I began testosterone on June 3, 2015. I have taken it ever since. Check out this Instagram post for a series of videos about testosterone, this post for information on how I made the decision to take it, and this video for why I got top surgery before starting T.

Where can I get testosterone?

Testosterone can be prescribed by an MD (doctor) and, in some states, a physicians assistant (PA) and nurse practicioners (NP). Usually the doctor is an endocrinologist, but they do not have to be. Typically, you will also need a letter from a psychologist or doctor that says you need testosterone to treat gender dysphoria. The requirements vary for different insurances, in different states, and for different doctors. I’d advise you to visit a local LGBTQ center, or, (even better) a LGBTQ health center if there is one around you and ask for resources and advice. You could also start with your primary care physician, if you feel they are trans friendly. Absolutely do not take testosterone without consulting a medical professional first.

What happens when I take testosterone? What are the side effects?

Taking testosterone is physiologically identical to going through puberty. The “side effects” are puberty. The table below indicates the changes resulting from testosterone, as well as the permanence of the effect.


Time on T for Effect to Show

Note: this is EXTREMELY generalized/estimates — everyone’s body is different, everyone metabolizes T differently, and people have different dosages!

Effect’s Permanence (i.e. If I go off of T, will this effect remain?)

Voice pitch deepening

Happens over the course of the first year or so. I saw changes within the first 3 months.


Wider and “boxier” facial structure

2-3 years.

Any bone structure changes are permanent. Some facial changes seem to occur as result of fat/body mass redistribution, and this is not permanent — it only occurs on testosterone.

Development of an Adam’s apple



Depending on genetics, increased facial/body hair

Varying, depends on genetics, often takes YEARS for beards to form, if ever. Check out this post for a quick reminder that facial hair does not make you a man.

The new follicles will not disappear if testosterone treatment stops, but new follicles will not form, so the increase of hair on body will stop

Cessation of one’s menstrual cycle within 1-6 months of treatment

1-6mo, (depending on dosage of testosterone – if your period continues past 6 months, you should talk to you doctor.)

Only occurs while on testosterone

Changing/receding of hair line on scalp

Varying/depends on genetics.


Shifting of body mass distribution – more mass will accumulate around the torso/gut and body line will be more streamlined than curvy

Varying/depends on genetics and the amount of activity and movement you do with your body. NOTE: You do NOT need to work out if you don’t want to. Diet and workout culture is so toxic. Take care of yourself and your body however works for you. Visit this post for more.

Only occurs while on testosterone

Mood swings, a potentially more ‘reactive’ or ‘moody’ disposition

First 3-12mo or so.

Will occur with any drastic hormone changes (going on OR off testosterone)


Varying, mine began the first year and continued through the third. I ended up taking minocycline during my third year because my acne became cystic that year. Here is a small post I made on my acne.

Usually occurs with any hormone changes (think: natal puberty) but usually more so with increases in testosterone. Will decrease if you cease testosterone therapy.

Hot flashes

First several months or so (for me).

Will occur with any drastic hormone changes (going on OR off testosterone)

Increased sweating

Almost immediately for me (can’t speak for others).

Only occurs while on testosterone

Increased libido

Depends on the individual but usually occurs fairly rapidly.

Only occurs while on testosterone

Enlarged clitoris

Depends on individual, but usually occurs pretty rapidly within the first couple months. Supposedly reaches the apex at 2-3 years but I feel like I observed most of the changes within the first several months.


Increased red blood cell count

This should begin happening almost immediately.

Only occurs on testosterone.

Increased muscle repair

This should begin happening immediately but obvious effects might take months. I noticed difference in strength (mostly in the weight room, less so in swim practice) beginning around 3 months. This depends on how much physical activity one engages in. NOTE: You do NOT need to work out if you don’t want to. There is so much toxic workout culture, especially (in my experience) among trans men. It’s like you’re supposed to take T, lift weights like a maniac, and become the hulk in order to “be a man.” You do not have to do this. Your manhood is secure in your knowledge of your identity, and you should take care of yourself and your body however works for you. Visit this post or this post for more.

