No one can predict how fast, or how much, change will happen after starting hormone therapy. Changes are often more noticeable for people who begin the process when they are younger. It’s also important to know that some effects may not be reversible once you have started hormone therapy.

To ensure you are getting a safe dose of hormones to help meet your goals of gender affirmation, your Care Pathway Center team will check on you often to help you understand your body’s response to the hormones.

During your first year on hormone therapy lab work must be done every 3 months. Your Care Pathway Center case manager will remind you when it is time for lab work. It is important that you complete your lab work when required.

If you are receiving testosterone injections, your labs need to be drawn halfway between your injection dates. Your Care Pathway Center case manager will contact you to review the results. At that time, your hormone dose may be adjusted to help you continue to reach your gender affirming goals. After your first year on hormone therapy, you may need less frequent lab work.

Testosterone is the sex hormone that causes physical characteristics that are typically masculine. For example, it:

• Builds muscle
• Causes facial hair growth
• May deepen the voice

We can prescribe testosterone as:

• An injection every one or two weeks
• A topical skin gel applied daily

Care Pathway Center does not prescribe testosterone in an oral pill form. The body may not absorb it properly and it may cause liver problems.

Care Pathway Center does not prescribe testosterone pellet implants.

How to inject intramuscularly

How to inject subcutaneously

Hormone doses (amounts) vary from person to person. How much you take will depend on:

• How your body reacts to the hormones
• Your treatment goals. People have a wide range of goals related to how they want to look and feel.

Talk with your Care Pathway Center team about your desired outcomes. Together we will develop a hormone therapy plan to help you achieve your goals safely and ensure that your hormones are in a healthy range for you.

Taking higher doses of hormones than prescribed:

• Does not increase the effects or make the changes occur faster. Your body can also convert excess testosterone into estrogen.
• Can increase the risk that you will develop serious side effects

Changes in your hormone levels may cause ups and downs in your mood and energy level. Please let us know if this happens to you. We may recommend you:

• Change how often you get your injections
• Change the dose
• Switch to a topical gel instead of injection

Everyone responds differently to hormone therapy. Some people may experience side effects.

Most side effects are mild. Others are more serious. We don’t yet know all of the side effects of taking hormones for a long time. In rare cases they can cause severe complications.

Using hormones for the purpose of gender affirmation is an off‐label use. This means that:

• It has not been approved by the Food and Drug Administration (FDA)
• The medicine and dose recommended for you is based on your healthcare provider’s judgment and experience

Before we prescribe hormones, we will talk to you about:

• The risks and side effects
• How to lower your risk of serious side effects
• Identifying early signs of serious side effects so we can address them

Testosterone can interact with other drugs and substances and cause medical problems that can be life-threatening. We need to know everything you take or use, including:

• Prescription medications
• Alcohol
• Diet supplements
• Herbs
• Other hormones
• Nonprescribed legal or illegal drugs
• Nicotine products

We need to know this information for your safety. This will not affect your ability to receive medical care.

Testosterone may not be the best choice if you have certain medical conditions. It should not be used by anyone who:

• Has had, or has a hormone-sensitive breast or endometrial cancer. This means that cancer cells may grow in response to androgens (testosterone)
• Is pregnant, or planning to get pregnant, or breastfeeding

We are careful about prescribing testosterone to anyone who uses nicotine products or is obese. It should also be used with caution by anyone who has:

• A family history of other cancers that grow more quickly when hormones are present
• Androgen-sensitive epilepsy
• Coronary artery disease or heart failure
• End‐stage chronic liver disease (cirrhosis)
• High blood pressure
• High cholesterol
• Kidney disease
• Migraines
• Obstructive sleep apnea
• Polycystic ovarian syndrome
• Polycythemia

You are most likely to have dangerous side effects if you:

• Smoke (or use other nicotine products)
• Are overweight
• Have high blood pressure

Common side effects of testosterone hormone therapy include:

