A Quick Guide to Testosterone

From the Transgender Man’s Perspective

The Testosterone Molecule. Image by Mario Olaya from Pixabay

Early experiments with testosterone go back as far as 1767, long before the word itself was coined. Testosterone was isolated and named in 1935 by Ernest Lacquer¹. This was the start of the endocrinology of testosterone and male reproductive physiology.

Historically testosterone has been a treatment for hypogonadism in adult men. In more recent decades, it’s also become a treatment for gender dysphoria in transgender men. In this article, I want to touch on what testosterone is known to do and dispel some of the myths about what it doesn’t do.

For the purposes of this article, I will be focusing on fully developed humans. There are additional effects on developing fetuses in the womb that I am not including.

What Testosterone Does

Testosterone effects a number of systems, regardless of our biological sex. It’s more dependent on the levels it occurs at. These hold true whether the levels are naturally occurring or are from hormone replacement therapy (HRT).

At Higher Levels

The range for testosterone in men is around 280 to 1,100 ng/dL². At these levels, the following changes happen in the body³.

Body and facial hair growth.

Deepening of the voice due to the vocal cords enlarging.

Growth of the genitalia.

Increased libido.

Increased muscle size and strength.

Increased chance of hair loss.

If the testosterone levels get too high, these potential side-effects can also occur:

Damage to the heart muscle, which increases the risk of heart attack.

Damage to the liver.

Increased acne.

Increased appetite and weight gain.

Also, when levels get too high, testosterone can begin converting to estrogen⁴. While this is not a common occurrence in people who are not taking HRT, there are a number of side effects when this does happen, including the development of gynecomastia⁵.

At Lower Levels

On the other side of the scale if a person has lower testosterone their body may exhibit features that are more commonly associated with biological females, such as³:

Reduced or loss of visible body hair.

Reduction of muscle mass.

Decreased libido.

Increased breast size.

Osteoporosis.

What Testosterone Doesn’t Do

There are a number of myths regarding testosterone that I feel need to be debunked.

Testosterone Creates Better Athletes

There were studies released that indicated that athletes with higher testosterone levels performed better than athletes with lower levels. Those studies were found to be flawed⁶. In fact, upon reexamination of the data and removing erroneous duplicate data points, the studies actually showed that athletes with lower testosterone in general performed better or the same to those athletes with higher testosterone levels.

Testosterone is Exclusive to Men

It’s a commonly held misconception that testosterone only exists in male bodies, and that taking any amount of testosterone will turn a woman into a man. The truth is that both males and females have testosterone and estrogen in their systems, albeit at different levels⁷. As a side note, estrogen is not a single hormone. There are three hormones that are considered estrogens: estradiol, estriol, and estrone⁸.

Regardless, both types of hormones are part of every person and has a function in our bodies. Neither is exclusive to a particular biological sex. In fact, there are some treatments for females that include taking low levels of testosterone⁹. As long as the dosage is carefully controlled, no male traits will develop.

Testosterone Causes Baldness

While baldness occurs more often in males than females, both male pattern and female pattern baldness exist¹⁰. Testosterone levels are not the cause of baldness in either sex. Instead, genetics is most often the culprit, although stress and even certain hairstyles can contribute to hair loss.

Why Transgender Men Take Testosterone

Taking all of those facts into account, transgender men take carefully prescribed doses of testosterone in order to facilitate our transition from female-to-male. As I stated earlier, if the dosage of testosterone is low, no male traits will develop. However, transgender men want that particular side-effect from testosterone.

Testosterone is a controlled substance and should only be taken under the supervision of a doctor, preferably an endocrinologist. If testosterone levels are too low, then the masculine changes that are desired won’t happen. If the levels are too high, then testosterone may start converting into estrogen and causing the opposite effects as desired.

However, if the dosage is correctly controlled and elevates a transgender man’s testosterone levels to within the normal male range, then the desired effects can be achieved. At the correct levels, a transgender man will experience the equivalent of a second puberty. Many of the effects young men experience during their puberty, as mentioned above, will occur. For example, our voices will begin to crack and deepen, and body and facial hair will begin to grow. At these carefully prescribed doses, testosterone has a very masculinizing effect, and that’s why we take the hormone.

Most changes for transgender men are done simply by taking testosterone. We require far fewer surgeries than transgender women do, and some transgender men opt not to have any surgeries at all. If our breasts are small enough, then the combination of taking testosterone and lifting weights can sometimes be enough to develop a masculine chest without surgery. For others, if we don’t want surgery, we’ll often wear a garment known as a binder to flatten our chests and make them look more masculine.

Since testosterone also causes our genitalia to grow, we don’t always require genital surgery. Some transgender men do have a lot of dysphoria regarding that part of their anatomy and will opt for phalloplasty¹¹, but many of us either opt for the simpler metoidioplasty¹² procedure or opt for no lower surgery at all.

Ultimately, the main goal of our transition is to be perceived as men in society, and testosterone does the most to help us achieve this.

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