Starting testosterone as a trans man involves finding a prescribing provider, completing either an informed consent process or a clinical referral, and choosing a delivery method that fits your life. The entire process from first appointment to first dose can take anywhere from a single visit to several months, depending on where you live and which clinical pathway you follow.
Two Main Pathways to Getting a Prescription
There are two models for accessing testosterone, and the one available to you depends on your provider and location.
The informed consent model is the faster route. No referral letters are needed. A provider walks you through the risks, benefits, alternatives, and unknowns of hormone therapy, confirms you can consent to treatment, and writes a prescription. This model is patient-initiated, fits within primary care, and is used by many clinics that specialize in transgender health, including Planned Parenthood locations and LGBTQ+ health centers. Some telehealth services also use this model. You can often start testosterone on the same day as your first appointment or within a few weeks.
The referral model follows guidelines from the World Professional Association for Transgender Health (WPATH), which suggest (but no longer require) one or more letters from a qualified mental health professional before a physician prescribes hormones. The pre-letter consultations are designed to confirm your commitment to transitioning and your ability to consent. This pathway is more common at academic medical centers and in areas with fewer gender-affirming providers. It typically adds weeks or months to the timeline because you need to schedule mental health evaluations first.
If you’re an adult, start by searching for providers in your area who offer gender-affirming hormone therapy. Planned Parenthood clinics, LGBTQ+ community health centers, and some endocrinologists or family medicine doctors are common starting points.
Requirements for Minors
The process is significantly more involved for people under 18. Requirements vary by state and have been changing rapidly, but common elements include a formal diagnosis of gender dysphoria from a psychiatrist or psychologist, evidence that puberty has begun (at least the early stages), parental or legal guardian consent given in person alongside the minor’s own written assent, and ongoing mental health counseling throughout treatment. Some states require evaluations as frequently as every three months, annual bone density scans, and hand X-rays to monitor growth. Other states have restricted or banned hormone therapy for minors entirely. Check your state’s current laws before beginning the process.
Choosing a Delivery Method
Testosterone comes in several forms. Your provider will help you choose based on your preferences, comfort level, and budget.
- Intramuscular injections are the most common choice for trans men. You inject into the thigh or gluteal muscle, typically every one to two weeks. Many people learn to self-inject at home after their provider demonstrates the technique.
- Subcutaneous injections use a smaller needle and go into the fat layer just under the skin, often in the abdomen or thigh. The frequency is similar to intramuscular injections, and some people find them less intimidating.
- Topical gel is applied daily to the skin, usually on the shoulders, upper arms, or abdomen. It provides a steadier hormone level without the peaks and valleys of injections, but you need to avoid skin-to-skin contact with others at the application site until it dries.
- Patches are applied daily and work similarly to gels. Skin irritation at the patch site is a common complaint.
Injections tend to be the least expensive option. Gels and patches cost more but eliminate the need for needles.
What Testosterone Costs
Cost varies dramatically depending on your formulation, pharmacy, and insurance coverage. Many insurance plans, including some Medicaid programs, cover testosterone for gender-affirming care, though you may need a prior authorization.
Without insurance, retail prices for testosterone gel run roughly $375 to $790 per month depending on the formulation and quantity. Discount programs like GoodRx bring gel prices down to around $43 to $175 per month. Injectable testosterone cypionate is generally cheaper, often under $50 per month with a coupon. The cost of syringes and needles adds a few dollars. You’ll also need to budget for blood work, which your provider will order several times in the first year.
What Changes to Expect and When
Testosterone triggers a second puberty, and like the first one, it unfolds gradually over years. Not everything happens at once, and genetics play a large role in the final outcome.
Voice changes are often the first thing people notice. Within a few weeks, your throat may feel scratchy or hoarse. Your voice will crack and break as it settles into a lower range, similar to what teenage boys experience. This change is permanent.
Body hair on your chest, back, and arms will get thicker, darker, and grow faster over time, with final results taking five or more years. Facial hair is highly individual. Some people grow a full beard within a couple of years, others take much longer, and some never develop dense facial hair. Both facial hair growth and voice deepening are irreversible, meaning they persist even if you stop testosterone.
Fat redistribution gives your face and body a more angular, typically masculine appearance as subcutaneous fat shifts away from the hips, thighs, and cheeks. Expect about two or more years to see the full effect of facial changes. Increased muscle mass, skin oiliness and acne, bottom growth, and changes to your menstrual cycle (periods usually stop within the first few months) are also common early effects.
Male-pattern baldness can occur if it runs in your family. This is also permanent.
Blood Work and Ongoing Monitoring
Your provider will order baseline blood work before your first dose, then recheck your levels two to four weeks after starting, depending on your delivery method. Once your dose is stable, expect blood draws every six to twelve months.
The two most important labs are your total testosterone level (to make sure your dose is putting you in the typical male range) and your hematocrit, which measures the percentage of red blood cells in your blood. Testosterone stimulates red blood cell production, and if levels climb too high, your blood becomes thicker and harder to pump, raising the risk of blood clots. Providers aim to keep hematocrit below 54%.
A large long-term study of trans men on testosterone found that about 11% developed elevated red blood cell counts at a clinically notable threshold over the course of treatment. After ten years, the cumulative risk of at least a mildly elevated reading was 38%. Smoking more than doubled the odds, and higher BMI nearly quadrupled them. Staying at a healthy weight and not smoking are two of the most effective things you can do to reduce this risk. If your hematocrit does creep up, your provider may lower your dose, switch your delivery method, or recommend blood donation.
Fertility Preservation
Testosterone can suppress ovulation and stop periods, but it is not a reliable form of birth control, and pregnancies have occurred in trans men on testosterone. The long-term impact on fertility is not fully understood, and individual outcomes vary.
If biological children are something you want in the future, egg freezing before starting testosterone is the standard recommendation. The process involves about two weeks of hormonal stimulation followed by an egg retrieval procedure. It’s traditionally been advised to complete this before starting testosterone or to pause testosterone first, which can be distressing. However, emerging case reports have shown successful egg retrieval in trans men who stayed on testosterone throughout the stimulation process, retrieving between 14 and 35 eggs. This is still a newer approach, so discuss it with a reproductive endocrinologist familiar with transgender care.
Egg freezing is expensive, often several thousand dollars per cycle plus annual storage fees, and is not always covered by insurance. If cost is a barrier, some fertility clinics offer payment plans or discounted programs for transgender patients.
Making Your First Appointment
If you’re ready to start, the practical steps are straightforward. Search for an informed consent clinic or gender-affirming provider near you. LGBTQ+ health directories, Planned Parenthood’s online locator, and community recommendations are good starting points. When you call, ask whether they use the informed consent model or require a referral letter, what the wait time for new patients looks like, and whether they accept your insurance. Bring a list of your current medications and any relevant medical history to your first visit. If your provider orders baseline blood work at that appointment, you may be able to start testosterone at your follow-up visit a week or two later.