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Microdosing Testosterone

Medically reviewed by Paul Gonzales on February 16, 2024.

Microdosing testosterone is an approach to hormone replacement therapy (HRT) or gender-affirming hormone therapy (GAHT) that involves taking low doses of testosterone either to produce the desired physical changes either indefinitely or for a short period of time. Microdosing testosterone HRT can provoke subtler or more gradual changes in the body that are considered conventionally masculinizing: a deeper tone of voice, increased hair growth (on the face, chest and other parts of the body), a redistribution of fat and more.

In this article, we will go over common reasons why patients choose to microdose, common dosage options, how microdosing affects surgical eligibility and real-life testimonies about receiving treatment. While microdosing testosterone is a common topic of discussion amongst the non-binary community, this approach helps ease dysphoria for those who identify within the binary as well. Learn more about how to access testosterone here.

Please note that this page is for informational purposes only and should not be taken as medical advice. The Gender Confirmation Center only performs gender affirming surgery and does not prescribe hormones to patients. Going on hormones or changing your hormone dose or regimen can carry a variety of risks, which is why it should only be done under the guidance of a medical provider who specializes in gender-affirming care.

Why microdose? 

As a method of HRT, testosterone impacts someone’s secondary sex characteristics. In this context, secondary sex characteristics are the changes to the body during adolescent puberty that can be altered during hormone replacement therapy or HRT. To learn more about what secondary sex characteristics are and/or what changes to expect while taking testosterone for HRT, visit UCSF’s guide to masculinizing hormone therapy.

While taking “standard” doses of testosterone (see information on dosage below), the changes to secondary sex traits can happen quickly and will eventually reach a maximal effect. On lower doses of testosterone, the physical changes are more subtle and occur gradually. Microdosing can be an ideal way to administer testosterone for masculine-spectrum non-binary and gender expansive patients who might want to achieve more subtle or gradual changes to their bodies without a drastic adjustment. Specifically, microdosing testosterone is often sought out as a treatment option for the following reasons:

• Initial low dose: In general, hormone therapy begins with a low dose and is gradually increased depending on the patient’s response to hormones or desired changes.
• Easing into physical changes: Some patients will begin with microdosing testosterone to ease into physical changes and see how they feel. On certain occasions, patients will wait until they have experienced certain irreversible changes like a deepening voice or bottom growth (the growth of the natal erectile tissue sometimes referred to as a penis or clitoris) before stopping.
• Pre-existing conditions: Microdosing might be helpful for someone with pre-existing medical conditions that might be exacerbated by the use of testosterone. For more information on the impact of testosterone on pre-existing medical conditions, visit UCSF’s guide to masculinizing hormone therapy. In rare cases where someone’s mental health could be worsened by the use of testosterone, going on lower doses of testosterone has the potential to alleviate some of these concerns. Research has shown the positive mental health benefits of starting hormones and how an open and honest conversation with physicians and mental health providers can help determine what HRT regimen and dose is right for you.
• Economic challenges: Microdosing testosterone could be a suitable option for someone facing economic challenges. When microdosing, less testosterone is administered per dose. This can help spread out the amount of testosterone over longer periods of time, making lower doses a more affordable option. Some insurance providers cover testosterone and other trans health care options. Consult with your specific provider if you have questions about the costs of testosterone and insurance coverage.

It should be noted that for some trans people who take testosterone, menstruation may continue, while for others, menstruation may end.  If periods are a cause of gender dysphoria or discomfort, this is something to consider when exploring what dosage will be ideal for you. Other considerations for choosing the right dose include reproductive health, fertility goals (such as access to fertility preservation), surgery goals, and medical history. Speaking honestly with your provider to talk about your goals can help guide the discussion on dosing.

Options for Microdosing Testosterone

There are many ways to administer testosterone into the body, and almost all of them have options for microdosing. The following information comes from UCSF Transgender Care:

Injecting: A “normal” dose of injectable testosterone is somewhere between 50 and 100mg every week. An injectable microdose would be around 20mg per week. Injections are either intramuscular or subcutaneous.

Gel: Testosterone gels come in multiple concentration levels, so make sure you understand how much to use and how often to use it based on your prescription. Generally speaking, for gels with 1%  concentration, a “typical” dose is somewhere between 50 and 100mg per day, and a microdose is in the 12.5 to 25mg per day range. For gels with 1.62% concentration, a “normal” dose is between 40.5 and 67.5mg per day, and a low dose is around 20.25mg per day.

Cream: Similar to gels, a “typical” dose of testosterone cream is somewhere between 50 and 100mg per day, and a microdose is around 10mg per day.

