Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy (HRT, for short) is a method many trans guys undertake to alleviate gender dysphoria. Typically, HRT is comprised of taking synthetic testosterone (colloquially known as "T") in either injections or a topical gel. There are many effects that happen to the body when taking synthetic testosterone, though medical research about T is still in its infancy.
There is no one or "correct" way to take T. The dosage and application method are entirely up to the individual and their care provider. Below is information consolidated from medical professionals and real trans guys on their experiences taking testosterone.
No one at the Trans Guy Archive is a medical professional and nothing on this page should be interpreted as explicit medical advice. If you have serious medical questions, contact your doctor or care provider.
A short history of HRT
Hormone Replacement Therapy (HRT, for short) has not been widely available for most of human history. Only during the 20th century were scientists and doctors able to synthesize the hormones to create artificial (but still effective) hormone replacements. Initially, drugs such as Premarin were made from pregnant horse urine, though Premarin is typically prescribed to cisgender women experiencing menopausal symptoms. Many forms of synthetic hormones are derived from natural origins, though many are are entirely lab-created.
With testosterone in particular, the first recorded instance of it being synthesized was in 1935 by Adolf Butenandt in Germany (2). Previously, synthetic masculinization had been observed in experiments where animal testes were transplanted onto other animals. While he may have not been the very first, Dr. Michael Dillon was among early candidates for masculinizing HRT, obtaining a prescription in 1939. Dr. Dillon is also notable for being the first ever recorded trans man to undergo gender confirmation surgery (aka 'bottom surgery').
Currently, synthetic testosterone is usually widely available. Many high-performing athletes and movie stars take forms of synthetic testosterone (which typically have a host of names: "test", "gear", "roids", etc.). For the average trans guy, testosterone is available via prescription from a doctor/endocrinologist.
Sources:
Rostom, Mary, Ranjith Ramasamy, and Taylor P. Kohn. “History of Testosterone Therapy through the Ages.” International journal of impotence research, November 2023. https://pubmed.ncbi.nlm.nih.gov/35075296/.
Salvo, Victor. “Dr. Michael Dillon - Nominee.” Legacy Project Chicago. Accessed September 4, 2025. https://legacyprojectchicago.org/person/michael-dillon.
Vance, Dwight A. “Premarin: The Intriguing History of a Controverisal Drug.” International journal of pharmaceutical compounding, July 2007. https://pubmed.ncbi.nlm.nih.gov/23974785/.
Effects of masculinizing HRT
The Physical
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Your skin will become thicker and more oily as your pores largen and oil production increases
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The smell of your sweat and urine may change. Typically your sweat becomes 'muskier' smelling.
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Fat deposits in certain parts of your body will begin to redistribute. Typically, fat in your thighs and butt will shift toward your abdomen (stomach). This can help you look less curvy, though your bone structure will not change, with some rare exceptions.
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Your breasts may shrink a little and become a bit saggy. This is due to the lower amount of estrogen in the area.
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Gaining muscle will become easier! With the right diet and exercise, many trans guys taking testosterone find their legs and arms have more muscle definition, often with more prominent veins and a slightly rougher appearance.
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Your eyes and face may begin to change shape as fat redistributes. Many trans guys taking testosterone experience "tom cat-ification" where their cheeks become very round for a while as their body adapts to the initial changes.
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Your vocal chords will begin to thicken and your voice will begin to drop, akin to how cisgender boys' voices drop during puberty. Your voice early on testosterone may sound squeaky or similar to a vocal fry, but voice training can slowly fix this. Issues of vocal fry may resolve itself on its own after taking testosterone for many years. Your voice will begin to drop within a few weeks of starting testosterone and will not reach full maturity for at least 5 years.
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Body hair will become more prominent. Hair on your chest, back, and arms will increase in thickness and will become darker. It will also grow at a quicker rate than before. You MAY develop male pattern baldness if other cisgender men in your family also have the condition. Unfortunately, male pattern baldness is not curable, but can be treated with topical medications such as finasteride, minoxidil, etc. Even if you do not experience male pattern baldness, hair thinning on the front of your scalp is relatively common.
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You may begin growing facial hair. This result varies heavily from person to person and each person's facial hair will have different degrees of thickness and coverage. Starting testosterone later in life (40 and above) may result in less overall facial hair growth than those who start at younger ages. Using hair growth treatments like minoxidil may promote the growth of facial hair, though be warned that minoxidil is extremely toxic to household pets!
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There may be vaginal dryness and partial atrophy of the vaginal walls. Not everyone experiences dryness to the same degree. It can be temporarily treated with a water-based lubricant, or treated long-term with a topical estrogen cream - don't worry, the cream isn't strong enough to 'undo' the effects of testosterone.
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Eventually, you may see menstruation slow and/or eventually totally cease. If you experience spotting/bleeding randomly after not experiencing it for a while, talk to your doctor. Some trans guys taking testosterone may not experience a cessation of menses at all. Ironically, an excess of testosterone may return your periods, so it is important to keep to your prescribed dosage.
