be, even when you get your prescription. there can be a lot going on, and some transmascs become very disheartened if their T isn't covered by insurance. i get that. i wanted to create a relatively easy to digest and succinct post detailing some common hurdles transmasculine people have to face on the doctor/prescriber and insurance level, as well as after getting their hormones. *please note that a lot of this information is United States centric as that's where i live, i can't give information for a country i've never lived in, unfortunately.*
about doctors, insurance, and getting your prescription:
you do not necessarily have to go to a gender affirming care clinic if you don't have one in your area. some primary care doctors will prescribe testosterone if they've received training from other coworkers who know more about transgender people. some doctors are actually also willing to learn if you give them enough info. this can be your chance to be an advocate for both yourself and other trans people in your area. i have had my family doctor prescribe me T because they were just aware of gender affirming care
please check to see if you have medical insurance. if you do not, try to look into insurance options in your area for your income level. if you are very poor, please look into seeing if medicaid is available in your state in if you are in the united states. it is for very low and no income people and testosterone and other gender affirming care services are covered by it in most states that have it. if you can't access insurance please look into services like GoodRx that offer coupons and discounted rates for prescriptions.
google and search for organizations in your area such as: trans resource centers, LGBT pride alliances, queer advocacy offices, queer focused mental health organizations or therapy groups, and queer/trans focused homeless organizations or crisis hotlines. any place like this can potentially help you in taking the first steps to finding a provider to who get you started if you have places like this in your area. check local colleges for organizations like this as well
make sure you talk to whoever is prescribing the testosterone to you about insurance, and if they are aware that testosterone is a controlled substance. a controlled substance is a substance that has been restricted by your country's government or governing medical organization and has to be monitored carefully. you need what's called a "prior authorization" from your doctor in order to get your insurance to give you your hormones in most states. please please please talk to your doctor and pharmacy about prior authorizations for your testosterone and syringes if you need them. this will save your life.
sometimes when you are requesting blood work to check on your testosterone levels before and/or after you start HRT, your paperwork can potentially be discarded due to the sex on your paperwork reading "F" while needing to check for T levels, as many techs see this as an "error". if you notice your paperwork keeps getting discarded or you never get results back from your tests, be firm and let your doctor know to include notation that you are transgender and that it is intentional.
about HRT itself and how to go about administering T:
when you get a prescription, how things go will depend on if you get your doses administered at the clinic, or if you choose to do them at home. if you are not comfortable self administering, ask if they will at the clinic. many places offer this service.
if you choose to administer at home, if you are using injectable T, note that pharmacies tend to like to give you the wrong gauges of needles because they don't often give out needles. you need two different sizes- a thicker, longer needle for drawing from the vial, as it has a self-healing rubber seal on the top, and testosterone cypionate is thick, like a syrup. this larger needle should be an 18 gauge. you will discard this needle tip into a sharps container and replace it with a much smaller one to inject, a 22 or 23 G. note that smaller gauges mean larger, thicker needles, not vice versa. make sure you are keeping an eye on what gauge needles they give you. do not try to draw testosterone from the vial with a 22/23 G needle, you will be there all day if it works, it usually just doesn't. also please make sure that you are sanitizing your injection site and your hands, never using the same needle tips twice for any reason, never using needles that have touched another surface, and please get a sharps container. (https://www.fda.gov/medical-devices/safely-using-sharps-needles-and-syringes-home-work-and-travel/sharps-disposal-containers)
you can often times buy large boxes of syringes and needles from your pharmacy if you don't want to deal with getting a small amount of them prescribed at a time, but this is not always an option. make sure your prescriber is including the prescription for the needles and syringes every single time they are prescribing your T if you can't buy extra syringes.
make sure you are injecting in different spots every time you inject. you do NOT want to inject into the same patches of skin every time, as this can cause tissue damage, tissue death (necrosis), and severe scarring after long periods of time of having to heal but being interrupted over and over again. inject into slightly different spots every time to make sure your skin and muscle tissue can heal.
here is a guide on safely injecting your own testosterone, including steps on how to prepare your skin for the injection, hold the vial while drawing, change needles, and more. (https://www.med.umich.edu/1libr/SpinalCordInjuryProgram/IMselfInjectionTesto.pdf)
if you receive topical testosterone like androgel or other alcohol based testosterone gels, make sure you read the informational packet that comes with it to ensure you are administering it in the correct areas- your exact formulation will need to be applied in a certain area, if you do not have the guide or packet that came with it, please read this page to figure out where you need to apply it. if your topical T isn't working you may be applying it in the wrong place. (https://www.mayoclinic.org/drugs-supplements/testosterone-topical-application-route/proper-use/drg-20073444)
when applying topical T, make sure you clean the skin before putting it on, and do not shower or go swimming for 2 - 5 hours after application. make sure you cover the skin with some kind of clothing. you want to make sure it doesn't rub off on other people, as other people can absorb it as well by touching you. do not ever have someone else apply topical testosterone for you, even if they are also transmasc, as this can mess with their levels in a bad way
after starting T you may have to adjust your dose over time to achieve desired effects. if so, you will start on a starter dose and then you can move up to higher doses as your body adjusts. this process is called titration. bodies need to be introduced to new chemicals gently and slowly to integrate them successfully- do not increase your dose without your doctor's advice or knowledge, and do not go any faster than advised. if you put too much testosterone into your body too quickly, your body can undergo a process called aromatization, meaning your body will convert excess testosterone into estriadol, which encourages the production of estrogen, because it simply does not have a need for that much testosterone. you can read more about this here. (https://pubmed.ncbi.nlm.nih.gov/27465894/)
i will add more as i think of things. =) there is a lot to transmasculine transition, and there is no real handbook or guide. we have to pass info around like a game of telephone and it's what it is. if people are interested i would potentially like to whip up some zines and other informational things transmasculine people can pass around to one another
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