Transgender hormone therapy is a form of hormone replacement therapy (HRT) in which sex hormones or other hormonal medications are prescribed for the purpose of getting the patient’s secondary sexual characters to align with their gender identity. Secondary sex characteristics are features that surface during puberty. For example, secondary sex characteristics can show up in the following ways:
Much like non-binary top surgery it’s hard to speak to the specificity of what would constitute as a non-binary HRT treatment plan. What we can do is talk about HRT for testosterone and some information on the ‘usual dosage’ and a ‘lower dosage’ that some non-binary patients may (or may not be) interested in. Not all trans and non-binary people chose to start hormones or get top surgery and any decision is valid.
Historically a ‘referral letter’ from a mental health professional was required in order to receive hormone therapy. However, experienced providers or larger volume trans healthcare clinics may use the ‘informed consent’ model to initiate hormones (therefore a referral may not be necessary). WPATH Standards of Care 7 indicates either is acceptable. However many insurance companies will require you to obtain a referral letter in order for them to cover your hormones. A wide range of medical providers (primary care physicians, endocrinologists, physician assistants, advanced practice nurses etc.) have the ability to prescribe gender affirming hormones. Despite the ability for a variety of medical providers to prescribe hormones, some may not due to lack of knowledge about the positive benefits of hormone treatment.
The goal of ‘masculinizing hormone therapy’ is the development of male secondary sex characteristics, and suppression/minimization of female secondary sex characteristics. General effects may include a redistribution of body fat, increased body hair, facial hair, deepening of voice etc. The T dose that most providers will start you on varies by the method of delivery (injection, oral, topical). In the United States, most prescribers follow a dosage guideline that has been designed for cisgender men with low androgen levels. Cypionate Testosterone is often prescribed as it is more widely covered by insurance and is readily available in most areas of the U.S. The method of delivery for Cypionate Testosterone is usually injection (intramuscular or subcutaneous). The initial dose (all done weekly) is usually 20 mg (which is considered a ‘low dose’), the initial typical dose goes up to 50 mg and the maximum typical dose is 100 mg. There is no ‘regular dose’ just a majority average and dosage varies greatly from person to person.
Testosterone effects everyone differently and you can’t pick and choose which changes you get when taking hormones (deeper voice, facial hair, fat re-distribution). This means you should weigh out the reversible and irreversible changes that come with being on T in order to make an informed decision. As you can tell from the wide range of dosing there is a great deal of flexibility as far as what your typical weekly dose could look like. It’s important to have a discussion with your provider regarding the goals you have around starting T so they can assist with individualizing your dosage.
The lower the dose the slower and more gradual the changes are, the higher the dose the faster and more drastic changes are. Some personal accounts from non-binary folks on a very low dose of T reported that the changes were gradual enough that they felt like they had room to explore the physical changes they wanted out of their alignment without their physical characteristics changing too quickly. If you want to start T but your goals are ambiguous then a low dose affords you time to think while experiencing gradual changes along the way.
Making the choice to start testosterone doesn’t mean you have to continue to take testosterone indefinitely. If you aren’t liking some of the effects of testosterone it’s best to contact your provider to discuss what your options and if you decide you want to stop all together they will be able to assist you with that. Reversible changes once you’ve stopped taking T are acne, body odor, oily/coarse/thick skin and muscle-fat redistribution (mostly around the hips, thighs and stomach). Irreversible changes after going off T are: Genital growth, voice drop, male-pattern baldness, and facial/ body hair.
More information on testosterone can be found here, but to sum up what we’ve discussed today: