How Testosterone Therapy Supports Transgender Health and Gender Affirmation

Introduction

Testosterone therapy is one of the most important medical treatments in transgender health care. It is used mainly by transgender men (people assigned female at birth who identify as male) and by some nonbinary people who want their body to have more masculine traits. This therapy is considered part of “gender-affirming care,” which means it helps align the physical body with a person’s gender identity. Gender-affirming care has been shown to improve mental health, reduce distress linked to gender dysphoria, and increase overall quality of life.

Testosterone is a hormone that plays a key role in the development of masculine features such as a deeper voice, facial hair, and increased muscle mass. In people who were assigned male at birth, testosterone is produced mainly in the testes. In people who were assigned female at birth, the ovaries produce smaller amounts. For transgender people, taking testosterone as a prescribed medication helps bring hormone levels closer to those found in cisgender men. This change allows the body to slowly develop characteristics that match the person’s gender identity.

The therapy can be given in different forms. Common options include injections into the muscle or under the skin, gels that are applied to the skin, patches that deliver testosterone over time, and small pellets placed under the skin that release the hormone steadily. In some regions, oral tablets are available, though they are less common because of concerns about liver health. Brand names exist for each method, such as AndroGel® for topical gel and Testopel® for pellets. The choice of method often depends on access, insurance coverage, comfort, and medical advice.

The introduction of testosterone therapy into transgender health care has been a turning point in medicine. In the past, many transgender people faced barriers to getting treatment, including stigma, lack of medical knowledge, and restrictive laws. Over time, scientific research and professional guidelines have made testosterone therapy safer and more widely available. Today, many international organizations, including the World Professional Association for Transgender Health (WPATH) and the Endocrine Society, recommend it as a medically necessary treatment for those who need it.

This article is designed to answer the most common questions people ask about testosterone therapy in relation to transgender health and gender affirmation. The questions often include: who can begin therapy, what physical and emotional changes to expect, how it affects fertility, what the risks are, and how long treatment must continue. Other concerns include the cost of therapy, how it is monitored by doctors, and how access may differ depending on health systems and laws. These are important topics, and clear information can help individuals and families understand what testosterone therapy involves.

One of the main goals of testosterone therapy is to ease gender dysphoria. Gender dysphoria is the distress that comes from a mismatch between one’s assigned sex at birth and one’s gender identity. This distress can affect mental health, cause anxiety, depression, or social difficulties, and lower a person’s overall quality of life. Research has shown that when transgender people begin testosterone therapy, many experience a significant improvement in mood, self-esteem, and confidence. These improvements are not only linked to physical changes but also to the sense of being recognized and affirmed in their gender.

It is important to understand that testosterone therapy is not a “one size fits all” treatment. The effects of therapy depend on many factors, such as genetics, age at the start of treatment, overall health, and the dosage prescribed. Some changes, like a deeper voice, are permanent. Others, such as changes in muscle strength or fat distribution, may be partly reversible if therapy is stopped. Because of these differences, medical supervision is always recommended. Doctors usually carry out blood tests before starting therapy and continue them regularly to check hormone levels, red blood cell counts, and overall health.

In addition to the physical effects, testosterone therapy carries medical considerations that must be monitored. Like any long-term treatment, it has potential side effects and risks. These include acne, changes in cholesterol levels, and possible impacts on cardiovascular health. However, with proper medical supervision, most risks can be managed. Monitoring allows adjustments in dosage and helps keep the therapy safe.

Another point that often arises is fertility. Testosterone therapy usually stops menstrual cycles and reduces fertility, though it does not act as birth control. For individuals who may want biological children in the future, fertility preservation options such as egg freezing can be considered before starting therapy. This is an important topic to discuss with a health care provider, since decisions about family planning are often deeply personal.

Cost and access to testosterone therapy vary around the world. In some countries, it is covered by health insurance as a medically necessary treatment. In others, individuals must pay out of pocket, which can make long-term therapy harder to maintain. Even when insurance covers testosterone, access may be limited by geography, provider availability, or local regulations. Advocates continue to work toward improving access and reducing barriers, since consistent therapy is essential for health and well-being.

This article will explore each of these issues in depth, section by section. It will look at the science of how testosterone works, the practical aspects of administration, the expected physical and emotional changes, the health benefits, and the risks that need monitoring. It will also explain how therapy interacts with fertility, how long treatment may last, and what financial and legal barriers exist. The aim is to give readers a clear, reliable, and detailed guide to testosterone therapy as a cornerstone of transgender health and gender affirmation.

What Is Testosterone Therapy?

Testosterone therapy is a medical treatment that uses the hormone testosterone to help people develop more masculine physical traits. It is a common part of gender-affirming care for transgender men and some nonbinary people. The therapy works by giving the body higher levels of testosterone than it would naturally produce. Over time, these levels cause changes in the body that support a masculine appearance and reduce features linked to estrogen.

Testosterone and Its Role in the Body

Testosterone is one of the main sex hormones in humans. It is naturally produced in larger amounts in people who are assigned male at birth and in smaller amounts in people assigned female at birth. The hormone affects many systems in the body. It plays a role in muscle growth, bone strength, energy levels, sex drive, and the development of secondary sex characteristics such as a deeper voice and facial hair.

When testosterone is given through medical therapy, the body starts to respond in ways that mirror puberty changes seen in males. For example, the voice deepens, hair grows on the face and body, and muscle mass increases. These changes often reduce feelings of gender dysphoria and help people feel more comfortable in their gender identity.

Forms of Testosterone Used in Therapy

Testosterone can be given in several different forms. Each method has unique advantages, disadvantages, and levels of convenience. A healthcare provider helps decide which option is best, depending on health history, cost, and personal preference.

1. Injectable testosterone – This is one of the most common forms. Testosterone is injected into a muscle (intramuscular) or under the skin (subcutaneous). Depending on the type, injections may be given every week, every two weeks, or sometimes less often. Injectable testosterone usually comes in forms such as testosterone cypionate and testosterone enanthate.

2. Transdermal gels – Testosterone gels are applied directly to the skin, usually on the shoulders, upper arms, or abdomen. The hormone is absorbed through the skin into the bloodstream. Gels such as AndroGel® and Testim® allow for steady daily dosing. Care must be taken to avoid skin contact with others after applying, as the hormone can transfer.

3. Transdermal patches – These patches stick to the skin and release testosterone slowly over 24 hours. They are replaced daily. Patches may sometimes cause skin irritation at the site of application.

4. Implants or pellets – Small pellets containing testosterone can be inserted under the skin, usually in the hip area. These pellets release testosterone steadily over several months. This method requires a minor procedure but avoids the need for daily or weekly dosing.

