The decision to use hormones to help align one’s body and mind as part of transition is an intensely person one. There is no right or wrong way to transition – and not everyone decides to pursue hormonal treatment. For those who do, however, there are different options available, and there isn’t one standard dosage for every patient.
If you are planning to pursue hormone therapy, you should have an endocrinologist manage your care, and they should be doing routine bloodwork to find the right hormone dosage for you.
Here are the most widely prescribed routes of administration:
Injectable is probably the most widely used – it is also usually the least expensive. In the US, the two most popular types of injectable testosterone are testosterone cypionate and testosterone enanthate. Depending on the dosage, those using injectable testosterone will likely see changes more quickly than those using other routes of administration. One consideration when using injectable testosterone is that because it is injected every 7-14 days, a few days before the next shot, T-levels can reach a low point, which can cause irritability, hot flashes, fatigue, and other symptoms. Patients using injectable testosterone should work with their doctor to find a dosage schedule that is best for them to avoid such symptoms. This might be different for everyone – some people are okay injecting every other week, some people need to inject weekly, and others might even inject every 10 days.
Gel + Cream + Topical
Testosterone in gel or cream form tends to be more expensive, and isn’t usually as widely covered by insurance as injectable testosterone. For folks who have fear of needles or struggle with getting shots, or don’t feel comfortable injecting themselves but don’t have someone else who can do it for them, gel or cream testosterone may be a really great option. Something to consider with gels and creams is that after applied, you will need to be careful about covering the area where they have been applied, or avoid contact with others to the area where applied until dry. One benefit of gels and creams, however, is that because they are usually applied daily, testosterone levels stay more steady than as with injections every 7-14 days, for instance. The two most widely used gels are AndroGel and Testim, although they can also be compounded by pharmacies. The benefit of compounded gels and creams are that they are usually less expensive, and doctors can also prescribe at different concentrations.
The FDA approved a topical testosterone in 2010 called Axiron. Axiron is applied in the armpit – it is applied by pumping the prescribed dose, and then applying it to the underarm just like deodorant. Because it is relatively new, it is likely to be more expensive than other types of testosterone that have been available longer.
Other Types of Testosterone
There are other types of testosterone, but they are not as popular or as widely used due to cost, availability, and other factors. Some of these other types include: transdermal patches (Androderm + Testoderm), oral, sublingual/buccal (Striant), and subcutaneous pellets (Testopel). Oral testosterone is not often used, as it can be extremely hard on the liver.