What is Testosterone FTM?
Testosterone FTM is masculizing hormone therapy Physical changes are induced in the body promoting gender congruence. If therapy is initiated prior to female puberty, secondary sexual characteristics can be eliminated. Masculizing hormone therapy is also referred to as cross-sex hormone therapy. The testosterone hormone is used to decrease the amount of estrogen produced by the ovaries and for the suppression of the menstrual cycle. The medication results in changes either permanent or temporary. Masculinizing surgery can be performed in conjunction with testosterone FTM.
Preparing for Testosterone FTM
Prior to beginning masculizing hormone therapy, an evaluation must be completed by a physician. Any medical issues will be addressed or ruled out to ensure the treatment will not be negatively affected. The majority of evaluations include:
- Family and medical history will be reviewed.
- A physical examination is performed. The external reproductive organs are assessed.
- Lab tests are necessary to measure blood sugar, liver electrolytes and enzymes, lipids and blood count.
- Pregnancy test is performed.
- Immunizations are reviewed
- Sex and age-appropriate screenings
- Use of tobacco, abuse of alcohol or drugs, and sexually transmitted infections including HIV are identified.
- Consultation regarding any intention of fertility in the future and contraception.
- Consultation regarding any treatment approaches with potentially harmful consequences including silicone injections of industrial strength and unprescribed hormones.
- A mental health evaluation may be required by a professional experienced with transgender health. This type of evaluation often assesses:
- Dysphoria and gender identity.
- How gender identity affects social and home environments, work and school.
- Issues regarding minority stress, relationship abuse, discrimination, mental health issues and mood.
- Concerns regarding sexual health.
- Risky behaviors such as unapproved hormone supplements or therapy, silicon injections of non-medical grade and substance use.
- Support received from friends, family and peers.
- Individual expectations risks and goals regarding treatment and care for the future.
Individuals below the age of 18 must be accompanied by a parent or guardian. Adolescents should consult with medical health professionals and physicians experienced in pediatric transfer health. Hormone therapy risks, potential complications and the effects of gender transition will be discussed.
In most instances, masculinizing hormone therapy starts with the administration of testosterone. Testosterone can be taken by a gel or patch placed on the skin or by injection. Due to the potential of negative effects on the lipids and liver, synthetic or androgen male sex hormone and oral testosterone medications should not be used. If the individual has a consistent menstrual flow, progesterone may be recommended by the physician to achieve control.
Once masculinizing hormone therapy has been completed, changes will start to appear in the body in weeks or months. A typical FTM testosterone timeline chart includes:
Between one to six months after the procedure, acne and oily skin will begin. The individual will see the maximum effect in one or two years.
The voice will deepen starting three to 12 months after the procedure. The maximum effect can be expected in one or two years.
The menstrual cycle will stop between two to six months after the procedure.
The growth of hair on the body and face will start between three and six months after the procedure. Three to five years are necessary to see the maximum effect.
Vaginal atrophy and clitoral enlargement start between three and six months after the procedure. One to two years are necessary for the maximum effect.
Loss of hair on the scalp can be expected within one year after treatment.
The redistribution of body fat starts between three and six months after the procedure. Between two and five years are required for the maximum effect.
An increase in strength and muscle mass starts between six and 12 months after the procedure. Between tow and five years are necessary to achieve the maximum effect.
FTM Testosterone Timeline Chart
Prior to starting treatment, the individual should have a complete understanding of their goals. Testosterone FTM offers different options for a variety of goals. Certain individuals are interested in maximizing safety, others want to proceed slowly by starting with a lower dose. Others are not interested in maximum effects for the long-term. Understanding individual goals are important for good communication with the medical professional. The individual works on their care plan with the help of this professional.
A lot of individuals want to have rapid hormonal changes. Although this is understandable, there are numerous factors responsible for the rate and extent at which the changes occur. This includes the individual’s overall health, their age when hormones are first used and genetics. Hormone therapy can be compared to puberty because the effects require years before the full impact is seen. Increasing the hormone dose does not mean the changes will occur any faster. Unfortunately, this can result in unnecessary health risks.
No two individuals are exactly the same. For this reason, the dosage and medication are often very different from the acquaintances and friends of the individual, what is posted on social media or what is written about in books. Caution must be taken for any hormone regimen guaranteeing dramatic, fast or specific results. In some cases, specific goals can be reached by adjusting dosing and medication. Despite this, the changes in the body are mostly dependent on the age the individual begins and their genetics as opposed to the type of medication, frequency or specific dosages.
The initial changes in the FTM testosterone timeline chart are a thickening of the skin with increased oil. As oil production increases, the pores enlarge. There is an increase in sweat for most individuals, with a change to the odor of both urine and sweat. The development of severe or unwanted acne is possible. In most cases, management can be achieved through typical acne treatments and healthy skincare routines. Certain individuals need prescription medication for the management of acne. This should be discussed with the individual’s physician.
