7 Downsides of Testosterone Therapy: Transmen

A couple of days ago, Nadia and I went for our routine medical check-up. We had been planning to book an appointment with our doctor for weeks. Every time we planned something came up. Finally we managed. We had done some blood test some few weeks before and they were already sent to the doctor’s office.

When one starts transitioning, especially medical transitioning, that is, hormone replacement therapy, you need to go for routine medical check-ups. This will usually involve monitoring your progress with the hormones and how your body is reacting to it. The doctor checks your weight, blood pressure, blood sugar, your liver profile, cholesterol levels and so forth…

After the catching up and updating the doctor on our progress, the doctor highlighted how testosterone is a ‘bad’ hormone and estrogen is a ‘good’ hormone. In other words testosterone has more adverse side effects compared to estrogen. I guess that explains why women have a longer lifespan than men, and why men are considered biologically weak compared to women. Thus I felt a need to talk about the side effects of testosterone replacement therapy.

We transmen yearn so much to start our hormones and rip all the good things it brings, but we need to be aware of the downsides of taking testosterone.
The long-term safety of testosterone is not fully understood. Most of the studies on hormone therapy involve non-trans men taking testosterone at different doses than transmen usually use, and transmen bodies are not exactly the same as non-trans men’s bodies. There may be long-term risks that are not yet known.

1. Testosterone may increase the risk of heart disease, stroke, and diabetes.
Testosterone tends to:
• decrease good cholesterol (HDL) and increase bad cholesterol (LDL)
• increase fat deposits around internal organs and in the upper
• abdomen
• increase blood pressure
• decrease the body’s sensitivity to insulin
• cause weight gain
These changes may increase the risk of heart disease (including heart attack), stroke, and diabetes. The risks are greater for transmen who smoke, are overweight, or have a family history of heart disease. Many of the known contributing factors to these conditions can be reduced by creating a care plan that is tailored to your specific situation. Prevention includes periodic blood tests to keep an eye on potentially risky conditions, and minimizing contributing factors. Stopping smoking, getting healthy levels of exercise, and eating well are key steps you can take to reduce your

2. Testosterone may cause or worsen headaches and migraines.
If you already suffer from migraine attacks, testosterone is most likely to worsen it. If you are getting frequent headaches/migraines or the pain is unusually bad, talk to a health professional.

3. Testosterone may increase red blood cells and hemoglobin.
While the increase is usually only to an average “male” range (which does not pose health risks), a high increase can cause potentially life threatening problems (erythrocytosis) such as stroke and heart attack. Blood tests should be done periodically to check red blood cell and hemoglobin levels.

4. Testosterone may cause water/salt retention in the body
Fluid retention in the tissues, usually marked by swelling of ankles or feet. The chances of this can be reduced by increasing your daily water intake.

5. Testosterone can negatively affect mental health.
There are often positive emotional changes from reduced gender dysphoria. However, in some transmen testosterone can cause increased irritability, frustration, anger, nervousness, depression and mood disturbances. There are reports of testosterone destabilizing transmen with bipolar disorder, schizoaffective disorder, and schizophrenia.

6. Testosterone may cause changes in sleeping patterns.
Insomnia is common during the initial stages. If you have sleep apnea (temporarily stopping breathing during your sleep) it may get worse if you are on testosterone. Let your doctor know if you are worried about this.

7. Testosterone may make you feel pregnant! Well, that’s an exaggeration
You may experience nausea and sometimes vomiting. Changes in sexual desires is to be expected (to others its good but for some it’s a downside. Also acne is commonly reported.

This isn’t meant to scare you. With doctor’s supervision and discipline, all more than often, goes well.

Source: Trans Care Gender Transition  by Olivia Ashbee and Joshua Mira Goldberg

The information contained herein is to be used for educational purposes only. The author is not a medical professional, and this information should not be considered medical advice. This information should NOT be used to replace consultation with or treatment by a trained medical professional.

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2 Comments on “7 Downsides of Testosterone Therapy: Transmen

  1. Please could you share your source on the reports of bipolar destabilisation in transmen

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