Hi, I'm Dr. Maddie Deutsch, Director of Clinical Services at the UCSF Center of Excellence for Transgender Health. I’d like to talk to you about some of the risks, expectations, long term considerations, and medications associated with your transition from female to male.
Many people are eager for hormonal changes to take place rapidly—I understand that. But it’s very important to remember that the extent of, and rate at which your changes take place, depend on many factors. These factors include your genetics, the age at which you start taking hormones, and your overall state of health.
Consider the effects of hormone therapy as a second puberty, and puberty normally takes several years for the full effects to be seen. Taking higher doses of hormones will not necessarily bring about faster changes, but it could endanger your health. And because everyone is different, your medicines or dosages may vary widely from those of your friends, or what you may have read in books or online.
There are four areas where you can expect changes to occur as your hormone therapy progresses.
The first is physical.
The first changes you will probably notice are that your skin will become a bit thicker and more oily. Your pores will become larger and there will be more oil production. You may develop acne, which in some cases can be bothersome or severe, but can be managed with good skin care practices and common acne treatments. You’ll also notice that the odors of your sweat and urine will change and that you may sweat more overall.
When you touch things, they may “feel different” and you may perceive pain and temperature differently.
Your breasts will not change much during transition, though you may notice some breast pain, or a slight decrease in size. For this reason, some breast surgeons recommend waiting at least six months after the start of testosterone therapy before having chest reconstructive surgery.
Your body will begin to redistribute your weight. Fat will diminish somewhat around your hips and thighs. Your arms and legs will develop more muscle definition, and a slightly rougher appearance, as the fat just beneath the skin becomes a bit thinner. You may also gain fat around your abdomen, otherwise known as your “gut.”
Your eyes and face will begin to develop a more angular, male appearance as facial fat decreases and shifts. Please note that it’s not likely your bone structure will change, though some people in their late teens or early twenties may see some subtle bone changes. It may take 2 or more years to see the final result of the facial changes.
Your muscle mass will increase, as will your strength, although this will depend on a variety of factors including diet and exercise. Overall, you may gain or lose weight once you begin hormone therapy, depending on your diet, lifestyle, genetics and muscle mass.
Testosterone will cause a thickening of the vocal chords, which will result in a more male-sounding voice. Not all transmen will experience a full deepening of their voice with testosterone, and some men may find that practicing various vocal techniques or working with a speech therapist may help them develop a voice that feels more comfortable and fitting. Voice changes may begin within just a few weeks of beginning testosterone, first with a scratchy sensation in the throat or feeling like you are hoarse. Next your voice may break a bit as it finds its new tone and quality.
Let’s talk about hair. The hair on your body, including your chest, back and arms will increase in thickness, become darker and will grow at a faster rate. You may expect to develop a pattern of body hair similar to other men in your family—just remember, though, that everyone is different and it can take 5 or more years to see the final results.
Regarding the hair on your head: most trans men notice some degree of frontal scalp balding, especially in the area of your temples. Depending on your age and family history, you may develop thinning hair, male pattern baldness or even complete hair loss.
Lastly, everyone is curious to know about facial hair. Beards vary from person to person. Some people develop a thick beard quite rapidly, others take several years, while some never develop a full and thick beard. This is a result of genetics and the age at which you start testosterone therapy. Non-transgender men have varying degrees of facial hair thickness and develop it at varying ages, just as with trans men.
The second impact of hormone therapy is on your emotional state.
Puberty is a roller coaster of emotions and the second puberty that you will experience during your transition is no exception. You may find that you have access to a narrower range of emotions or feelings, or have different interests, tastes or pastimes, or behave differently in relationships with people.
Psychotherapy is not for everyone, but most people in transition will benefit from counseling that helps them get to know their new body and self while exploring their new thoughts and feelings.
The third impact of hormone therapy is sexual in nature.
Soon after beginning hormone treatment, you will likely notice a change in your libido. Quite rapidly, your clitoris will begin to grow and become even larger when you are aroused. You may find that different sex acts or different parts of your body bring you erotic pleasure. Your orgasms will feel different, with perhaps more peak intensity and a greater focus on your genitals rather than a whole body experience. Some people find that their sexual orientation may change when taking testosterone; it is best to explore these new feelings rather than keep them bottled up.
Don’t be afraid to explore and experiment with your new sexuality through masturbation and with sex toys. Involve your sexual partner if you have one.