The severity of the acne generally reaches the peak within the first year after the procedure, followed by a gradual improvement. Acne can be decreased using the correct dosage of testosterone without extremely high levels. Testosterone FTM does not result in much of a change in the chest. Despite this, the recommendation of most surgeons is to wait for a minimum of six months to one year after beginning testosterone therapy prior to having masculinizing chest surgery or top surgery. This gives the contours of the soft tissues and muscles of the chest wall time for settling into a new pattern.
The weight of the individual’s body will start to redistribute. The fat around the thighs and hips will become somewhat diminished. More muscle definition will begin to develop in the legs and arms. The fat located just under the skin starts to thin, with a slightly rougher quality. Veins become more prominent, with additional fat often gained in the abdomen. A more angular appearance develops in the face and eyes due to the shifting and reduction of facial fat common for the appearance of males. The chances of any changes in the bone structure are very slim.
If therapy is started when the individual is in their early twenties or late teens, there is a possibility of some subtle changes in the bones. A minimum of two years may be necessary to see full changes within the facial structure. There is an increase in both strength and muscle mass. The extent is dependent on several factors such as exercise and diet. Once the individual begins therapy, there can be a loss or gain of weight dependent on muscle mass, genetics, lifestyle and diet. The vocal cords begin to thicken from the testosterone, resulting in a deeper and more male voice.
Testosterone does not cause the pitch of the voice to deepen for everyone. To help ensure the development of a more fitting and comfortable voice, some individuals work with a speech therapist or practice a range of different vocal techniques. Changes in the voice can start in a few weeks after starting testosterone therapy. The first stage is usually a scratchy or hoarse sensation in the throat. As the voice changes in quality and tone, there are often breaks in the sound. Body hair begins increasing in thickness on the arms, back and chest, grows much quicker and starts to darken.
The majority of individuals develop a body hair pattern a lot like the other males in the family. The pattern is different for each individual, with the final results often requiring a minimum of five years. There are also changes regarding hair growing on the head. The majority of individuals experience at least some thinning on the front scalp area. This is most common around the temples. Complete hair loss, male pattern baldness and the development of thinning hair are all possible depending on the individual’s family history and age.
Options for the management of hair loss are the same as the standard treatments. The most common procedures include hair transplants and finasteride or Rogaine which is a partial testosterone blocker. The product is applied directly to the scalp. Unfortunately, there is currently no technique for preventing male pattern baldness. Certain individuals have a predisposition to the development of this condition. The individual’s physician can recommend different techniques for the management of hair loss.
The development of facial hair including beards varies from individual to individual. In some cases, the growth of a thick beard happens quickly, certain individuals do not see much growth for a few years, and others never develop a thick, full beard. The growth of facial hair and thickness is also different for each individual, although there are similarities based on age. When testosterone FTM is used at a later age, the development of facial hair is not as extensive as for those beginning at an earlier age.
There may be differences in sense perception. This means the individual receives a different sensation when touching familiar objects. Temperature and pain can have different perceptions. There can also be changes in preferred scents and foods.
Testosterone FTM has an impact on sexuality. Shortly after starting the treatment, most individuals notice a difference in their libido. Rapid growth occurs in the genitalia including increased growth of the clitoris. When the individual is aroused, the clitoris becomes even larger. Erotic pleasure is often obtained in different areas of the body or through different sexual acts. The feeling of orgasms changes, including a greater intensity. Sexual focus is placed on the genitalia as opposed to the experience of the entire body.
Certain individuals taking testosterone experience differences in their sexual orientation, attraction or interests. Exploring these feelings is recommended as opposed to attempting to ignore them. The individual is encouraged to experiment and explore new sexual feelings by using sex toys and masturbating. If the individual has a sexual partner, involving them in the process is recommended as well.
Testosterone FTM impacts an individual’s emotional state. The constant shifts in emotion while the transition is occurring is often compared to the roller coaster ride of puberty. For some individuals, their feelings and emotions become less varied. Others experience changes in pastimes, tastes, interests or in their relationships with others. For the majority of individuals, everything begins to settle as time passes. Some individuals experience little or no difference in their emotions. The recommendation is taking enough time to learn what has changed.
The individual should explore any unfamiliar or new emotions and feelings to understand the important changes and become familiar. Although the same techniques are not appropriate for everyone, some individuals are assisted by a therapist during their transition. This is a good way to explore and understand new feelings and thoughts and learn about a new self and body. Therapists can help with coming out to friends, family and coworkers and the development of increased acceptance and self-love.
The reproduction system undergoes numerous changes due to hormone therapy. The first thing the majority of individuals notice is a lighter, later or shorter menstrual cycle. The menstrual cycle can become longer or heavier for a few months for certain individuals before completely stopping. Although the ability to get pregnant is generally decreased by testosterone, there is still a chance the individual can become pregnant. The individual may become pregnant while taking testosterone. Precautions need to be taken by any sexually active individual with a partner able to produce sperm.