Only occurs on testoserone; this impacts athletics. However, there is a huge misconception that taking testosterone simply creates muscle on its own; THIS IS FALSE. You must exercise the muscles to build them. When you exercise, you create small micro-tears in your tissue. When these rebuild, they rebuild stronger/in larger volume. That is muscle growth. Testosterone aids in that repaid/rebuilding – it doesn’t create muscle out of nothing. Many people also believe it will cause one to lose weight. This is also FALSE. On its own, testosterone will usually actually facilitate weight gain.


My mom is worried testosterone will harm my body. What should I tell her?

I would assure her that testosterone therapy is safe & researched and that many cis people actually take testosterone for various reasons – some boys assigned male at birth have to or choose to take T because their bodies don’t produce the ‘right’ amount of it. That said, you are seeing a doctor (I assume, and if not you really, really should) and that will ensure that your treatment is well managed and all the more safe.

Does testosterone cause cancer?

There is little to no empirical evidence that testosterone “causes cancer.” But you can still get cancer in the reproductive organs that you have and many trans folks don’t end up getting the proper routine exams for these organs because either they are not comfortable seeing their doctors or their doctors do not know they are transgender and therefore assume they do not have the organs that they do. It’s important to remember that taking testosterone does not mean you stop having to take care of the reproductive organs that you still have. You still need to get routine exams — such as pap smears — to make sure they are healthy and screen for any cancer.

How can I take testosterone? Do I have to take shots?

There are three main ways to administer testosterone in the US:

  1. Injections. Typically involves a weekly or biweekly (every other week) shot of testosterone. There are two main types of injections:
    1. Intramuscular (IM): Injected into the muscle — usually the thigh or glutes, but could also do the deltoid/shoulder. This is typically done with a 1-1.5in 21g needle.
    2. Subcutaneous (SubQ): Injected into the subcutaneous layer, beneath the dermis, which is essentially fat. This is typically done in one’s stomach fat or “love handles” with a smaller needle — 0.5in and 25g or so.
  2. Topical gels/lotions. Spread on one’s skin daily, where the testosterone is then absorbed and processed. Many people report the speed of changes to be slower with this mode, but the overall/end results are no different. This is usually a better option for those looking for more gradual and slow changes, or people very averse to needles.
  3. Testopel. Tiny rice-sized pellets are inserted subdermally (beneath your skin), usually in your buttocks, and dissolve over 3-6months time to release testosterone slowly into your bloodstream. This is an outpatient surgical procedure that must be done in a doctor’s office. Many people prefer this as it means no daily lotions, no weekly shots/needles — only having to go to the doctor 2-4x a year for the procedure. For more on my experience with testopel, see this video.

In many European countries, something called Nebido is legal. This is a long-lasting shot of testosterone that you only need once every several months or so. It is very similar to Testopel, but without the whole insertion of pellets. It’s just a shot. For some reason the FDA has not legalized it here in the US.

Please note: There really is NO “standard” or “average” or “typical” dosage. Comparing dosages is super harmful and toxic and absolutely unnecessary. Every body is different and therefore metabolizes testosterone differently! Although I have shared my dosage before, I believe it was unnecessary to have done so – your testosterone dosage is yours; mine is mine! Neither is better or worse as long as it works for you!

What kind of testosterone do you take? What’s your dose?

I take testosterone cypionate. That’s just what my first doctor prescribed me and I haven’t needed to change it.

There really is NO “standard” or “average” or “typical” dosage. Comparing dosages is super harmful and toxic and absolutely unnecessary. Every body is different and therefore metabolizes testosterone differently! I only shared my own dosage because I was sharing each step of my own testosterone usage, but I realize now that it was unnecessary to have done so – your testosterone dosage is yours; mine is mine! Neither is better or worse as long as it works for you!

How much does testosterone cost?

This depends on your insurance. With my insurance (BlueCross BlueShield), my testosterone costs $12-24 for 4-6 weeks’ worth. It’s fairly inexpensive with most insurances that cover it, and many insurances do these days.