Patch: Testosterone patches come in 2mg or 4mg options. “Normal” doses fall somewhere in the 4 to 8mg per day range, and a low dose is around 1 to 2mg per day.

Mythbusting

There is a lot of misinformation about what one can expect when starting testosterone. To learn more about myths related to testosterone use, head to the bottom of our testosterone page.

Will microdosing affect my ability to undergo gender-affirming surgery?

At the Gender Confirmation Center we strive to make gender-affirming surgeries accessible to patients who have traditionally been marginalized within transgender healthcare: non-binary patients, patients with high BMIs, patients with disabilities and senior patients. We strive to make the highest quality gender-affirming surgical care available and affordable to patients who do not conform with the gender binary. Below are our guidelines and recommendations around surgical eligibility and testosterone HRT:

• Top surgery:

• • • Undergoing testosterone HRT is not a requirement for chest reconstruction, breast reduction or breast augmentation procedures.
    • Some patients try to develop their pectoral muscles through weight training so that their surgeon can contour their top surgery incisions/scars to their muscle border. Testosterone can help with this process, though it is not necessary.

• Body contouring:

• • • Though hormone replacement therapy (HRT) is not a requirement for surgery, it can have a positive effect on fat redistribution and changing someone’s gluteal shape. For patients whose transition process involves HRT on regular or full doses, we recommend that you wait until at least a year has passed on hormones before undergoing a body contouring procedure. Still, many patients experience difficulty with reducing or increasing fat reserves around the hips, legs and buttocks with HRT, exercise and diet alone. This is why even with hormone usage, some find it necessary to undergo a body contouring procedure (gender-affirming liposuction or fat grafting) to feel aligned with the shape of their bodies.

• Facial surgery:

• • • HRT is not a requirement to undergo facial surgery. HRT can only alter soft tissue such as fat redistribution–most commonly, the amount of fat in the cheeks and the softness of the jawline. That said, the effects of HRT cannot change bone structure, which is why many patients seek out facial surgery to change the overall structure of their face. Though not a requirement, if you are considering or currently taking HRT, talk to one of our surgeons about how that might figure into your gender affirming facial surgery plan.

• Bottom surgery:

• • Dr. Ley does not require patients to undergo HRT for bottom surgery. If you have specific questions about your case, you can schedule a free, virtual consultation with her here.
  • Some patients who microdose testosterone might still experience menstruation. Undergoing a hysterectomy can allow a patient to stop monthly bleeding without having to increase their testosterone dosage. That said, a hysterectomy is a sterilization procedure, which is why we recommend our patients look into their options around fertility preservation first.
  • Patients who are interested in getting a metoidioplasty are often encouraged to undergo a full dosage of testosterone HRT for 1-2 years after to maximize their chances of bottom growth. That said, the natal erectile tissue (sometimes referred to as a penis or clitoris) does not always grow as a result of exposure to testosterone. Bottom growth is also not a requirement to undergo this surgery with us. Additional procedures like a mons resection can be performed to help emphasize the appearance of the penis after a metoidioplasty when and when there has not been enough bottom growth for a patient’s liking.

If you have questions about how microdosing might affect your surgical outcomes, you can schedule a free, virtual consultation with one of our surgeons today.

Personal accounts of microdosing testosterone 

Below are some personal accounts of people who have chosen to microdose testosterone. Folks explain the benefits and side effects of microdosing testosterone, and how they talked to their medical provider about microdosing.

• Marisa Rivas, Micah Rajunov, and others tell their stories with the help of NBC news. They document their journeys with hormones and providers and discuss how to support fellow non-binary folks through online and in-person support groups.
• Alyza Enriquez discusses their hormone journey, non-binary gender identity, and navigating the medical system and health providers with the help of Vice.
• On this blog, Micah discusses his journey with microdosing. He gives advice for talking with doctors about going on low doses of testosterone and talks about his history with intermittent hormone use.

In summary

• This page is not meant to be medical advice. You should seek out a consultation with transgender-competent medical providers before starting hormones or adjusting your hormone dosage. 
• There are many trans, non-binary, and gender-expansive people that choose to microdose testosterone for different reasons. You do not have to only identify as non-binary to microdose testosterone; microdosing could be a good option for many folks.
• There are many ways to administer testosterone in lower doses. Having an open and honest conversation with your medical and mental health providers is key to finding the right regimen for you.

Talking to your doctor about microdosing does not have to be a scary thing. The World Provider Association for Transgender Health’s standards of care recommends microdosing for non-binary people, and many providers are already knowledgeable about the benefits of low doses of testosterone.