Transmasculine HRT

Some transgender men and transmasculine non-binary people choose to undergo hormone therapy to masculinise their bodies and resolve body dysphoria. In most cases, this also has positive effects on physical and mental health.

If you are looking to pursue HRT, it is highly recommended to seek advice from qualified medical professionals to assess your suitability for HRT and better understand its risks and benefits.

Proper medical supervision and regular blood tests are required to ensure your medical safety. Ideally, you should take a blood test before starting HRT to check your baseline hormone levels. This also checks if you have any medical conditions or are on any medication/treatment which may interfere with HRT.

HRT changes your biological profile to that of the sex you are transitioning to, and this includes the respective health risks for each sex. HRT thus also affects blood test results, which should be measured against that of others of that sex.

HRT is well supported and recommended by medical authorities as the appropriate treatment for transgender people with body dysphoria.

After gonadal removal, HRT is necessary for proper health function, as your body would no longer produce its own sex hormones, and without HRT will result in health problems similar to that experienced at menopause and andropause.

If you wish to pursue HRT, you should consult a qualified healthcare professional. HRT is safe when done under proper medical supervision, with regular blood testing to ensure that everything is fine. If cost is a concern, consider going to the public healthcare system rather than seeing a private doctor.

We strongly caution against obtaining hormones through the black market, due to the high potential for dangerous side effects.

As an example, a batch of testosterone purchased online by a member of the Asia-Pacific Transgender Network was tested and discovered to contain petrol. Other sources may be severely watered down and consist primarily of oil, or may be mixed or laced with toxic substances like mercury that could cause serious damage to your body.

In other cases, consistency may be an issue, where what seems like the same dosage may end up introducing wildly different levels of hormones into your body.

Introduction to masculinising hormone therapy

A person’s hormonal profile is dependent on the gonads they were born with. Most people undergoing transmasculine hormone therapy would have ovaries, and thus the chief clinical goal of the treatment would be to decrease and eliminate the effects of estrogen and increase the level of testosterone in the body so that its masculinising effects can take place.

Testosterone (T) is the main sex hormone used in medical transitions to masculinise the body. It is responsible for and determines the body’s secondary sex characteristics, much like estrogen and progesterone in women.

While it is most commonly delivered via injections, transdermal applications (patches, gels, creams), oral pills, or implants may also be used, though these are rarely available or not available in Singapore.

Anti-estrogens are not needed for transmasculine HRT as T is usually sufficient to masculinise the body.

Sex hormones affect the brain, influencing cognition, emotions and behaviour. Androgens and estrogens both play roles in regulating sexual desire and arousal.

Obtaining masculinising hormone therapy in Singapore

Your doctor will assess your suitability for hormone therapy and discuss the risks and benefits of treatment. Ideally, you’ll first be given baseline laboratory blood tests to determine if you have any concurrent medical issues that may affect your suitability for HRT or your dosage level. This also allows your doctor to know if any future medical concerns are due to HRT or pre-existing conditions.

These tests should be repeated regularly after treatment is initiated to ensure that everything is going fine, after which the frequency can be decreased to about once a year.

Some doctors will recommend starting on a low dose and gradually ramping up to normal dosage levels so as to give your body time to adapt. If you are a singer, this process may also help to protect your voice by slowly breaking it in.

Other doctors may not do so, however, because of logistical difficulties (managing and charging for the flux in hormone levels and HRT administered).

Take a look here for more information on how to obtain gender-affirming hormone treatment in Singapore.

Forms & delivery of testosterone

Many forms of T can be used for HRT. However, options in Singapore are limited to Depo-T (testosterone cypionate), Sustanon 250 (combination of 4 esters), Nebido (testosterone undecanoate), and Androgel. Additional information on other forms of testosterone can be found here.

While healthcare professionals in Singapore prefer intra-muscular injections, subcutaneous injections are an alternate delivery mode for Depo-T and Sustanon 250.

Depo-T and Sustanon 250 can be self-injected, but Nebido must be administered by a healthcare professional.

