Masculinizing HRT

• 1: Testosterone injections and gel
• 2: Non hormonal treatments

1 - Testosterone injections and gel

Overview and science

Masculinizing HRT is commonly testosterone monotherapy. This means adding the hormone testosterone to the body. This will naturally decrease the production of estrogens and progesterone from the ovaries, through the negative feedback mechanism first decreasing the hormones FSH and LH. The use of anti-estrogen medication is almost never necessary.

Testosterone gel is applied daily to the skin. Injections allow for a longer time between each dose (the frequency will depend on the chosen ester). More time between injections usually means less stable effects. This is particularly true for testosterone undecanoate, which allows for a very long time between injections (up to 3 months). Which route of administration you choose should be based on your lifestyle and what works best for you. No route is less effective than the others, so you should choose based on your own needs.

Gel

Gel is often the first option prescribed by Swedish healthcare to start masculinizing hormone replacement therapy. It is uncommon to find gel online. The gel comes in either a pump bottle or in single packets. It is alcohol-based and has a similar smell and texture to hand sanitizing gel. The gel is applied to the skin daily, either on the stomach or upper arms. It takes about a minute to dry. To mitigate the risk of transfer to others, the treated area should be covered with clothes and hands should be thoroughly cleaned with soap. Testosterone gels available in Sweden include Testavan, Testogel and Tostrex.

Injections: the different esters

Testosterone has been esterified in several forms, meaning there are different types of testosterone available for injections. Testosterone esters are prodrugs of testosterone, and hence considered bioidentical testosterone. There are three main esters used for injections:

• Testosterone undecanoate: This ester is prescribed for injection by Swedish healthcare. This ester is used for its long half-life. This means that the time between injections is between 10 and 12 weeks. After the injection, the testosterone stays in the body and is slowly absorbed by the body until the next injection.

• Testosterone cypionate: This ester is often prescribed in other countries or the one you might find online. The half-life for this ester is 8 days. This means that testosterone cypionate is injected once a week.

• Testosterone enanthate: This ester is also common abroad and online. The half-life is slightly shorter than cypionate but should still be injected as frequently, i.e. once a week.

• Testosterone propionate: You might also come across this ester. Because of its short half-life of only 2-3 days, it is not used much anymore. Using this ester would mean injecting multiple times a week. Therefore, other esters are generally recommended.

Testosterone can be injected intemuscularly or subcutaneously, although intramuscular injections are more common. Check what your vial says and listen to your doctor’s recommendations to decide which method you should use. Undecanoate injections are always administered in the buttocks because of the larger injection needle and larger injection volume. Other intramuscular sites include the thighs, which are usually used for weekly injections. Subcutaneous injections are injected into the fat tissue in the stomach.

As stated above, less time between injections also means more stable levels and fewer side-effects stemming from underdosing. Additionally, errors in dosage can be corrected more quickly when there is less time between injections.

Caution: Don’t overdo it

When starting HRT it might be tempting to take a very large dose to get the desired effects faster. But when it comes to testosterone, this will have the opposite effect of what you want because of aromatization. If the body has too much testosterone, it will convert it into estrogen.

Taking too much testosterone can also cause polycythemia (high concentration of red blood cells). This condition is rare but can be dangerous. A blood test for CBC/FBC (complete blood count or full blood count) is important to ensure your good health. Testosterone hormone replacement therapy is completely safe when done the right way. To get the desired masculinizing effects, stay within recommended dosages and levels.

2 - Non hormonal treatments

• Minoxidil …

• Castor oil …