5. Oral and buccal forms – Pills and tablets that release testosterone exist but are less commonly used due to possible side effects on the liver. Some buccal forms, which stick to the gum or inner cheek, are available but less common in gender-affirming care.

How Testosterone Therapy Works in the Body

When therapy begins, testosterone levels in the blood rise. The brain and body respond by adjusting hormone signaling. In people assigned female at birth, higher testosterone reduces estrogen-related features, such as monthly menstrual cycles, while encouraging male-typical features. Over time, this leads to both physical and emotional changes that are often sought by transgender men and nonbinary people.

The therapy works gradually, much like a natural puberty. Some changes, like an increase in oil production in the skin or a deeper voice, may appear within the first few months. Others, such as facial hair growth and increased muscle mass, take longer and continue to build over several years.

Goals of Testosterone Therapy

The primary goal of testosterone therapy in transgender health is to create a body that aligns more closely with a person’s gender identity. The treatment reduces the distress that comes from having physical features that do not match one’s identity. By shifting hormone levels, therapy supports gender affirmation and improves overall well-being.

A secondary goal is to maintain healthy hormone levels over the long term. Testosterone affects many parts of the body, including bones, muscles, heart, and blood. Proper medical monitoring ensures that hormone levels remain safe and effective.

Importance of Medical Supervision

Although testosterone therapy is powerful and effective, it is not a one-size-fits-all treatment. The dose and form of testosterone must be carefully chosen and adjusted for each individual. Blood tests are needed to track hormone levels, red blood cell counts, and cholesterol. Regular check-ups with a healthcare provider help reduce risks and support the best outcomes.

Who Can Start Testosterone Therapy?

Testosterone therapy is a type of medical treatment used to help transgender men and some nonbinary people affirm their gender. Before starting this treatment, a careful process is usually followed to make sure it is safe and appropriate. This process looks at overall health, readiness, and the individual’s goals. It also involves medical guidelines and professional support.

Medical Assessments Before Starting

A person considering testosterone therapy usually begins with a medical evaluation. This involves a review of medical history, a physical exam, and laboratory tests. The doctor or nurse may check for conditions that could affect how testosterone works in the body, such as:

• Heart and blood vessel health – High blood pressure, high cholesterol, or a history of heart disease may require extra monitoring.

• Liver function – Since testosterone is processed through the liver, tests may be needed to ensure it is working properly.

• Blood counts – A baseline blood test is often taken to measure red blood cell levels, because testosterone can increase these levels over time.

• Hormone levels – Current hormone levels may be tested to guide treatment.

This medical review does not act as a barrier but instead helps create a safe starting point. Adjustments in the dose or method of testosterone may be made depending on the results.

Informed Consent and Clinical Guidelines

Access to testosterone therapy often follows one of two main approaches: the informed consent model or the mental health assessment model.

• Informed consent model – In this approach, a healthcare provider explains the expected benefits, possible risks, and long-term effects of testosterone therapy. If the person understands and agrees, treatment can begin without the need for letters from a mental health professional. This model is becoming more common and is designed to reduce barriers to care.

• Mental health assessment model – Some clinics still require an evaluation by a mental health professional before starting testosterone. The goal is to confirm the presence of gender dysphoria and to assess readiness for hormone treatment. While this model can provide extra support, it may also delay access for some individuals.

International standards such as the World Professional Association for Transgender Health (WPATH) Standards of Care and guidance from the Endocrine Society both emphasize that testosterone therapy should be available when there is persistent gender dysphoria, the ability to give informed consent, and when medical risks are carefully managed.

Age Considerations

Age is another important factor in deciding who can start testosterone therapy. The process is different for adolescents and adults.

• Adults – Most adults can start testosterone therapy after completing a medical evaluation and giving informed consent. There is no upper age limit, but older adults may require closer monitoring of heart, liver, and bone health.

• Adolescents – For younger people, the decision is more complex. Some adolescents may start with puberty blockers before beginning testosterone, especially if they are in early puberty. Testosterone therapy may be started in later teen years with guidance from both healthcare providers and, when legally required, parental or guardian consent. The Endocrine Society suggests that starting testosterone in adolescents should involve a team approach, including pediatricians, endocrinologists, and mental health professionals.

The timing of therapy can have important effects. For example, starting testosterone earlier in adolescence may allow for smoother development of secondary sex characteristics such as voice deepening and facial hair. For those who start later, changes still occur but may progress differently.

Readiness and Mental Health Support

Being ready for testosterone therapy includes more than physical health. Readiness also involves understanding what changes to expect and having support in place. While testosterone often improves well-being, it can also bring challenges, such as adjusting to a new body image or dealing with changes in mood.

Mental health support can help in this process. Even when not required, many people benefit from talking with a therapist or counselor. Support groups can also provide connection with others who have gone through similar experiences. These resources can make the transition smoother and safer.

Medical Conditions That May Require Extra Care

Some health conditions do not prevent testosterone therapy but may require special monitoring. These include:

• Blood clotting disorders

• Severe obesity

• Sleep apnea

• Diabetes

• Polycystic ovary syndrome (PCOS)

In these cases, healthcare providers may adjust the dose, choose a different method of delivery, or schedule more frequent check-ups.

Not everyone starts testosterone therapy in the same way, but most follow a pathway that includes medical evaluation, informed consent, and ongoing support. Adults can often begin after a clear medical review, while adolescents usually need more structured care. International guidelines stress that the main goals are safety, respect, and helping people live in a body that matches their identity. By combining medical monitoring with supportive care, testosterone therapy can be started safely and effectively for those who seek it.

How Is Testosterone Therapy Administered?

Testosterone therapy can be given in several different ways. Each method has unique benefits and possible drawbacks. The choice often depends on medical advice, personal comfort, cost, and how easily the treatment fits into daily life. Understanding the main options helps explain how the therapy is managed and what people may expect once treatment begins.

Injections

One of the most common ways to take testosterone is through injections. These can be given either into a muscle (intramuscular) or just under the skin (subcutaneous).

• Intramuscular injections: The needle is placed deep into a muscle, often the thigh or buttock. Testosterone cypionate and testosterone enanthate are two of the most widely prescribed injectable forms. Injections are usually given every 1 to 2 weeks, though schedules can vary. This method provides a strong dose that slowly decreases over time until the next shot. Some people notice changes in energy or mood near the end of the dosing cycle, known as “peaks and troughs.”

• Subcutaneous injections: These are placed into the fatty layer just beneath the skin, often in the stomach or thigh. Many find this less painful and easier to learn compared to intramuscular injections. Subcutaneous injections may allow for smaller, more frequent doses, which can keep hormone levels more stable.