A type of birth control should be used for the prevention of an unwanted pregnancy. The individual can choose any type of contraception including everything available for typical use provided the method does not use estrogen or any hormones. A variety of contraceptive methods are available not requiring a pill be taken every day, with a long-lasting effect. Emergency contraceptives referred to as a morning-after pill are also appropriate for use. The individual’s physician can offer additional information regarding the available family planning and contraceptive options.
FTM Testosterone Side Effects
The individual should discuss any concerns and changes in their body with their physician. FTM Testosterone Side Effects can include all of the following.
- Polycythemia or the production of excess red blood cells
- Sleep apnea
- Individuals with polycystic ovary syndrome have a higher risk of dyslipidemia or an abnormal number of lipids contained in the blood.
- Development of male-pattern baldness
- Weight gain
- Elevated liver function
- If the risk factors are present, the individual is at a greater risk for hypertension or high blood pressure, cardiovascular disease and type 2 diabetes.
- Underlying psychotic or manic conditions can become worse
According to the latest evidence, the risk of cervical or breast cancer does not increase with hormone therapy. All studies conducted regarding an increased risk of uterine or ovarian cancer have been inconclusive. Additional research is required. Fertility can be decreased due to masculinizing hormone therapy. This means the individual must make decisions regarding fertility prior to beginning treatment. When hormones are used long-term, there is the risk infertility will become permanent. The risk increases when therapy begins before puberty.
Even when hormone therapy is discontinued, the recovery of the uterine and ovarian function may not be enough to enable the individual to become pregnant. If the individual intends to have biological children, they should consult with their physician about having their embryos or eggs frozen. Understanding there are numerous steps for freezing eggs is important. The steps are ovulation induction, retrieval of the egg and freezing. In order for embryos to be frozen, the eggs must be fertilized first.
Despite the fact fertility can be limited by testosterone, if the individual still has ovaries and a uterus, they can become pregnant. This risk can be virtually eliminated with the use of an intrauterine device or a barrier type of contraceptives. Masculinizing hormone therapy is not the right choice for every individual. Both sexual function and fertility can be impacted resulting in other health issues. The individual should consult with their physician to understand FTM testosterone side effects.
FTM Testosterone Personality Changes
Psychological FTM testosterone personality changes are difficult to define. This is because the initial physical action occurring during the transition is hormone replacement therapy or HRT. The psychological impact is very similar to changes induced by the hormones. The majority of individuals using testosterone FTM have reported an increase in sex drive and energy. Some have stated their confidence level has increased. One of the personality changes associated with high testosterone levels results from increased aggression.
There is a connection between high testosterone levels and increased aggression, although this is not noticeable for the majority of individuals using testosterone FTM. Even the highest doses of testosterone FTM are still a lot lower than the standard dose of steroids used by athletes. The testosterone levels are similar to a typical male. There is no evidence higher testosterone levels result in more aggression than the same estrogen level. Certain individuals have reported increased aggression, anger and mood swings after beginning therapy.
The issue is that only small scale studies are currently available conducted during a period of approximately seven months. Some studies indicate improved anger control and mood and decreased aggression and emotional liability. Low testosterone levels can result in low energy levels and disruptive sleep. There are numerous other factors influencing the individual’s personality traits including environmental and biological factors. The personality of the individual will not completely change due to testosterone FTM.
Pros and Cons of Testosterone FTM
Although there are advantages to testosterone FTM, there are also risks. The pros and cons of testosterone FTM include:
- Deeper voice
- Growth of hair on the face and body
- Increase in strength and muscle mass
- Menstrual cycle stops
- Potential decrease in emotional sensitivity such as crying
- Redistribution of body fat
- Increased sex drive
- Acne and oily skin
- Potential increase in temper and aggression
- Potential negative impact regarding medical conditions
- Development of male-pattern baldness, thinning hair or complete hair loss
- Potentially adverse impact on the lipids and liver
- Increase in appetite and body weight
- More overall sweat with possible odor
Once the treatment has begun, the individual meets with their physician on a regular basis. This includes:
- Documents all physical changes
- Ensures the desired physical effects are achieved by monitoring the hormone concentration and ensuring the lowest possible dose is used.
- Stability of mental health is monitored.
- Changes potentially due to hormone therapy are monitored including fasting blood sugar, liver enzymes, lipids, blood count and electrolytes.
Routine preventative care is required after testosterone therapy if specific surgical interventions have not been performed including:
- Age and recommendation-based screenings for breast cancer
- Age and recommendation-based screenings for cervical cancer
- Obstructive sleep apnea evaluation
- Early evaluations for recurrent or persistent vaginal bleeding
During cervical cancer screenings, the individual must inform the medical professional they are receiving testosterone therapy to ensure their gender designation is disregarded for their sample. Testosterone FTM causes cervical atrophy or a thinning of the cervical tissues. This can be mistaken for cervical dysplasia or abnormal cells located on the cervix surface.