What medications are used for masculinizing hormone therapy?

The goal of masculinizing hormone therapy is to raise the testosterone level to the normal, physiologic male range. Only one medication is needed: testosterone.


Testosterone is the hormone responsible for most masculine characteristics. It is prepared in oil (cottonseed or sesame) and given as an injection under the skin (subcutaneous) or into the muscle (intramuscular). Most people receive an injection every 7 days; some receive one every 10 or 14 days.

Our clinic prefers to use testosterone given by the subcutaneous route (injected under the skin, into the fat). Most people easily learn to do their own injections, or a family member or friend can be taught to give the medication. These are general guidelines only and each patient’s medication regimen is tailored to the needs of the individual.


Effects in BOLD are permanent changes.

Effect First Noticeable Maximum Effect


Oily skin / acne


1-6 months 1-2 years


Menstrual periods stop


2-6 months  


Clitoris enlarges


3-6 months 1-2 years


Facial and body hair growth


3-6 months 3-5 years


Body fat redistribution (more on the abdomen, less on the buttocks, hips, thighs)


3-6 months 2-5 years


Deeper voice


3-12 months 1-2 years


Increased muscle mass / strength


6-12 months 2-5 years


Scalp hair loss (male pattern balding)


After 12 months or more Variable

What are the emotional and intellectual effects of testosterone?

People are very different so their emotional and intellectual changes vary widely. People taking testosterone have reported:

  • Feeling less emotional and not crying as easily
  • Feeling more angry, irritable, or aggressive
  • Thinking differently, having different ways of looking at things
  • Mood swings, especially feeling “down” right before the next injection
  • Feeling “more like myself” when taking a hormone that aligns with gender identity; feeling more comfortable in one’s body

What testosterone does not do:

  • Change a person’s bone structure
  • Change a person’s height
  • Reduce the size or cause shrinkage of the breasts
  • Provide reliable birth control
  • Protect against sexually transmitted infections

What are the risks of taking testosterone? 

The major risks are:

  • High red blood cell counts which can cause blood clots
  • Liver disease
  • High cholesterol which causes heart disease
  • Weight gain

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