Injections are often affordable and reliable. They allow exact dosing and can be done at home after proper training. However, they require needles, syringes, and safe disposal. Some may also feel anxious about self-injecting or may develop soreness at the injection site.

Gels

Testosterone gels are applied directly to the skin, usually on the upper arms, shoulders, or abdomen. Brand names include AndroGel® and Testim®. The gel absorbs through the skin and enters the bloodstream, providing a steady release of testosterone.

The main benefit of gels is that they avoid the sharp rises and drops in hormone levels that injections can cause. They are also simple to apply and do not involve needles. However, the exact dose absorbed can vary depending on skin type, body hair, or how well the gel is rubbed in. Gels must be applied daily, which requires routine. Another concern is the risk of transferring testosterone to others through skin contact. For example, touching the application site before the gel dries could pass the hormone to a partner, child, or pet. To reduce this risk, it is important to wash hands after application and allow the gel to dry before covering the area with clothing.

Patches

Testosterone patches, such as Androderm®, deliver the hormone through the skin over a 24-hour period. The patch is applied once daily, usually to the back, abdomen, thighs, or upper arms.

Patches provide stable hormone levels and are convenient because they do not require needles or daily measuring of gel. The downside is that some people develop skin irritation, redness, or itching at the patch site. Rotating the patch location each day can reduce irritation, but for sensitive skin, this may still be a challenge.

Pellets

Testosterone pellets are small, solid cylinders placed under the skin by a healthcare provider. This minor procedure is done in a clinic, usually under local anesthesia. Once inserted, the pellets release testosterone slowly over three to six months.

Pellets offer long-lasting results without the need for frequent injections or daily applications. They also avoid the problem of hormone fluctuations that may occur with other methods. However, they require a minor surgical procedure for insertion and removal. There is also a small risk of infection or pellets moving from the insertion site. Because the dose cannot be adjusted until the next insertion, this method may be less flexible than others.

Oral and Other Forms

Oral testosterone is not usually recommended because it can stress the liver. Some newer forms, such as buccal tablets that stick to the gums, are available in certain regions. These provide slow absorption through the lining of the mouth. While convenient, they are less common and may cause gum irritation or taste changes.

Comparing the Options

Each method of testosterone delivery has different effects on convenience, cost, and stability of hormone levels.

• Injections: Effective, lower cost, but may cause peaks and troughs.

• Gels: Easy to apply, stable levels, but require daily use and caution to avoid transfer.

• Patches: Steady hormone release, but possible skin reactions.

• Pellets: Long-lasting, low maintenance, but less flexible and require a procedure.

Monitoring and Safety

Regardless of the method chosen, ongoing medical supervision is essential. Blood tests are used to check testosterone levels, red blood cell counts, and liver function. Dose adjustments may be needed to achieve safe and effective hormone levels. The best method is one that provides steady results, is affordable, and fits into a person’s lifestyle while being medically monitored.

What Physical Changes Can Be Expected?

Testosterone therapy leads to a wide range of physical changes in transgender men and some nonbinary people. These changes happen slowly over time and may vary for each person. Some changes are permanent, meaning they will not go away even if testosterone is stopped. Others are reversible and may lessen if therapy is discontinued. Understanding what to expect, when changes usually begin, and how the body responds can help set realistic expectations.

Voice Deepening

One of the earliest and most noticeable changes is voice deepening. Testosterone thickens the vocal cords, which causes the voice to drop in pitch. This process usually begins within the first 3 to 6 months and continues for up to 1 to 2 years. The degree of voice change varies, but once the voice deepens, it is considered permanent. Speech therapy may help some people adjust to the new pitch and develop vocal control, but the change itself remains even if testosterone is discontinued.

Facial and Body Hair Growth

Another common change is the growth of facial and body hair. Testosterone stimulates hair follicles, leading to the development of sideburns, mustaches, beards, chest hair, and abdominal hair. This change usually begins within 6 to 12 months, but full development can take 3 to 5 years. Genetics play a major role in how thick or sparse hair growth becomes. Some people may grow a full beard, while others may develop only light facial hair. Over time, body hair often becomes darker and coarser.

Skin and Acne

Testosterone increases oil production in the skin. This can cause acne, especially in the first one to two years of therapy. Acne may appear on the face, back, and shoulders. For some, the acne improves over time, while for others, it may require medical treatment. Dermatologists often recommend standard acne therapies, such as topical creams or medications, to help manage breakouts. Over time, the skin may also become slightly rougher or oilier in texture compared to before therapy.

Muscle Growth and Fat Distribution

Testosterone increases muscle mass and strength by stimulating protein production in muscle tissue. Many people notice an increase in upper body strength and broader shoulders within the first year. Body fat distribution also shifts. Instead of being stored mostly in the hips, thighs, and buttocks, fat is more likely to settle around the abdomen. These changes create a more typically “masculine” body shape. Exercise and nutrition can influence the degree of muscle development, but testosterone alone has a significant effect.

Body and Facial Shape

Along with fat and muscle changes, the face may take on a slightly different shape. Cheeks may appear less rounded, and the jawline can look more defined. These changes are gradual and depend on both genetics and the duration of therapy. The chest may also change in appearance due to fat redistribution, but chest contour surgery is often needed if someone desires a flatter chest beyond what testosterone can achieve.

Hair Loss on the Scalp

In addition to increased facial and body hair, testosterone can lead to scalp hair thinning or male-pattern baldness. This usually happens in people who have a genetic tendency toward baldness. The process may begin within a few years of therapy. Medications such as minoxidil (Rogaine®) or finasteride are sometimes used to slow this process, but baldness, once established, is typically permanent.

Menstrual Cycle Changes

One of the earlier internal changes is the reduction or stopping of menstrual periods. Many people stop menstruating within 3 to 6 months of starting therapy, although the timeline can vary. The end of menstruation is usually permanent as long as testosterone is continued. For those who continue to bleed after several months, medical adjustments may be needed to regulate hormone levels.

Genital Changes

Testosterone causes growth of the clitoris (also called clitoral enlargement). This usually begins within the first 3 to 6 months and may continue for 1 to 2 years. Growth varies, but the change is permanent. Vaginal tissue may also become thinner and drier, which can sometimes cause discomfort or increase the chance of irritation. Lubricants or medical treatments can help manage these changes.

Timeline of Changes

The timeline of physical changes varies by individual, but general patterns are as follows:

• 1 to 6 months: acne, voice changes, increased oil in the skin, and early clitoral growth.

• 6 to 12 months: facial hair begins, muscle growth increases, fat redistributes, and menstruation usually stops.

• 1 to 2 years: continued hair growth, deeper voice stabilizes, and facial/body shape changes become clearer.

