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10 myths about testosterone treatment

MYTH 1
Transition on testosterone is complete in two years or less.

FACT
Physical changes take time. Usually this is between four to seven years depending on your genetic heritage. Your body and facial hair will continue to develop over the next ten years and as you age.

MYTH 2
Testosterone will make hands and feet grow.

FACT
Some men feel like their feet or hands grew after starting testosterone treatment or their skull or jaw became thicker. Others feel like they grew taller after testosterone. They can point it a change in shoe size, hat size or other evidence of height or growth.

If you start testosterone after you have been through puberty, your growth plates have sealed off and it is impossible for your long bone (legs and arms) to grow after this. These changes can be due to a few things other than testosterone. See Will I grow taller on testosterone?

MYTH 3
Changes will happen faster if I inject more testosterone/inject more often.

FACT
Extra testosterone in your body will only convert to oestrogen causing your breasts to grow and will set you up for serious health problems. Injecting more testosterone, or more often is extremely dangerous and life-threatening. You risk death or stroke, severe acne scarring and significant hair loss.

MYTH 4
My biological mother’s brothers aren’t bald – so I won’t get any male pattern baldness.

FACT
‘Male pattern baldness’ is linked to the ‘x’ chromosome. Most men (xy) have only one ‘x’, while it’s likely you have two (xx). This makes the prediction a little more complex in your case.

MYTH 5
Testosterone makes you gay.

FACT
Testosterone is a very powerful drug but it doesn’t determine your sexual preference. Testosterone will have psychological effects and often means you feel more comfortable about your body. You might feel better and more confident about exploring your sexuality and this can mean you are willing to experience or explore different sexual behaviour and activity.

MYTH 6
If I stop testosterone the only change that is irreversible is my voice / my body fat distribution/ my sex drive etc.

FACT
If you start testosterone treatment, it’s safer to assume after about a year all your changes will be irreversible. Some people who were on testosterone for a while and then stopped, say their voice ‘went back’ to a female register, others say their body shape resumed a female shape or they started menstruation again.

This doesn’t happen for everyone all the time. We know people who were on testosterone for a while and then stopped, found their neck and shoulders never lost the effects of testosterone. Others had to undergo painful and expensive electrolysis to remove unwanted body hair (especially facial and back hair). Some found that other people started to assume they were a transgender woman (male-to-female). It’s safer to assume your physical changes will be permanent.

MYTH 7
Testosterone won’t cause me to gain fat, only muscle.

FACT
While most men experience a reduction of subcutaneous fat (fat just below the surface of your skin), studies show there is an increase of abdominal fat storage like other men who were identified male at birth.1 Unless you make a conscious effort to maintain your weight through exercise and food intake, you will gain weight. Most men gain weight due to the increased muscle mass and calorie intake.

MYTH 8
I can’t get pregnant if I’m on testosterone.

FACT
When you first start testosterone and your levels are low or your body is still adjusting to testosterone, your ovaries can still produce eggs. Vaginal sex with a fertile male could mean pregnancy. The only way you can ensure you don’t get pregnant is to have your female reproductive organs completely removed or use condoms.

MYTH 9
Testosterone will cause anger problems or ‘roid rage’.

FACT
If you have an angry personality before treatment, you’re likely to be the same on testosterone. Testosterone can’t cause your rage or anger problems. Most men report they feel calmer and more centred after they have started hormone treatment under medical supervision.

MYTH 10
Testosterone will protect me from HIV or STIs (sexually transmitted infections).

FACT
The most common STIs are gonorrhoea, syphilis, chlamydia, genital Warts, HIV and herpes. The only protection against these STIs is by using safer sex practices and avoiding exposure to them. If you don’t use safe sex practices, you are just as likely to get an STI whether you take testosterone or not.

Sexually active with men? You might want to think about taking PrEP.

References

1. Elbers, et al., 1997; Gooren, 1999.

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