Here’s another topic I see a lot of questions about.
I’ll explain the how’s and why’s of the process in a step by step format.
Step 1: Decide that this is what you want
Testosterone, or T, changes you. A lot. You need to know this going in. It’s great for a lot of people because most trans dudes in particular want this. Other people on the spectrum might not want as much change which is completely fine. If you’re a trans guy and want to start T then the doctor will give you enough to be in the average range of a cis guy. For any non-binary people looking to take it, you can request a low dosage.


Step 2: Make a therapist appointment
You will need to be evaluated by a therapist in order to get the hormones from the doctor so this is your first stop. I’m a trans guy and had known this quite awhile before starting hormones so it only took me one session which was covered by my insurance at the time. I was quickly diagnosed with gender dysphoria (they have to code it this way but even most therapist dislike a lot of the terminology) and was given a referral letter to take to the doctor and start hormone replacement therapy.

Depending on your mental state and other factors, it could take any number of visits, but there’s a lot of deciding factors involved. An important thing to note is that not only did I get my letter for T in this visit but I also got a letter for top surgery. This is amazing to have and the earlier you get it the better. Most insurance companies/surgeons require it to have surgeries covered and it’s always better to have things as early as possible.

Step 3: Go to the doctor/endocrinologist
This is who you take the therapist letter to. You will get a physical and blood test to make sure there’s nothing going on that hormones might throw off. Blood tests can typically take anywhere from one day (if the lab is onsite) or a week. Once the results come back clear you will then get your prescription for T.


Step 4: Start taking T
So testosterone comes in many different forms. The most common is in the form of a liquid which is then injected into a muscle. This is what I take so I’ll describe that but keep in mind that there’s also subcutaneous ones and even creams like Androgel.

The first shot I got was given to me by a nurse in the lower hip area. They showed me how to do it and my mom actually gave me my shots for the first few months. Then I moved and started to do them on my own. I’m not flexible at all so I just inject into my thigh muscle. It’s an easy spot and because T is thick it’s easy to inject straight on. The hip was too tricky for me. For the thigh, it’s best to inject into the side of your thigh as it hits a bigger muscle than the top. Because of this, your body is more likely to take to the testosterone better. I’ve also heard guys that inject in the stomach and arm as well. Your shots may also be every two weeks or every week. I started doing them every two weeks and changed to weekly due to moodiness. My mood is much better now and every week is much easier to remember.

Another thing to keep in mind is to have a safe way to dispose of the used syringes like a sharps container.


Step 5: Follow ups and refills
You’ll have to go to follow ups at the doctor so they can make sure your T levels are normal. This will be a blood test and they may adjust your dosage. A common misconception is that more is more, but many trans guys including myself have found that a lower dosage actually has a stronger effect. Too much testosterone will then convert itself to estrogen which is the opposite of what we’re trying to accomplish here.

It’s a case by case thing and everyone’s body react differently. I also heavily suggest getting whatever pharmacy you go pick up at to auto refill your prescription. This will ensure that you always have it the soonest day available and certain places have run out before so this would give them time to order it if needed. If you ever change pharmacies and your price skyrockets or if it just sounds too high to begin with, never be afraid to ask the pharmacist if they used your insurance and how much it covers. My first insurance (United Healthcare) made my prescription $60 a month whereas my current insurance (Blue Shield of California) made my prescription only $15 a month. Money adds up and between therapy, changing documents, and surgery every single dollar can help in a huge way.

by Nathan Grey

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