• 2 to 5 years: full facial hair pattern and final fat and muscle distribution.

Permanent vs. Reversible Effects

• Permanent changes: voice deepening, facial and body hair growth, clitoral enlargement, and male-pattern baldness.

• Reversible changes: fat distribution, muscle mass, acne, and menstruation (though stopping periods often lasts as long as testosterone is continued).

Testosterone therapy produces gradual but powerful changes in the body. Some appear quickly, such as voice deepening and acne, while others take years to fully develop, such as facial hair and body shape. Genetics, age, and overall health all influence the speed and extent of these effects. Knowing which changes are permanent and which may reverse helps people prepare for the journey of hormone therapy and set clear expectations.

What Emotional and Psychological Effects Can Occur?

Testosterone therapy is not only about physical changes. It also plays an important role in emotional and psychological health for many transgender men and nonbinary people. Understanding how testosterone influences the brain and mood can help explain both the positive effects and the possible challenges that may come during treatment.

How Testosterone Impacts Mood and Emotions

Testosterone is a hormone that affects many systems in the body, including the brain. Research shows that testosterone can influence how people feel, think, and react emotionally. For many individuals, testosterone therapy brings relief from distress caused by gender dysphoria. Gender dysphoria refers to the discomfort or distress that arises when someone’s gender identity does not match their sex assigned at birth.

When the body begins to develop in a way that matches gender identity, there is often a significant improvement in overall mood. Many people report feeling calmer, more confident, and less anxious once testosterone levels stabilize. These improvements are thought to be connected to both the biological effects of the hormone and the emotional relief of living in a body that feels more aligned with one’s identity.

At the same time, testosterone can have direct effects on brain chemistry. It may increase certain neurotransmitters, such as dopamine, which play a role in motivation, energy, and positive mood. This change may explain why many people feel a boost in vitality and motivation after starting therapy.

Reduction of Gender Dysphoria

One of the most important psychological effects of testosterone therapy is its role in reducing gender dysphoria. Visible and audible changes—such as a deeper voice, facial hair growth, and changes in body shape—can provide strong affirmation of gender identity. These changes often make it easier for a person to be recognized by others as their true gender, which can lessen social stress and improve mental health.

Studies have found that testosterone therapy is associated with lower rates of depression and anxiety in transgender individuals. It is not a cure for every mental health concern, but it can be a powerful tool for easing the emotional distress linked to gender incongruence. For many, the reduction of dysphoria allows greater focus on personal growth, relationships, and overall life satisfaction.

Possible Emotional Challenges

Although many people experience positive changes, it is important to recognize that testosterone therapy may also bring emotional challenges. Some individuals report feeling more irritable or experiencing sudden mood swings, especially in the early months of treatment. These changes are often temporary and may improve once hormone levels are stable and the body adjusts.

Increased energy and libido can sometimes feel overwhelming at first. A person may notice stronger emotions, including both positive and negative feelings. These shifts are normal and often settle with time, but they highlight the need for careful medical monitoring and emotional support during the early phases of therapy.

Mental Health and Support

The psychological effects of testosterone therapy highlight the importance of mental health care as part of transition-related medical care. Regular counseling or support from mental health professionals can help manage new emotions and provide strategies for coping with changes. Support groups and community networks also play a valuable role, offering connection with others who have similar experiences.

It is important for healthcare providers to monitor not only physical health but also mental well-being during testosterone therapy. Routine check-ins can help identify whether changes in mood are temporary adjustments or signs that the dosage may need to be reviewed.

Long-Term Emotional Outcomes

Over the long term, most individuals report positive emotional outcomes with testosterone therapy. Improved self-esteem, reduced social anxiety, and greater comfort in daily interactions are commonly described. Many also note that the ability to live openly in their affirmed gender reduces stress and improves overall life satisfaction.

Research continues to explore the full range of psychological effects of testosterone therapy. So far, studies suggest that the benefits—such as reduction in depression, anxiety, and dysphoria—are significant, while challenges like irritability or mood swings are usually manageable with proper care.

What Are the Health Benefits of Testosterone Therapy?

Testosterone therapy is one of the most important forms of gender-affirming care for many transgender men and some nonbinary people. Its purpose goes beyond creating physical changes. Testosterone has many health benefits that affect the body, mind, and quality of life. These benefits can be seen in areas such as gender identity alignment, bone strength, muscle growth, energy, sexual health, and overall emotional well-being.

Alignment With Gender Identity and Quality of Life

One of the strongest benefits of testosterone therapy is the way it helps people feel that their bodies match their gender identity. This process, often called gender affirmation, can reduce gender dysphoria, which is the distress that comes from a difference between a person’s gender identity and their physical body.

For many individuals, hearing their voice deepen or seeing facial hair grow provides relief and comfort. These physical changes help reduce social stress when interacting with others and allow people to be recognized as the gender they know themselves to be. This sense of congruence between identity and body supports mental health, lowers anxiety, and reduces the risk of depression.

Studies have shown that people who start testosterone therapy often report a stronger sense of self-confidence and greater satisfaction with life. This improvement in mental well-being is one of the most important benefits because it supports resilience, social functioning, and the ability to take part fully in daily life.

Increases in Bone Density and Strength

Bone health is another key benefit of testosterone therapy. Testosterone plays an essential role in bone growth and maintenance. Without enough testosterone, bones can become weaker over time, which increases the risk of osteoporosis—a condition where bones are fragile and more likely to break.

Research shows that transgender men who use testosterone therapy usually experience an increase in bone mineral density, especially within the first few years of treatment. This makes bones stronger and lowers the risk of fractures later in life. Healthy bones also provide better support for physical activity, which is important for overall health and independence as people age.

Regular monitoring through bone scans may be suggested by healthcare providers, but overall, testosterone is widely recognized as protective for bone strength in transgender people.

Growth in Muscle Mass and Strength

Testosterone naturally increases muscle mass and physical strength. When someone begins therapy, their muscles typically grow larger and stronger, and fat distribution in the body begins to change. Fat often shifts away from the hips and thighs and moves toward the abdomen, creating a more traditionally masculine body shape.

This shift not only changes appearance but also improves physical stamina and energy levels. More muscle mass supports joint health and makes daily tasks easier. Many people also find it easier to take part in sports or exercise, which in turn supports cardiovascular health and weight management.

The increase in lean body mass may also help regulate blood sugar and improve metabolic health, reducing the risk of certain long-term conditions like diabetes.

Improvements in Sexual Function and Libido

Testosterone therapy also has important effects on sexual health. Many people experience an increase in libido, or sex drive, within the first few months of treatment. This is a natural effect of higher testosterone levels in the body.