• Acne. Testosterone increases skin oil production, which can clog pores and cause acne. This usually peaks in the first year of hormone therapy, but let us know if acne becomes a problem for you so we can provide you with treatment options
• Alopecia. Testosterone may cause some degree of scalp hair loss. This usually depends on your family history of male pattern balding. If scalp hair loss becomes a concern for you while taking testosterone, let your Care Pathway Center team know so we can discuss treatment options
• Weight gain. Testosterone hormone therapy can lead to weight gain. It’s important that you maintain a healthy diet and exercise program to control your weight. Let us know if weight gain is a concern of yours so we can provide you with dietary/nutritional support and access to a health coach

Less common side effects of testosterone include:

• Abnormal liver blood tests. This is very rare. We will monitor your liver function before starting hormone therapy. Let us know if you have a history of liver problems
• Agitation/Anxiety. People with a history of anxiety may notice feelings of agitation, or increased anxiety after starting testosterone. This usually diminishes in the first few weeks of starting hormone therapy. Let your Care Pathway Center team know if you struggle with anxiety or notice new onset anxiety after starting hormones. Sometimes a minor adjustment to your hormone therapy dosing can reduce the anxiety
• Polycythemia. The amount of red blood cells in your body may increase after starting testosterone. This can be worsened if you smoke cigarettes or have obstructive sleep apnea. If your red blood cells increase too high you can be at risk for medical complications. We will monitor your labs routinely while you are on testosterone hormone therapy to make sure your levels stay within a safe range. Let us know if you have a history of obstructive sleep apnea, or if you have been told that you snore or gasp for air while you are sleeping

To get the best and safest results from Masculinizing hormone therapy, it’s important for you to:

• Take your hormones only as prescribed. Taking more than prescribed won’t make the changes faster or more noticeable. We will prescribe you hormone therapy based on your goals and what is safest for you. Everyone’s body responds differently to hormone therapy
• Avoid taking any other hormones that are not prescribed by Care Pathway Center. Once we start you on hormone therapy, you will need to agree to not use hormones from any other source
• Tell your Care Pathway Center team if you have any problems or are unhappy with your hormone therapy
• Follow through with all scheduled physical exams and blood tests to check for any side effects
• Let your Care Pathway Center team know if you have or develop any of the conditions that make it risky to take testosterone. Your healthcare provider can determine whether it’s safe to start or continue testosterone hormone therapy, and may suggest you lower the dose or stop taking it. This may happen if the side effects are severe or there are health risks that cannot be controlled
• Stop smoking. Quitting smoking will lower your risk of developing blood clots and reduce your risk for developing cardiovascular disease
• If you decide to stop taking hormone therapy, please discuss it with your Care Pathway Center team

It is important to keep others safe from your hormones and hormone blockers:

• Do not share your hormones with anyone
• Keep your hormones in a safe location away from children
• Do not share needles with anyone or use them more than once. Dispose of needles properly in a sharps container

The full effects of testosterone on fertility are not yet known.

• You may or may not be able to get pregnant even if you stop taking testosterone hormone therapy
• Some people who have temporarily stopped testosterone have gone on to have normal pregnancies

Talk to us about any plans or hopes you have about starting a family so we can discuss your options. You may wish to consider collecting and freezing eggs to be used in the future by you or someone else. The best time to collect and freeze your eggs is before you start hormone therapy.

It is possible you could get pregnant even after testosterone stops your menstrual periods.

• You cannot take testosterone if you are pregnant or breastfeeding
• Testosterone can cause serious birth defects if you do get pregnant

If you’re having sex that could result in a pregnancy, continue using birth control if pregnancy is not desired. Hormone therapy is not a form of contraception.

You may have a range of feelings about the changes you experience after starting masculinizing hormone therapy.

• It can be a relief to be recognized and accepted in your affirmed gender.
• It can also be challenging if other people do not respond to you the way that you want and deserve to be treated.

There are many resources to help you find support as you transition. We can help connect you to local support groups, online forums, community groups, events, and other resources.