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After a short time, your clitoris will begin to lengthen and widen. It will also increase in sensitivity. Many people experience uncomfortable chafing against their underwear as the clitoris grows (often referred to as "bottom growth"). Most trans guys taking testosterone will average 1 to 2 inches of erection after growth slows. The size of your growing clitoris depends on genetics. Some 'pump' their clitorises in an effort to increase their size, though it is not confirmed that will make a long-term difference.
The Mental
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You will begin to experience emotions differently. Many trans guys taking testosterone report increased anger, depression, and anxiety. Thankfully, these are all manageable symptoms. Taking testosterone will NOT make you permanently angry, depressed, etc. Many report these feelings lessening the longer they've been on HRT and with external help (e.g. medication/therapy).
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Your libido will skyrocket, especially for those on higher doses. You will frequently become aroused, even by small things. You may find that different things arouse you than prior to starting testosterone. Your kinks and tastes in people may also change. Many trans guys taking testosterone report feeling a stronger romantic/sexual attraction to men/masculinity while taking HRT.
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Orgasms will feel different. Rather than a pleasant, whole-body rush, the pleasant feeling may feel entirely consolidated in your clitoris, lending to the feeling of being "shot" with pleasure.
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Your appetite will increase. You may often feel ravenous, or that you're hungrier more frequently than you were prior to taking the medication. There is not a specific reasoning why this is, though take caution with overeating. It's very easy to eat with your eyes first.
Potential Risks
No medication comes without potential risks. Weigh the risks with your doctor or care provider before starting testosterone. Take note that these are POTENTIAL risks. There is a chance you will not experience any of these, but it doesn't hurt to stay vigilant.
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Testosterone HRT is not birth control. It may lessen your ability to become pregnant, but as long as you have your uterus and ovaries (and were not completely sterile to begin with), there is a chance of conceiving if you have sex with a person capable of producing sperm. If you are looking to conceive a child, your doctor will instruct you to stop taking testosterone, as the medication is fatal to the fetus. You are still able to take birth control, including non-hormonal kinds. You are also still able to take "day-after" types of birth control like Plan-B (though as an external precaution, medications like Plan-B have a weight limit).
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It is unclear if testosterone HRT contributes to an increased risk of high cholesterol and heart disease. Unfortunately, long-term studies are lacking. If you and/or your family has a risk of these conditions, talk to your doctor about ways to mitigate risks.
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Testosterone may make your blood thicker, otherwise known as a high hematocrit count. This can potentially lead to a stroke, heart attack, or other conditions relating to the heart. If you and/or your family has a risk of these conditions, talk to your doctor about ways to mitigate risks.
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It does not appear that testosterone HRT increases the risk of cancer to the uterus, ovaries, or breasts. However, data is still limited and caution should still be considered. During top surgery, they do not remove 100% of the breast tissue, so there is still a theoretical risk of breast cancer.
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Cervical cancer is caused by the human papillomavirus (aka HPV). HPV is transmitted sexually, though some may contract it via other methods. It is important to screen for cervical cancer, though the HPV vaccine can greatly reduct your risk.
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While you do not have a prostate (to the extent someone AMAB does), there is emerging research surrounding a sort of "pseudo-prostate" that trans guys taking testosterone begin to grow while on testosterone HRT. It is currently unclear if trans guys who have been on HRT for an extended time have to screen for prostate cancer.
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If you have had one or both of your ovaries removed, it is critical to remain on at least a low dosage of hormones until the age of 50. This will help your bones to remain strong and avoid osteoporosis.
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Some autoimmune conditions can improve or worsen, as well as migraines. The science behind this is currently unclear. Talk to your doctor or care provider with any overlapping concerns.
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SOME EFFECTS OF TESTOSTERONE ARE IRREVERSIBLE. These include: hair loss on your scalp, voice deepening, facial and body hair growth, and clitoral enlargement. Otherwise, every other effect is reversible (though results may vary).
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YOU CANNOT PICK AND CHOOSE WHAT EFFECTS YOU GET. As annoying as this may be, taking testosterone is similar to a regular genetic lottery. For example, if you don't like having facial hair you can shave/laser it off, but it won't stop growing.
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MICRODOSING TESTOSTERONE WILL NOT PREVENT SPECIFIC EFFECTS FROM HAPPENING. Microdosing HRT is not "I'm only going to get [X]% of effects". It is more like "I'm going to get 100% of my intended effects, but at a rate of [X]%". For example, if you are genetically predisposed to male pattern baldness, microdosing testosterone will not 100% prevent it, but it will slow the rate at which it inevitably happens to you.
Timeline of masculinizing effects
Below is a table showing the expected onset of mental and physical effects from taking testosterone HRT. Remember these are expected timelines. Some people see changes early, others see them much later. This is a general guide to when you should expect to see changes. You also may not experience every change on this list.

What dosage is right for me?
Unfortunately, there is no "one dosage fits all" criteria. Those wishing for a more binary transition may have a higher/more frequent dosing schedule than those who only wish to change things subtly. You can typically choose between injectable testosterone or have it in a topical gel form. Dosing is entirely up to you and what you wish to get out of HRT.
Consult the chart below regarding what "level" of dosing you may prefer when speaking to your doctor. They may recommend a different dose to start you out on.