In addition, some individuals notice physical changes that can make sexual experiences more comfortable. For example, the clitoris often enlarges under the influence of testosterone, which can improve sensitivity. These changes can support a more satisfying sexual life, which is closely linked to overall quality of life and emotional well-being.

For some, sexual function improves not only because of biological changes but also because gender dysphoria decreases. Feeling more at home in one’s body allows for more comfort and confidence in intimate settings.

Support for Emotional Health and Daily Energy

Although emotional changes can vary, many studies note that testosterone therapy is linked to better mood stability for many transgender men. Reduced gender dysphoria, improved body satisfaction, and the ability to live more openly as one’s true gender identity all contribute to emotional balance.

Testosterone can also improve overall energy levels. This effect is not always immediate, but as therapy continues and physical changes stabilize, many people report feeling less fatigued and more capable of handling daily activities. Having more energy often supports healthier habits, such as exercise, social interaction, and work productivity.

Long-Term Health Benefits

Over time, the combination of stronger bones, more muscle, better energy, and improved emotional health creates lasting benefits. These changes help reduce long-term health risks, support active lifestyles, and allow individuals to live in a body that reflects their identity.

While it is important to monitor for potential risks or side effects, the benefits of testosterone therapy for transgender health are well established in clinical research. When managed under medical guidance, testosterone therapy offers powerful and lasting improvements in both physical and mental well-being.

What Are the Risks and Side Effects?

Testosterone therapy is an important part of gender-affirming care for many transgender men and nonbinary people. While it brings many benefits, it is also important to understand the possible risks and side effects. This helps individuals make informed decisions and allows healthcare providers to monitor health closely. Side effects can appear in the short term or long term, and their severity often depends on dosage, method of administration, overall health, and medical supervision.

Short-Term Side Effects

Some side effects may appear in the first few months of therapy as the body adjusts to higher levels of testosterone. These are usually manageable but can be uncomfortable.

Acne and Oily Skin

Increased testosterone can lead to more active oil glands in the skin. This can cause acne, especially on the face, chest, or back. For many, acne improves with time, but in some cases, dermatology treatment or medical creams may be needed. Good skin care and regular washing can help reduce discomfort.

Mood and Energy Changes

Testosterone can influence mood and energy levels. Some people feel more energized and motivated, while others may notice irritability, frustration, or quick shifts in mood. These changes are often temporary, but if they continue, a healthcare provider may check hormone levels to see if the dosage needs adjustment.

Increased Red Blood Cell Count

One of the most common effects of testosterone therapy is a rise in red blood cell count, known medically as erythrocytosis. While this can improve oxygen delivery in the body, very high levels may increase the risk of blood clots or stroke. Regular blood tests are important to monitor this. If counts rise too much, a doctor may lower the testosterone dose or recommend other interventions.

Changes in Menstrual Cycle

Testosterone usually reduces or stops menstruation within a few months. Before cycles stop completely, spotting or irregular bleeding may occur. This is not dangerous, but it can be inconvenient and sometimes emotionally distressing.

Long-Term Risks

Over time, testosterone therapy may increase certain health risks if not carefully monitored. These risks highlight the importance of regular check-ups and open communication with healthcare providers.

Cardiovascular Health

Testosterone may affect cholesterol levels, sometimes lowering HDL (“good cholesterol”) and raising LDL (“bad cholesterol”). This can increase the risk of heart disease over many years. Blood pressure can also be affected in some individuals. Doctors often check cholesterol and blood pressure regularly and may recommend diet, exercise, or medication if needed.

Liver Function

Most modern forms of testosterone, such as injections and gels, are considered safe for the liver. However, older oral forms, which are less commonly prescribed today, were linked to liver stress and damage. Even with safer forms, occasional blood tests to check liver enzymes are recommended.

Fertility Changes

Testosterone reduces the production of eggs in the ovaries and may make pregnancy difficult. This effect can be partly reversible if therapy is stopped, but long-term use may cause permanent changes. Because of this, many doctors encourage discussions about fertility preservation before starting treatment.

Weight, Fat, and Muscle Distribution

Over time, testosterone increases muscle mass and decreases fat around the hips and thighs. While these changes are expected and often desired, they can also affect overall metabolism. Some people may notice changes in appetite, blood sugar regulation, or weight gain. These should be monitored, especially for individuals with a family history of diabetes.

Possible Links to Cancer

There is no clear evidence that testosterone therapy increases the risk of cancer. However, people who still have a uterus, ovaries, or breasts should continue to follow medical guidelines for cancer screening. Regular check-ups help detect any problems early, even if the risk is not directly linked to testosterone.

Strategies to Minimize Risks

The side effects and risks of testosterone therapy can often be reduced through careful medical care. Some strategies include:

• Regular Blood Tests: Checking red blood cell counts, cholesterol, and liver function helps detect problems early.

• Dosage Adjustments: Doctors may lower or raise the dose depending on hormone levels and side effects.

• Healthy Lifestyle: A balanced diet, exercise, not smoking, and limiting alcohol can lower risks for heart disease and other complications.

• Dermatology Care: For acne or oily skin, topical treatments and routine care can help improve comfort.

• Ongoing Monitoring: Regular visits with an endocrinologist or primary care provider ensure that health changes are tracked over time.

Testosterone therapy offers many benefits, but it also brings risks that require careful attention. Short-term side effects, such as acne, mood changes, or irregular bleeding, often improve with time or adjustments. Long-term risks, including heart health concerns, fertility changes, and metabolic effects, highlight the importance of ongoing monitoring. With proper medical supervision and lifestyle care, testosterone therapy can be both safe and effective in supporting gender affirmation.

How Does Testosterone Therapy Affect Fertility and Reproductive Health?

Testosterone therapy is an important part of gender-affirming care for many transgender men and some nonbinary people. While it has many benefits, it also has direct effects on the reproductive system. Understanding these changes helps people make informed decisions about fertility, family planning, and long-term health.

Stopping Menstrual Cycles

One of the first reproductive changes caused by testosterone therapy is the reduction and eventual stopping of menstrual cycles. Many people notice lighter periods within the first few months, and cycles often stop completely after six to twelve months of consistent treatment. This change happens because testosterone lowers the signals from the brain that normally control ovulation and the menstrual cycle.

The absence of periods can reduce dysphoria for many people and improve quality of life. However, it is important to know that even if cycles stop, ovulation may still happen occasionally. This means pregnancy is still possible unless other birth control methods are used.

Effects on Ovulation and Fertility

Testosterone therapy does not act as a reliable form of contraception. While it reduces the chances of ovulation, it does not always fully prevent it. Studies show that ovulation can continue in some people, especially during the first months of therapy or if doses are missed.

