Starting testosterone (often called “T”) involves finding a prescribing provider, completing baseline bloodwork, and choosing a delivery method that fits your life. The process can take anywhere from a single appointment to several months depending on where you live, your age, and the type of provider you see. Here’s what each step actually looks like.
Two Paths to a Prescription
There are two main models for accessing testosterone: informed consent and the referral-based model. Which one you use depends on your provider and, in some cases, your state.
With informed consent, a medical provider assesses your understanding of the risks, benefits, alternatives, and unknowns of testosterone therapy, then prescribes it without requiring a letter from a therapist. This is the faster route. Many large-volume transgender care providers have used this model for years, and it’s become the standard at most gender clinics, Planned Parenthood locations, and telehealth services that offer hormone therapy. Primary care doctors, OB-GYNs, endocrinologists, nurse practitioners, and physician assistants can all prescribe testosterone this way.
The referral-based model requires one or more letters from a mental health professional confirming a diagnosis of gender dysphoria before a doctor will prescribe. Some providers, insurance plans, and surgical programs still use this approach. If your provider requires a letter, expect to spend a few sessions with a therapist before getting referred.
What Happens at Your First Appointments
Before starting testosterone, your provider will order baseline blood tests. These typically include total testosterone levels (drawn in the early morning on two separate occasions), a complete blood count to check your hemoglobin and hematocrit, and sometimes additional markers like estradiol or a lipid panel. The hematocrit check is especially important because testosterone stimulates red blood cell production, and your provider needs to know your starting level. If your hematocrit is already above 50%, your provider will want to investigate why before prescribing.
Your provider will also ask about your medical history, current medications, and whether you want to preserve fertility (more on that below). Some clinics complete all of this in one visit, while others spread it across two or three appointments. Once your labs come back normal, you’ll discuss delivery methods and get your prescription.
Choosing a Delivery Method
Testosterone comes in several forms, and the “best” one depends on your comfort level, lifestyle, and insurance coverage.
- Injections are the most common choice. You inject into muscle or subcutaneous fat, typically once a week or every two weeks. Most people learn to self-inject at home after a quick training session. Weekly doses usually fall in the range of 50 to 200 mg depending on the formulation. There’s also a long-acting injectable given by a healthcare provider every 10 weeks after the initial loading doses.
- Topical gel is applied daily, usually in the morning. Starting doses vary by product but are commonly around 50 to 60 mg per day, adjusted based on your blood levels. Gels require you to avoid skin-to-skin contact at the application site until the gel dries, since testosterone can transfer to other people.
- Patches are worn on the skin and changed daily. They’re convenient but can cause skin irritation at the application site.
- Pellets are small implants placed under the skin every 3 to 4 months. A provider inserts them in a quick office procedure. This option means you don’t have to think about daily or weekly dosing, but you have less flexibility to adjust your dose between insertions.
- Oral testosterone is taken as a pill twice daily with food. It’s a newer option and less commonly prescribed, but it works for people who want to avoid needles and topical products.
Injections tend to be the least expensive option, especially with insurance. Gels and patches cost more but offer steadier hormone levels throughout the day. Your provider will help you weigh the tradeoffs.
When Changes Start and Which Are Permanent
Physical changes from testosterone follow a rough timeline, though individual variation is significant.
Body fat redistribution and facial and body hair growth typically begin within 3 to 6 months. Voice deepening usually starts between 3 and 12 months. Fat redistribution reaches its full effect over 2 to 5 years, facial and body hair over 3 to 5 years, and voice changes within 1 to 2 years.
Some changes reverse if you stop testosterone: your body fat may redistribute back, your skin may become less oily, and menstrual cycles may return. Others are permanent. A deeper voice, increased body and facial hair, bottom growth, and scalp hair loss (if it occurs) will not reverse. Knowing which changes are permanent matters, especially if you’re unsure about long-term use.
Ongoing Monitoring
Starting testosterone isn’t a one-and-done process. Your provider will check your blood levels periodically, especially in the first year, to make sure your testosterone is landing in the target range (generally 450 to 600 ng/dL for most guidelines) and that your red blood cell count isn’t climbing too high. The most common adverse effect of testosterone therapy is an increase in red blood cells, a condition called polycythemia. If your hematocrit reaches 54% or higher, your provider will intervene, which could mean lowering your dose, switching delivery methods, or temporarily pausing treatment.
Expect blood draws every few months at first, then less frequently once your levels stabilize. These check-ins are also a chance to adjust your dose if changes are happening too slowly or you’re experiencing unwanted side effects like acne, mood changes, or hair thinning.
Fertility Considerations
Testosterone suppresses ovulation and will likely stop your period within the first few months. If there’s any chance you’ll want biological children in the future, talk to your provider about fertility preservation before starting. Egg freezing (oocyte cryopreservation) is the most established option.
If you’ve already been on testosterone and are now considering fertility treatment, the picture is more encouraging than many people expect. Research on transgender men with a history of testosterone use shows successful egg retrieval, embryo creation, and even pregnancies after stopping T. One study found no correlation between time spent on testosterone and the number of eggs retrieved. Patients who completed fertility treatment produced high-quality embryos regardless of their testosterone history. That said, freezing eggs before starting is simpler and gives you more options later.
Access for Minors
If you’re under 18, accessing testosterone is more complex and depends heavily on where you live. As of mid-2026, 27 states have enacted laws restricting minors’ access to gender-affirming care, affecting roughly half of trans youth ages 13 to 17. The U.S. Supreme Court upheld Tennessee’s ban in June 2025, ruling that such restrictions do not violate the Equal Protection clause, which left 25 state bans in place.
In states where care is available, minors generally need parental or guardian consent. Some states also require mental health screening for co-occurring conditions like anxiety, depression, or autism before a minor can be diagnosed or treated. The specific requirements vary by state, so checking your state’s current laws is an essential first step. Organizations like the KFF policy tracker maintain up-to-date maps of state restrictions.
In states without bans, gender clinics at children’s hospitals and some private practices offer hormone therapy for adolescents, typically starting with puberty blockers before introducing testosterone. Adults 18 and older can consent to their own care in every state, though Alabama’s law extends its restrictions to include 18-year-olds.
Finding a Provider
Planned Parenthood locations in many states offer testosterone through informed consent, often with shorter wait times than specialty clinics. LGBTQ health centers and university-affiliated gender clinics are other reliable options. Telehealth services have expanded access significantly, especially for people in rural areas or states with fewer in-person providers. When calling a clinic, ask whether they use informed consent or require a referral letter, what their wait time for new patients looks like, and whether they accept your insurance.
If cost is a barrier, look into manufacturer discount programs for your chosen testosterone formulation, sliding-scale clinics, or patient assistance programs. Injectable testosterone, particularly the generic forms, is one of the more affordable prescription medications, often costing under $50 per month even without insurance.