What is your experience like with testosterone and school? Did taking T affect school?

I started testosterone on June 3, 2015, three months before I began college. (Here’s my video for my first T shot, and here’s the Instagram post.) I presented as male in college. I do not regret the timing of my starting T – I think I would have done it earlier, though, if I’d known. (I didn’t come out as trans until my gap year before I started college.)

I don’t think hormones affected my academic/social experience my first year too much. However, I spent my first three months on hormones at home and I experienced a lot of mood swings during my first 1-3 months, so I would be aware of that. Make sure you give yourself time and space to breathe – especially during stressful times and moments when you feel like you might get angry. Take a step back. Taking T is going through puberty all over again, at an accelerated rate. Sometimes you’re going to be moody. And that’s okay. But give yourself and others space so you don’t do anything you might not be proud of.

Can I use testosterone and compete in college?

The short answer is yes! For more, visit my page on NCAA regulations for trans folks.




Some relevant Instagram posts:

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I have been on testosterone for over four years, but deciding to take it was not an easy decision. Here’s why: First and foremost, I had been recruited to swim for Harvard ~women’s~ swim, which meant I couldn’t take testosterone per NCAA rules. However, after I decided to swim for the men’s team (NCAA allows testosterone for transmasc individuals in this case), I began considering HRT. Secondly, aside from sport, I had many reservations about taking testosterone. I deeply disliked the idea of having to take it for the rest of my life, I wasn’t sure what it meant athletically, and I was worried it would change how my hair felt (yes, really.) But mostly, I wasn’t sure if the dysphoria I felt was valid, or if I should just “get over it.” — In the end I decided to try for one reason: I still felt like I was hiding pieces of myself from myself. Taking T wasn’t about anyone else; it wasn’t even really about passing. It was about wanting to look in the mirror and not feel the need to hide from it. And for my other concerns… I decided to take a leap of faith. This is my life, and I’d rather live it happy and feeling like myself than miserable and doing what other people thought I “should” do. I’m so glad I decided to take that risk on myself and on testosterone. HRT has allowed me to feel worlds more comfortable in my body. I feel like I finally grew into my body. And now I almost never feel like hiding. And I am so grateful ☺️ — It’s important to remember that if you begin testosterone, you always have the option to stop. So, you should consider the things that will not revert if you choose to go off of testosterone: the permanent effects like voice drop, hair growth, Adam’s apple, etc. – for more on this, check out pinkmantaray.com/testosterone. That is, if you are worried about T, but want to just try it, ask yourself: will you be okay with some of the permanent effects? For me, the answer was yes. And so I began. — #transgender #trans #testosterone #hrt #selfcare #transathlete #transswimmer #t #hormonereplacementtherapy

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Testosterone FAQs! 1. Testosterone TAKES TIME. If you’ve been following me a while, you’ve probably read this a thousand times but imma say it again in case not: HRT is physiologically identical to puberty. If you are 5mo on T, your physiology is that of a 13 year old boy. Your beard depends on genetics and might take years. So be patient with your body & find peace in the knowledge that it ~will~ change. Also a quick reminder that testosterone does not make you a man. Identifying as a man makes you a man. There are no other requirements. 2. Slides 2-4: An explanation of the three main ways to administer testosterone (in US, that I know of) — injections (intramuscular and subcutaneous), topicals, Testopel. 3. Slides 5-7: I walk you through my own shot process. I do subcutaneous shots! I have not experienced shot anxiety as I know other folks sometimes do. Everyone’s experience is different, though! 4. Slides 8-10: Insurance, pricing, TSA/travel, and a tip! My insurance is BlueCross/BlueShield and it covers my testosterone – about $12 for 4-6 weeks. I fly all the time with my testosterone and have never been stopped by TSA for it. It is not illegal. But I always bring my prescription just in case! 5. I began testosterone June 3, 2015 – I was just over 19 years old. — A little addendum: There really is NO “standard” or “average” or “typical” dosage. Comparing dosages is super harmful and toxic and absolutely unnecessary. Every body is different and therefore metabolizes testosterone differently! I only shared my own dosage because I was sharing each step of my own testosterone usage, but I realize now that it was unnecessary to have done so – your testosterone dosage is yours; mine is mine! Neither is better or worse as long as it works for you!