Long-term use of testosterone often decreases ovarian function. Over time, the ovaries may shrink in size and become less active. The lining of the uterus also thins, which lowers the chances of pregnancy. Still, fertility can vary greatly from person to person. Some may find it difficult to conceive after years of therapy, while others may still become pregnant even after long-term use.

Fertility Preservation Options

For those who wish to have biological children in the future, doctors often recommend considering fertility preservation before starting testosterone. Several options are available:

• Egg (oocyte) freezing: This process collects eggs from the ovaries and stores them for future use. It usually requires stopping testosterone temporarily to allow the ovaries to respond to stimulation medications.

• Embryo freezing: Eggs can be fertilized with sperm before freezing, which creates embryos for future use in pregnancy through in vitro fertilization (IVF).

• Ovarian tissue freezing: A newer option that removes and stores tissue from the ovary, which can later be re-implanted.

These procedures can be expensive and may not be covered by insurance. They can also be emotionally challenging. Still, for those who know they want biological children later, early planning can increase the chances of success.

Pregnancy Considerations

It is possible to become pregnant after stopping testosterone therapy, even after years of use. In many cases, fertility improves once testosterone is discontinued, and menstrual cycles may return within several months. Some people are able to conceive naturally, while others may need assistance from fertility specialists.

If pregnancy occurs while still on testosterone, medical care is needed right away. Testosterone is not safe for use during pregnancy because it can affect the development of the fetus. Doctors usually advise stopping testosterone as soon as pregnancy is confirmed.

Reproductive Health Monitoring

Regular medical care remains important for those on testosterone therapy. Even if periods stop, the uterus and ovaries are still present unless they have been removed through surgery. Doctors may recommend monitoring for any unusual bleeding, pelvic pain, or other symptoms.

Screenings such as Pap tests and pelvic exams may still be needed, depending on the individual’s age, medical history, and anatomy. These exams can sometimes cause discomfort or dysphoria, but they remain important for cancer prevention and reproductive health.

Contraception While on Testosterone

Since testosterone is not birth control, additional methods are needed to prevent pregnancy. Options include:

• Hormonal contraception (such as progestin-only pills, implants, or injections). These are often safe to use alongside testosterone and can stop periods as well.

• Intrauterine devices (IUDs), such as Mirena® or Paragard®. These provide long-term protection and may reduce or stop bleeding.

• Barrier methods (such as condoms), which also reduce the risk of sexually transmitted infections.

Doctors can help decide which method works best depending on medical needs and comfort.

Emotional and Identity Considerations

Reproductive health can bring up complex emotions. For some, the ability to stop periods through testosterone is an important relief. For others, discussions about fertility preservation or pregnancy may feel stressful or even painful. Medical providers who are experienced in transgender health can give both medical and emotional support, helping patients feel respected and understood.

Testosterone therapy greatly influences reproductive health. It often stops menstrual cycles and reduces fertility, but pregnancy is still possible. Because of this, contraception should be used if avoiding pregnancy is important. Fertility preservation options like egg freezing may be considered before starting therapy for those who want biological children in the future. Stopping testosterone can restore fertility in some cases, but results vary. Ongoing reproductive health monitoring and supportive medical care remain essential for long-term well-being.

How Is Progress Monitored During Testosterone Therapy?

Monitoring progress during testosterone therapy is one of the most important parts of safe and effective care. Testosterone changes the body in many ways, and medical providers need to make sure the therapy is working as expected while avoiding unwanted risks. Regular monitoring also helps to adjust the dose so that hormone levels stay in a healthy range. This process usually involves scheduled medical visits, blood tests, and ongoing evaluation of physical and emotional health.

Regular Medical Check-Ups

Medical check-ups are the foundation of monitoring testosterone therapy. At the beginning of treatment, appointments are more frequent, often every 3 to 6 months. This allows the healthcare provider to carefully follow early changes in hormone levels and overall health. Once testosterone levels and overall health are stable, visits may be spaced further apart, often every 6 to 12 months.

During these appointments, the provider will:

• Review physical changes such as voice deepening, hair growth, and changes in muscle or fat distribution.

• Ask about mood, energy, and emotional well-being.

• Discuss any side effects, such as acne, hair thinning, or changes in sexual health.

• Check blood pressure, weight, and sometimes heart health indicators.

These check-ups provide an opportunity to adjust the treatment plan and make sure it continues to meet health goals safely.

Blood Tests for Hormone Levels

Blood tests are one of the most important tools for monitoring testosterone therapy. Testosterone levels must be kept within a safe range to achieve the desired effects while avoiding complications. If the levels are too low, physical changes may not occur as expected. If the levels are too high, there is a higher risk of side effects such as thickening of the blood, liver strain, or mood changes.

The typical blood tests include:

• Total testosterone levels: This shows the overall amount of testosterone in the blood.

• Free testosterone levels: This measures the active testosterone not bound to proteins in the blood.

Providers usually draw blood tests at specific times, depending on the method of testosterone delivery. For injections, blood may be tested midway between doses to reflect an average level. For gels or patches, blood is often tested a few hours after application.

Monitoring Red Blood Cell Counts

One of the most common side effects of testosterone therapy is an increase in red blood cells, a condition called polycythemia. When the blood has too many red blood cells, it becomes thicker, which can increase the risk of blood clots, stroke, or heart attack.

To prevent this, a complete blood count (CBC) is done regularly. This test measures the number of red blood cells, hemoglobin, and hematocrit (the percentage of blood made up of red cells). If these levels rise too high, the healthcare provider may lower the testosterone dose, adjust the delivery method, or recommend donating blood to reduce red cell levels.

Tracking Cholesterol and Metabolic Health

Testosterone can affect cholesterol and other markers of metabolic health. For some individuals, testosterone therapy may lower levels of “good” HDL cholesterol and raise levels of “bad” LDL cholesterol. Over time, this could increase the risk of heart disease.

To monitor these changes, providers often order a lipid panel, which measures cholesterol and triglycerides. Blood sugar levels may also be checked, since testosterone can influence how the body handles glucose. Regular monitoring helps detect early warning signs, so steps can be taken to protect heart and metabolic health.

Liver and Kidney Function Tests

Although uncommon, high levels of testosterone can sometimes affect liver or kidney health. Blood tests for liver enzymes and kidney function markers are used to ensure these organs remain healthy. This is especially important if there are other medical conditions, or if medications are taken that may interact with testosterone therapy.

Adjustments to Dosage and Treatment Plan

Monitoring is not only about checking for risks. It also helps the provider adjust the treatment so the individual reaches their personal health goals. If testosterone levels are too low, the dose may be increased. If they are too high, the dose may be reduced, or the timing of injections or gel applications may be changed.