Possible allergies

The cheapest and most common form of testosterone, testosterone cypionate (of which Depo T is a branded version of) is suspended in cottonseed oil, which some people are allergic to. Testosterone enanthate is a similarly-priced alternative suspended in sesame seed oil, but is not presently available in Singapore.

Sustanon 250 is suspended in arachis (peanut) oil. While it is tentatively deemed safe for those with peanut allergies, caution is still advised, and if you have a severe allergy to peanuts (or soy), it is best you stay away.

Signs of an allergic reaction include spreading redness and swelling at the injection site as well as itching. Some soreness is normal after an injection and should go away after a couple days.

Speak to your health provider should you have any concern about allergic reactions to HRT.

Expected changes on transmasculine hormone therapy

Effects of masculinising HRT will often include: deepening voice; increased muscle growth and strength, increased energy and appetite; clitoral growth; decrease in fatty breast tissue; cessation of menstruation; growth/thickening of facial and body hair; increase in libido (especially with respect to visual stimuli); increased sweating; rougher and more oily skin; changes to body odour; reduction in fat-to-muscle ratio; fat redistribution away from hips, thighs and buttocks to the abdomen; increase in gross motor skills with decline in fine motor skills; and an increase in bone density.

Every person’s body is ultimately different, and expected changes will likely vary significantly between individuals due to factors like genetics, diet and hormone levels as well as HRT regimen and at what age HRT began.

Anecdotal reports include slight increases in height, feet and hand size. For those who go on HRT as adults, this is due to cartilage and muscle growth rather than bone growth.

Some potential side effects include acne, mood swings, anxiety, hot flashes and other menopausal symptoms, loss of fertility, increased risk of heart disease, polycythemia (overly high red blood cell count), vaginal dryness and atrophy, and male pattern hair loss.

Should you choose to stop HRT for any reason – from finances, health, a desire to have children, an inability to socially transition, or a desire to detransition – it is important to note that some effects of T will remain permanent.

While there is a general timeline where you can expect the effects of T to show in your body, the speed and extent of your bodily changes differs from person to person. This can be affected by your dosage, dose frequency, delivery method, and your body’s sensitivity to T. Most major changes set in within 2-5 years, though your body continues masculinising beyond that and it may take up to a decade (or longer) to see the full extent of T’s effects on your body.

This list is non-exhaustive, and represents only effects most commonly experienced by those on T. You cannot pick and choose which effects will occur to you, when they will occur, and to what degree. However, going on low dose T may help in achieving slower or fewer effects. Looking at AMAB relatives may also act as a guide for what you can expect, but that does not necessarily account for all the changes you may experience on T.

It is crucial to remain patient if you have yet to see any change. Do not increase your dosage or combine steroids without consulting your doctor’s guidance. This is because:

1. Your body converts excess T into estrogen (using an enzyme called “aromatase”)
2. This instead feminises your body, countering the effects of T and increasing the likelihood of health risks, especially with your heart and liver.

Some effects of a previous feminine puberty cannot be reversed with transmasculine hormone therapy; skeletal changes – like widening and rounding of the pelvis – cannot be reversed after your growth plates close during puberty.

Notes on fertility

HRT usually but not always results in infertility – but there is still a very small chance of getting pregnant even while on testosterone. Take all necessary precautions, especially since cessation of menstruation would not be available as a sign of pregnancy.

Loss of fertility may or may not be reversible upon cessation of HRT, depending partly on how long it has been. Some trans people thus choose to bank their sperm or eggs prior to undergoing HRT.

Others temporarily pause HRT while they attempt to have a child, with success varying on a case-to-case basis. Trans men on HRT who wish to get pregnant have to stop T for several months to a year (testosterone could harm a fetus) and undergo a regiment of female hormones.

Risks and tests

To monitor your health, doctors will perform some lab tests on your body. These mostly test for your testosterone levels, red blood cell (RBC) count, liver function, clotting factor, and lipid profile.

You can take a look at this guide for more information.