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Feeling very vulnerable sharing these comparisons but recently many folks have made comments about my body, saying that I must be confident because of how I look; of course I swim in a speedo! So I think it important to note: I did ~not~ begin where I am today. I did not begin with any of the confidence I have today either. I began years ago. That is to say: You begin exactly where you are now. Not where you want to be in 5 years. Five years ago I was heavier & curvier than I’d ever been before. My breasts were larger than DDDs. I had decided to get top surgery. But even after that, I still wore a women’s suit and planned on swimming for the women’s team. I felt so stuck. I had spent my entire life practicing swimming – to be good. To be a winner. I’d begun 4am practices at 10yo, swimming more than 20hrs a week by 12, and was nationally ranked by 15. Swimming on the men’s team meant giving all of that up. After top surgery, I remember standing in the women’s locker room, staring at my reflection. For the millionth time, I wondered what I’d look like in a speedo. I peeled down my suit, pretending. I had been doing that for years before top surgery. But top surgery made the possibility feel so tangible. In that moment, I remember seeing myself. I remember wanting desperately to swim in a speedo, to feel that free, to feel like myself. I stared at the pictures of myself, seeing a mixture of discomfort & resolve. Discomfort knowing that this was not where I wanted to be. But resolve knowing it was absolutely a step in the right direction. And that being myself was really possible. So like I said. I did not start where I began today. I started feeling misshapen, feeling “too curvy” and funky lookin and “too girly” and all kinds of other mean things I used to say to myself. But I chose to stand up anyway. On April 27, 2015, I threw away that potential success I could‘ve had as a female athlete & accepted the coach’s offer to swim for the men’s team. I have not regretted doing so for a second. Because I got to grow into this speedo and truly swim as myself. — I never diet. More info in comments. — #transgender #transswimmer #transathlete #transathletesbelonginsport

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Top surgery was not about proving my manhood. You don’t need top surgery to be a man; be a man your way. Top surgery was also not about “cutting off perfectly good boobs” as many people said. (What are ‘good’ boobs anyway and who gets to decide that @ the patriarchy and cis men.) Top surgery wasn’t at all about other people or pleasing society. Top surgery was for my mind, for my heart, and for my relationship with my body. It was a megaphone message to my heart: I will protect you. I will commit to actions that will bring you peace, even if it means disrupting binaries and going against what society wants from me. — A few FAQs about top surgery: 1) It did not hurt much at all for me. It was mostly itchy. 2) Recovery time? Listen to your doctor! Wait even longer if you’re worried about stretching the scars. 3) I cannot feel my nipples. They have little to no sensation. 4) I went with Garramone because at the time, he was really the only guy doing large chests that I saw producing results I liked. 5) Left is 2 weeks post op, right is today. More questions? Go to pinkmantaray.com/top-surgery. — #transgender #topsurgery #drgarramone #doubleincision #selflove #selfcare #loveyourlines #transformationtuesday

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More recently the facial hair population seems to be increasing, so I thought I’d show a little comparison over the years, as well as current shaved/not shaved. A little confession… facial hair is far more irritating than I ever expected 😂 it to be — the length feels strange, almost ticklish, and I find myself constantly playing with the hairs lol. As always, I want to emphasize that facial hair does not make you a man. Neither does testosterone. You do not even have to take testosterone if you don’t want to or cannot. Your identity as a man alone is what makes you a man. Testosterone can also take YEARS. Facial hair can (and probably will) take YEARS, and depends on genetics. I started T over 4 years ago and only this year has anything really changed with my facial hair. And it might keep changing/filling in, but it also might not! I’ve mentioned this before but: If you’re 5mo on T, you’re physiologically identical to a 13yr old or so boy! Details about how I got to that numerical comparison in the comments!

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