Hormone therapy in trans men is a pivotal step for many in their journey toward gender affirmation. While not all trans men choose to undergo hormone therapy, it’s important to understand that this process is not solely about physical transformation – it also involves emotional, sexual, and social dimensions. Starting hormone therapy isn’t just about changing the body; it’s about giving visible form to an identity that already exists and deserves to be lived with fullness and health. Understanding how masculinizing hormone therapy works, what effects to expect (and which not to), and how to navigate this journey in a healthy way with appropriate medical and emotional support is essential. Not only for those going through it themselves but also for their families and loved ones.
What Is Hormone Therapy in Transgender Men?
Masculinizing hormone therapy, or gender-affirming hormone therapy (GAHT) for trans men, involves the administration of testosterone to induce physical changes that are typically considered masculine. This therapy usually begins following an individualized assessment that takes into account the person’s physical, emotional, and mental health, as well as their desire to transition.
According to the international standards of care by WPATH (World Professional Association for Transgender Health), initiating hormone therapy should be supervised by specialized professionals and approached with clear information about expected effects, risks, and available alternatives. It’s important to understand that there is no “correct age” or one-size-fits-all model for transitioning. Each individual has their own needs, pace, and way of living their gender identity.
Physical Changes with Testosterone
Taking testosterone brings about certain physical changes and symptoms, detailed below:
Common Changes That Typically Occur
One of the most visible aspects of testosterone therapy is the physical transformation. Many of these changes become noticeable within the first few months, although their intensity and speed can vary depending on factors like genetics, age, and dosage.
- Voice changes: The voice deepens progressively due to the thickening of the vocal cords.
- Increased body and facial hair: Facial hair begins to grow sparsely and thickens over time. Body hair also increases on the legs, arms, and areas like the linea alba, though the pattern and amount depend on genetics.
- Increased muscle mass and physical strength: Muscle development becomes easier, and fat distribution shifts from the hips and thighs toward the abdomen. If this change is insufficient, surgical masculinization techniques like liposculpture may be considered.
- Changes in skin texture: The skin becomes thicker and oilier, often leading to acne.
These effects appear gradually and vary among individuals.
Other changes that usually take longer include:
- Clitoral growth (clitoromegaly), often accompanied by increased sensitivity.
- Progressive cessation of menstruation, typically within the first six months.
- Changes in body odor and sweat, becoming stronger and more typically masculine.
- Male-pattern hair loss, especially if there is a genetic predisposition.
What Doesn’t Change with Hormone Therapy
Not all aspects of the body change with testosterone, and this is important to keep in mind. For example:
- Height does not change, as testosterone does not reopen growth plates.
- Facial features, the jawline, and the Adam’s apple may shift slightly, but not drastically.
- Bone structure and breast size generally remain unchanged.
For chest dysphoria, a trans man may consider top surgery (mastectomy) to achieve a more typically masculine torso.
Emotional and Psychological Changes
Testosterone affects more than just appearance—it can influence emotional states too. Many people experience increased self-confidence and well-being as their physical body begins to reflect their gender identity. This can reduce dysphoria and improve the relationship with one’s body.
However, it’s not always a linear process. In the first few months, some may experience emotional instability such as irritability or impulsivity. These are common reactions that tend to stabilize over time. Psychological and/or emotional support can be very helpful in navigating and integrating these changes in self-image.
Changes in the Sexual and Affective Sphere
Testosterone also affects sexuality. One of the most common changes is an increase in libido. Many individuals rediscover their bodies with a new perspective, exploring new sensations and ways of experiencing pleasure.
It’s important to note that these changes vary from person to person. Some may feel increased genital sensitivity, while others experience changes in desire or connection. There is no single way to experience sexuality during transition. What matters is listening to yourself, showing self-respect, and allowing time to adapt to your own transformations.
How Hormone Therapy Affects Fertility and Reproductive Health
One of the most sensitive and often overlooked aspects of hormone therapy is its impact on fertility.
Even if menstruation stops, ovulation may still occur irregularly beyond the initial months. Until full ovarian suppression is achieved, pregnancy is still possible if engaging in unprotected penetrative sex.
In the long term, testosterone often reduces or eliminates reproductive capacity, though not always. Therefore, if there’s a desire for biological children in the future, it’s essential to learn about fertility preservation options like oocyte cryopreservation before starting hormone therapy. Informed decision-making is key, and guidance should be sought before beginning treatment.
Social and Relational Changes: Identity and Environment
External gender recognition can bring great relief but also challenges. Transitioning involves changes in how others perceive us. On one hand, hormone therapy can facilitate social recognition as male, often reducing awkward situations. On the other hand, it may introduce new challenges in work, education, family, or social settings.
Some people experience unexpected reactions from loved ones, ranging from misunderstanding to tension or discrimination. Others may face new prejudices. That’s why having a safe emotional support network is crucial for emotional and relational well-being.
Risks and Medical Recommendations During Hormone Therapy
While testosterone is safe when administered properly under medical supervision, it’s essential to conduct regular medical checkups to monitor blood pressure, hormone levels, hematocrit, liver function, lipid profile, and more.
Possible side effects include:
- Polycythemia (increased red blood cell count
- Liver or cholesterol issues
- Mood changes
- Altered blood pressure
It’s important to emphasize that self-medication or unsupervised hormone use can seriously endanger physical and mental health. Reliable information and professional guidance are the cornerstones of a safe transition.
Comprehensive Support: Every Journey Is Unique
There’s no one way to be a trans man. Each person must choose their own path. Some opt for hormone therapy, others do not. Some pursue specific goals, others simply seek to feel more comfortable in their own skin. Every body, experience, and story deserves to be lived with respect and individuality.
Hearing from other trans men may help inform your decision, but it should never dictate your path.
Having reliable information, emotional support, and experienced professionals about Testosterone therapy for trans men, is essential to ensure that transitioning is a journey toward greater well-being, freedom, and a life free from fear or taboo. At IM GENDER, we’ve spent more than 25 years helping trans people find their path.
Having reliable information, emotional support, and experienced professionals about Testosterone therapy for trans men, is essential to ensure that transitioning is a journey toward greater well-being, freedom, and a life free from fear or taboo. At IM GENDER, we’ve spent more than 25 years helping trans people find their path.