Some people may respond better to a different form of testosterone delivery. For example, someone who experiences strong fluctuations in mood or energy with injections may do better with a gel or patch. Others may prefer long-acting injections or implants to reduce the number of applications. Adjustments are made based on blood test results, reported symptoms, and the individual’s comfort with the method.

Importance of Long-Term Monitoring

Even after testosterone levels are stable, long-term monitoring remains essential. Risks such as changes in cholesterol, blood pressure, or red blood cell counts can appear later in therapy. Long-term care also ensures that bone density, reproductive health, and cardiovascular health are maintained over time.

Skipping regular monitoring can allow silent problems to develop. For example, high red blood cell counts may not cause symptoms until a serious event occurs. Consistent monitoring reduces these risks and keeps treatment safe and effective.

Progress during testosterone therapy is carefully tracked through regular medical check-ups, blood tests, and ongoing communication with healthcare providers. Monitoring hormone levels, red blood cell counts, cholesterol, liver, and kidney health ensures that treatment remains safe while providing the desired changes. Adjustments to dosage and delivery methods are made as needed. Long-term monitoring is essential for continued health and safety, making it a cornerstone of successful testosterone therapy.

How Long Does Someone Need to Stay on Testosterone Therapy?

Testosterone therapy is often described as a long-term or lifelong treatment for transgender men and some nonbinary people. The length of time a person stays on testosterone depends on their health goals, medical needs, and how their body responds to the treatment. For many, testosterone becomes part of ongoing care in the same way that other long-term treatments are managed for chronic conditions, such as thyroid medicine or insulin.

Lifelong Use for Gender Affirmation

Most people who start testosterone therapy choose to continue for life. The main reason is that testosterone supports the development and maintenance of masculinizing features, such as deeper voice, facial and body hair, and changes in body fat and muscle distribution. Once testosterone has created these changes, many are permanent, but others require continued hormone support. For example, voice deepening and facial hair remain even if treatment stops. However, muscle mass, fat distribution, and energy levels may shift back toward pre-treatment patterns without ongoing therapy.

Because of this, continuing testosterone is often important for maintaining physical appearance and reducing gender dysphoria. For many, stopping therapy would lead to distress as the body partially reverses to a state that does not match their gender identity.

Temporary or Short-Term Use

Some people may use testosterone only for a period of time. For example, a person may begin therapy to experience certain permanent changes, such as a deeper voice or facial hair growth, and later stop once those goals are reached. Others may start testosterone to explore how it feels before deciding whether to continue long-term.

Short-term use is less common, but it can be an option. However, stopping testosterone after only a few months or years usually means that temporary effects, like increased muscle mass or fat distribution changes, will fade. Menstrual cycles may return, and fertility may become possible again. Medical guidance is essential when making decisions about short-term use because hormone levels can shift quickly, and changes to health and mood may occur during withdrawal.

Effects of Stopping Testosterone Therapy

Stopping testosterone after long-term use leads to several changes in the body. Some of these are reversible, while others remain permanent.

• Reversible changes: Muscle mass, body fat distribution, acne, libido, and menstruation often return to pre-treatment levels. Emotional and energy shifts may also occur.

• Permanent changes: A deeper voice, facial and body hair growth, and enlargement of the clitoris usually remain even if therapy is stopped.

Health risks may also arise when therapy is discontinued. Bone health is one of the most important concerns. Testosterone supports bone density, and without it, there may be a higher risk of osteoporosis or fractures over time. Monitoring bone density with medical imaging, such as a DEXA scan, may be recommended for those who stop treatment.

Medical Guidance for Discontinuation

Ending testosterone therapy should always involve medical supervision. A healthcare provider may recommend tapering off slowly instead of stopping suddenly to reduce risks such as mood swings or rapid hormonal imbalance. Ongoing medical check-ups can help manage bone health, cholesterol, and reproductive health after discontinuation.

Some people may stop testosterone temporarily for health reasons, such as high red blood cell count, liver issues, or before certain surgeries. In these cases, therapy may be restarted once the condition is stabilized.

Healthcare providers also help manage fertility goals when discontinuation is considered. Menstrual cycles and ovulation may return after stopping testosterone, making pregnancy possible. For those not planning pregnancy, contraception may be needed even after years of therapy.

Long-Term Health Monitoring

For those who continue testosterone therapy for life, regular medical care remains essential. Blood tests are used to check hormone levels, cholesterol, and red blood cell counts. Over time, dosage adjustments may be required to keep testosterone within safe and effective ranges.

Older adults on testosterone therapy may also need additional monitoring for cardiovascular health, prostate health, and overall metabolic function. In many cases, lifelong use can be safe when carefully supervised.

The duration of testosterone therapy varies depending on health goals, personal needs, and medical guidance. For most transgender men and many nonbinary people, testosterone is a lifelong treatment that maintains gender-affirming changes and supports well-being. Some may choose temporary use, but discontinuation should be carefully planned with a healthcare provider to manage physical, emotional, and long-term health effects. With proper monitoring, both lifelong use and safe discontinuation can be managed in ways that protect health while respecting individual gender identities.

Cost and Access to Testosterone Therapy

Access to testosterone therapy is an important part of gender-affirming care, but the cost and availability can vary greatly depending on location, insurance coverage, and type of medication used. Understanding these factors helps explain why some people can begin therapy quickly while others face delays or financial barriers.

Insurance Coverage and Health System Differences

In many countries, health insurance plans or national health services cover at least part of the cost of testosterone therapy. In the United States, coverage depends on the insurance company and the specific plan. Some insurers recognize testosterone therapy as medically necessary care for transgender people and will pay for the medication, doctor visits, and lab tests. However, other insurers may deny coverage or require extra paperwork, such as proof of diagnosis or letters from medical professionals.

In countries with national healthcare systems, such as Canada or the United Kingdom, testosterone therapy is usually available at low or no cost through public health services. However, wait times to see specialists or begin treatment can be long. In contrast, people in private healthcare systems may gain faster access but face higher out-of-pocket expenses if their insurance does not cover all services.

Cost of Testosterone Medications

The price of testosterone therapy depends on the form of testosterone prescribed. Common options include:

• Injectable testosterone: This is often the least expensive form. Testosterone cypionate and testosterone enanthate are widely used. A vial can last weeks to months depending on the prescribed dose. Costs may range from about $20 to $100 per vial in the United States without insurance, but prices can be much lower if covered by insurance or purchased in countries with regulated medication pricing.

• Topical gels and patches: Testosterone gels (such as AndroGel® or Testim®) and patches deliver a steady daily dose through the skin. These are more convenient for some people, but they are usually more expensive than injections. Without insurance, a month’s supply can cost several hundred dollars. Insurance coverage can lower this cost, but some plans may only cover generic versions or limit the number of approved products.

