This article was reviewed by Jess Schwab, DNP.
Getting to the place when you are finally ready to start hormone replacement therapy (HRT) can be an exciting and sometimes daunting experience for many transgender and non-binary people. Most of us were raised in a cultural context filled with fear-mongering anti-trans narratives about the irreversible biological effects of hormones such as testosterone. This, paired with the lack of research and trans-competency in the medical field can make the process of deciding to go on hormones confusing and scary for a lot of people. That’s why we compiled a list of the top nine myths that you might have heard about going on testosterone HRT.
Obviously, everyone’s experience of going on hormones is unique and entirely their own. The myths surrounding testosterone are often widespread misconceptions that people believe are guaranteed to happen when they start taking HRT. While some people might experience some of these to a certain degree, these are by no means automatic outcomes of going on hormones. Many people have varying and nuanced experiences with the emotional, psychological, and physical changes of hormone replacement therapy. We’ve compiled a list of the 9 top myths you might have heard about testosterone HRT and worked with our trusted clinicians to address each one of them. Here is everything that you need to know is true and not true for transgender and gender-expansive people taking testosterone HRT.
1. Taking testosterone will make you angry or violent.
This is one of the myths that our clinicians hear most often. The misconception that taking testosterone will somehow make someone angry, violent, or emotionally unstable is widespread. A lot of people who are considering taking T might fear this, even if they have thought critically about gender before. So where does this myth come from? When it comes to testosterone, there is this idea that masculinity is innately violent. Even though it’s been proven time and time again that the biological link between higher levels of testosterone and aggression or violence is weak, if not completely nonexistent, many people still believe in this correlation. It is easier to reduce toxic masculinity down to biology rather than unpacking why some men and masculine people act out of anger or aggression and trying to help those individuals heal, understand, and ultimately be accountable for their actions.
“Sometimes new emotions come up as we start to become more comfortable with ourselves, and this could include any emotion, even anger."
Nathan Levitt, one of our clinicians at FOLX, puts it this way. “Sometimes new emotions come up as we start to become more comfortable with ourselves, and this could include any emotion, even anger. Everyone is different. I’ve been on testosterone for 15 years and this hasn’t been my personal experience, nor an experience I’ve heard often from patients. Hormones do affect mood though, so sometimes you might feel irritable when you’ve missed a shot or your levels change.” Or perhaps when you are feeling #hangry. The good news is that taking testosterone HRT won’t change who you are or mean that you suddenly develop personality traits that weren’t already present.
2. You will lose your ability to cry.
Another common myth is that going on testosterone will prevent you from being able to cry ever again. While some people might find it more difficult to cry, there are many factors at play. Rocco Kayiatos spoke with us about the changes he experienced after going on testosterone. “I had two emotional experiences before I started testosterone: anger and frustration. After I started hormones and my body and face started to match my mind's eye version of myself, I started to feel a full range of emotions and found myself able to access tears more often and more easily.”
It’s important to remember that for everyone, this will be different and nuanced. We all have a wide variety of emotions and processing styles that may or may not intersect with our gender expression. You might find it easier or harder to cry at various moments in your life depending on your emotional circumstances, your healing journey, or the world we live in. Some people might find it more difficult to cry after starting testosterone while others will find it easier or experience no difference in this area of their life. Remember to accept yourself where you are at and know that things can change.
3. Testosterone makes your monthly bleeding stop, forever.
While taking testosterone often halts the process of menstruation (depending on the dosage) you might find that monthly bleeding comes back periodically, especially if your levels decrease. While some transgender people find they stop bleeding between two to six months when first taking T, others continue to spot or continue menstruating, especially if on a lower dose. Being on testosterone HRT does not completely guarantee that you will stop ovulating or menstruating forever. If stopping monthly bleeding is an important goal of yours, there are a variety of ways this can be managed with your provider here at FOLX.
4. Testosterone makes you infertile or unable to get pregnant.
Many people believe that testosterone HRT makes you automatically infertile. The long-term results of testosterone HRT on fertility are unknown, but many transgender men and non-binary people are able to pause HRT and get pregnant. It is still possible to ovulate while on testosterone HRT (even if you aren’t bleeding) and, therefore, get pregnant—unless you have had a hysterectomy. If you are on testosterone HRT, it is important to use birth control or condoms when having the types of sex that might result in pregnancy.
5. Gel doesn’t work “as well” as shots.
Testosterone gel is just as effective as injectable T, depending on the dose. T gel is just a different route of taking T, as it is a topical gel that is absorbed into the body and allows for more gradual changes.
6. Your sexuality and sexual preferences will change.
You might have heard other people say that taking testosterone makes you gay. Some people do find that once they take testosterone, the experience of being seen as more masculine and/or a man can change who they are attracted to. But there are a variety of reasons why our sexualities might change over the course of our lives, some related to gender and experiences, and others not. Many people find little to no changes in their sexual preferences after taking hormones. Remember that gender and sexuality are two different things— while they might be connected or influenced by each other for some, they are fully distinct and separate for others.
7. Testosterone increases risk of cancer.
Taking testosterone will not outright give you cancer. There is limited data and studies available on the incidence of age-related effects of HRT, including cancer, because of the lack of investment more broadly in trans healthcare. Transgender people on HRT should keep up with routine cancer screening protocols, the same as cisgender people. Poor health outcomes in trans and non-binary populations are likely linked to inadequate access to affirming healthcare providers and delayed routine screenings, rather than the use of gender-affirming hormone therapy.
8. Going on testosterone will make you unattractive and you’ll have a hard time finding anyone who wants to be with you.
While it’s not completely scientifically backed, it’s a well-known fact that transitioning (socially, medically, or by any other means) makes you hotter. What could be hotter than someone breaking through stigmatized social barriers to realize your true authentic self? Often, the beauty standards that we internalize from a young age are based on cis-centric notions of the gender binary. It can be hard to work through and unlearn the narratives that we have learned from an early age about transgender and gender-expansive people. Many people have the fear that they won’t be attractive or that by transitioning, other people will no longer find them attractive or worthy. We are here to tell you that transgender and non-binary people are some of the hottest people we know.
9. HRT is an irreversible process and linear experience that you have to be on for life.
It’s important to know that HRT is just one component of gender expression and transitioning. Some people find that staying on hormones at a steady dose works best for them, while others go through periods of pausing and restarting hormones. Some changes are permanent (such as bottom growth, hair growth, and deepening of the voice) but others are reversible. For many people, their experience on testosterone HRT is not a one-directional journey from point A to point B. Once you start, you can always reduce your dose or come off HRT completely. Whether you are already on T or considering taking it, you should feel empowered to have all the information you need to make the best decision for you. Remember that everyone’s bodies and timelines are different, and comparing yourself to other people is not helpful. We all have complex lives and experiences with our genders, bodies, and transitions. Take the pressure off, be patient with yourself, be generous, and give yourself as much time and space as you need to figure it out.
For those ready to get started with FOLX for testosterone, the process begins here. For existing FOLX members with questions about testosterone, don't hesitate to schedule time with a clinician. And for those who’ve just got some more questions, read up on testosterone here or feel free to reach out to us at email@example.com.