Starting testosterone as a trans man or transmasculine person is more accessible now than it has ever been, with multiple pathways depending on your age, location, and preferences. The process typically involves finding a provider, completing either a mental health assessment or an informed consent visit, getting baseline blood work, and receiving your first prescription. Many adults can have testosterone in hand within one to three visits.
Two Main Pathways to a Prescription
There are two routes to starting testosterone: the traditional referral model and the informed consent model. Which one you use depends largely on your provider and your state.
In the traditional model, you work with a therapist or mental health professional who assesses your gender identity and provides a referral letter to a prescribing clinician. This follows the framework laid out in the WPATH Standards of Care, most recently updated to Version 8 in 2022. The process can take weeks to months depending on therapist availability and how many sessions are required before they write a letter.
In the informed consent model, you skip the therapist letter entirely. A medical provider explains the benefits, risks, and alternatives of testosterone therapy, and you give your informed consent to proceed. Gender dysphoria is not a prerequisite diagnosis. Your provider will ask about your gender identity and transition goals, but this is to determine the right approach for you, not to gatekeep access. If you’re over 18, you can often start testosterone the same day as your first appointment or within a couple of visits once blood work comes back.
For minors, the picture is more complicated. Most informed consent clinics require you to be at least 18. Some will see patients at 16 or 17 with parental consent. Access for minors varies significantly by state, and a growing number of states have passed laws restricting gender-affirming care for people under 18. If you’re a minor, calling a local gender clinic directly is the fastest way to find out what’s available in your area.
Finding a Provider
You have several options for where to go. Planned Parenthood locations in many states offer testosterone through informed consent. Dedicated LGBTQ+ health centers are another strong option, including well-known clinics like Howard Brown Health in Chicago, Fenway Health in Boston, Callen-Lorde in New York, the Los Angeles LGBT Center, and Whitman-Walker in Washington, D.C.
If none of those are nearby, telehealth services like Plume and Folx Health provide testosterone prescriptions online and work with many insurance plans. You can also search the OutList LGBTQ+ Affirming Healthcare Directory or the LGBTQ+ Healthcare Directory to find affirming providers in your area. Some primary care doctors and endocrinologists prescribe testosterone too, though not all are experienced with gender-affirming care, so it’s worth confirming before booking.
What Happens at Your First Visits
Your provider will order baseline blood work before writing a prescription. This typically includes a complete blood count (to check your red blood cell levels), a metabolic panel, liver function, and a hormone panel. These results serve as your starting point so your provider can track changes over time.
You’ll discuss your goals. Some people want full masculinization at a standard dose, while others, particularly some nonbinary individuals, prefer a lower dose for more gradual or partial changes. Your provider will tailor your starting dose accordingly. Once your labs come back normal and you’ve completed the consent process, you’ll get your prescription.
Testosterone Delivery Options
Testosterone comes in several forms, and the best choice depends on your comfort level, lifestyle, and budget.
- Weekly or biweekly injections are the most common method. Testosterone cypionate and testosterone enanthate are both injected either into muscle or subcutaneously (into the fat layer just under the skin). A typical starting dose is 50 mg per week, with a low starting dose of 20 mg per week for those who want slower changes. Most people eventually land somewhere up to 100 mg per week. If you inject every two weeks instead, the dose is simply doubled. Many people learn to self-inject at home after their provider demonstrates the technique.
- Topical gels are applied to the skin every morning. The 1% gel typically starts at 50 mg daily. Gels provide a steadier hormone level throughout the day compared to injections, which peak and trough over the week. The tradeoff is that you need to apply it consistently every morning and avoid skin-to-skin contact with others at the application site until it dries.
- Long-acting injections use testosterone undecanoate, given by a healthcare provider (not self-administered). After the first two doses four weeks apart, you only need an injection every 10 weeks. This is convenient if you don’t want to think about weekly dosing, but it requires clinic visits and is sometimes harder to get covered by insurance.
What Changes to Expect and When
Testosterone triggers a second puberty, and like the first one, it unfolds gradually over months and years. Not everything happens at once.
Voice changes are often among the first things you’ll notice, sometimes within just a few weeks. You may feel a scratchy or hoarse sensation in your throat before your voice starts cracking and settling into a lower register. Increased oiliness of the skin and acne tend to show up early as well. Menstrual periods typically stop within the first few months, though this varies.
Fat redistribution happens more slowly. Fat gradually decreases around the hips and thighs and may increase around the abdomen, shifting toward a more typically masculine pattern. Your arms and legs will develop more visible muscle definition, with more prominent veins and slightly rougher skin texture. Facial changes from fat redistribution can take two or more years to fully settle.
Facial hair is one of the most variable changes. Some people grow a noticeable beard within a year or two, others take several years, and some never develop thick, full facial coverage. Body hair growth on the chest, stomach, and legs also increases, but the extent is heavily influenced by your genetics, just as it is for cisgender men. Bottom growth (clitoral enlargement) typically begins in the first few months and is considered one of the permanent changes.
Ongoing Blood Work and Monitoring
Starting testosterone isn’t a one-and-done event. You’ll need regular lab work to make sure your levels are in the right range and that your body is responding safely. The target testosterone level for transmasculine people is 300 to 1,000 ng/dL, the same reference range used for cisgender men. During your first year, expect to have blood drawn roughly every three months. After that, monitoring shifts to every 6 to 12 months.
The most important thing your provider watches for is erythrocytosis, a condition where testosterone causes your body to produce too many red blood cells. This is measured by your hematocrit level, the percentage of your blood made up of red blood cells. Research shows that trans men on long-term testosterone have an average hematocrit of about 47%, compared to 40% in cisgender women and 45% in cisgender men. When hematocrit climbs too high, blood becomes thicker, which increases the risk of blood clots. If your levels rise above the safe range, your provider may adjust your dose or frequency.
Blood pressure and weight are also tracked at regular visits. Testosterone can raise both systolic and diastolic blood pressure. Cholesterol and blood sugar levels generally remain stable on testosterone, though individual responses vary, so these are checked periodically too.
Fertility Considerations
Testosterone suppresses ovulation and stops menstrual cycles, but it is not a reliable form of birth control. Some people have become pregnant while on testosterone. If preventing pregnancy matters to you, use a separate contraceptive method.
Long-term testosterone use may reduce fertility, though some trans men have successfully conceived after stopping testosterone. If you think you might want biological children in the future, it’s worth discussing egg freezing or other fertility preservation options before starting, since it’s easier and potentially more effective to do this beforehand.
Cost and Insurance
Testosterone itself is relatively inexpensive. Generic testosterone cypionate, the most commonly prescribed form, often costs between $20 and $60 per month without insurance. Many insurance plans, including Medicaid in a number of states, now cover gender-affirming hormone therapy, though coverage varies widely. Topical gels and long-acting injections tend to cost more than standard injectable testosterone, especially without insurance. Telehealth services like Plume charge a monthly membership fee that typically includes the consultation, prescription, and lab orders, though the medication and lab costs may be separate.
If cost is a barrier, community health centers and LGBTQ+ clinics often operate on sliding-scale fee structures. Manufacturer discount programs and services like GoodRx can also reduce out-of-pocket costs for the medication itself.