• Pellets and implants: These are placed under the skin and release testosterone slowly over several months. While convenient, the initial procedure is more costly, often several hundred dollars per treatment, and may not be covered by all insurance plans.

• Compounded medications: In some areas, compounding pharmacies prepare custom doses of testosterone. Prices vary depending on location and regulations, and not all insurance companies will reimburse these forms.

The cost difference between these methods is significant, so many people choose the option that balances effectiveness, convenience, and affordability.

Medical Visits and Laboratory Testing

Testosterone therapy requires regular medical monitoring to ensure safety and effectiveness. Doctors check hormone levels, red blood cell counts, cholesterol, and liver function through blood tests. The cost of these tests can add up over time, especially without insurance.

• Initial consultation fees may range from $100 to $300 depending on the provider.

• Follow-up visits often cost less, but they are needed every few months in the first year and then once or twice a year.

• Blood tests can cost $50 to $200 per set without insurance.

When insurance covers both visits and testing, the cost burden is greatly reduced. In some countries with public healthcare, these services may be free or included in standard care.

Barriers to Access

Even when testosterone is affordable, other barriers can delay or prevent treatment.

• Geographic barriers: In rural or underserved areas, there may be few healthcare providers experienced in transgender care. This forces some individuals to travel long distances or seek telehealth services, which may not be covered by all insurance plans.

• Legal restrictions: Laws and policies differ by country and state. In some places, restrictions make it harder for transgender people to access hormone therapy, requiring additional medical approvals or limiting who can prescribe testosterone.

• Financial challenges: For those without insurance or with high co-pays, the total cost of treatment—including medications, visits, and lab work—can be overwhelming. Community clinics, LGBTQ+ health centers, and patient assistance programs sometimes help reduce costs, but availability varies.

Generic Options and Pharmacies

Generic testosterone medications are often less expensive than brand-name products. Pharmacies may offer lower-cost generic injectable testosterone or discounted versions of gels and patches. Large pharmacy chains, mail-order services, and patient discount cards can also help reduce expenses.

In some cases, people save money by filling prescriptions through online pharmacies or importing from countries with lower prices. However, this can carry risks if medications are not regulated or come from unreliable sources. Medical supervision is always important when using testosterone therapy, regardless of where the medication is purchased.

The cost and access to testosterone therapy depend on many factors: the healthcare system, insurance coverage, type of medication, and local availability of providers. For those with good insurance or access to public healthcare, the cost may be minimal. For others, high prices and limited access create barriers to starting or continuing treatment. Reducing these barriers is a major goal in improving transgender healthcare worldwide.

Conclusion

Testosterone therapy is one of the most important medical treatments available for many transgender men and nonbinary people. It plays a central role in gender affirmation, helping the body develop traits that align more closely with a person’s gender identity. By supporting both physical and emotional health, testosterone therapy contributes to a sense of well-being, confidence, and authenticity in daily life. This conclusion brings together the key points covered throughout the article to show why testosterone therapy is such an essential part of transgender health care.

Testosterone therapy is first and foremost about alignment. For many people, living with a body that does not match their gender identity creates a deep sense of distress called gender dysphoria. This discomfort can be both physical and emotional. When testosterone is prescribed and carefully managed by a medical professional, it helps the body change in ways that reduce this distress. Over time, the development of a deeper voice, facial and body hair, increased muscle mass, and a shift in fat distribution can make a person feel more at ease with their reflection and how they are seen in society. These changes are not only cosmetic. They are also tied to health, self-esteem, and daily function.

The benefits of testosterone therapy extend beyond outward changes. Studies have shown that many people experience improved mental health after beginning treatment. Reduced anxiety, less depression, and greater overall satisfaction with life are frequently reported. This improvement is likely related to both the physical changes and the knowledge that the body is moving closer to one’s true gender identity. Feeling comfortable in one’s body can have a positive effect on social interactions, relationships, and the ability to participate fully in work, education, and community life.

Health benefits also come from the way testosterone affects the body’s systems. Testosterone can increase bone density, lowering the risk of osteoporosis, which is especially important as people age. It also helps build muscle mass and strength, which supports overall physical function and mobility. Some people also report improvements in sexual health, including an increase in libido and changes in sexual function that better match their gender identity.

Of course, testosterone therapy must always be understood in the context of safety and medical care. Like any long-term treatment, it carries risks that require monitoring. Short-term side effects such as acne or shifts in mood are common but often manageable. Over time, more significant concerns can include an increase in red blood cell counts, which raises the risk of blood clots, as well as changes in cholesterol and cardiovascular health. This is why ongoing medical supervision is critical. Regular blood tests, physical checkups, and adjustments in dosage help ensure that therapy remains safe and effective. With proper monitoring, most risks can be managed, and the benefits often outweigh the challenges.

Fertility and reproductive health are another important area of consideration. Testosterone usually stops menstrual cycles within a few months of treatment and reduces fertility over time. While this is desirable for many people, others may want to preserve the option of having biological children in the future. Options such as egg freezing before beginning therapy can provide that choice. Even though pregnancy is less likely while on testosterone, it is still possible if therapy is paused, so discussions with health professionals about family planning remain important.

Access to testosterone therapy remains uneven around the world. In some regions, treatment is widely available through clinics, endocrinologists, or general practitioners. In others, people face barriers such as legal restrictions, cost, or lack of knowledgeable providers. Insurance coverage can also vary greatly, leaving some individuals with high out-of-pocket expenses. Generic versions of testosterone are available and can lower the cost, but access depends heavily on local healthcare systems and policies. Addressing these barriers is essential for ensuring that all transgender people can receive the care they need.

The length of time a person remains on testosterone therapy is usually lifelong, though some may choose to stop for personal, medical, or reproductive reasons. Stopping therapy often leads to the return of some feminine traits, such as menstruation, and can affect bone and muscle health. For this reason, most people remain on therapy with continued medical support throughout their lives. The long-term safety of testosterone therapy has been studied, and when managed properly, it is considered a safe and effective treatment.

In summary, testosterone therapy supports transgender health in profound ways. It reduces gender dysphoria, promotes physical and emotional well-being, strengthens bones and muscles, and allows people to live more authentically. At the same time, it requires careful medical oversight to manage risks and ensure safe, ongoing results. Access to treatment remains an area where improvements are needed, but the evidence is clear: testosterone therapy is a cornerstone of gender-affirming care. By continuing to expand knowledge, access, and support, healthcare providers can help more transgender and nonbinary people live healthier, more fulfilling lives in bodies that reflect their true selves.