T Without Pain: A Review of Topical Testosterone: Virginia Transgender Health News - Vol. 5, Issue 1

Transgender Health Brought to you by Virginia’s own Transgender Task Force T Without Pain: A Review of Topical Testosterone Gel By Julian Carr, J.D. Six months ago I began testosterone treatment for the first time, and I have been using topical testosterone gel (Androgel 1%, at 5 grams per day) rather than intramuscular injections. I apply the gel in the morning to my upper arms and shoulders and allow it to dry, which only takes a few minutes, before dressing for the day. I had two primary reasons for choosing gel versus injections. First, like many folks, I didn't relish the thought of administering my own shots via a large needle. Second, and for me the more important factor, I was concerned about potential mood swings that might result from a semimonthly shot. I thought an everyday treatment might help keep my hormones (and emotions) more stable. My voice began deepening after about a month of treatment, and some very light facial hair began developing within that same time frame. Neither my voice nor facial hair has changed very much since these initial developments, however. After about two months of treatment, my menstruation stopped completely. Within the last month or so, I have started seeing larger muscles in my biceps and triceps regions, as well as increased hair growth on my stomach and upper legs. My emotions seem to have remained relatively stable during this time period. Initially, I did notice an increased intensity to my emotions, though no noticeable change in frequency of emotions. This seems to be leveling off more recently, however. I have also seen a moderate increase in my sex drive. I am not often read as male at this point (i.e., I don't "pass"). This is not a large issue for me, personally, but it very well might be for some individuals. Unfortunately, I can't provide a direct comparison with intramuscular injections, as I've never undergone injection testosterone treatment. That said, to provide a balanced picture, I can mention some of the downsides to the gel treatment I've experienced. At my six month appointment, my doctor walked in and regarded me with a look I can only describe as "dismayed." She explained that I was far behind in terms of physical developments compared to where her other testosterone-taking patients usually are at the six month mark, and she has doubled my Androgel prescription in response. It's also important to note that testosterone gel is expensive--two to three times more expensive than injectable testosterone. If one's insurance doesn't cover it, it's probably not a financially feasible treatment option for many. Lastly, the gel can be washed off or transferred to others through skin contact for a period of several hours after initial application. Not only does this mean the user might not be receiving the full dose of testosterone but also that those coming into contact with the gel might be getting some very unwanted testosterone. (My partner is trans female and on estrogen hormone therapy, and ze very much does not want any of my testosterone!) This means that showers, swimming, massages, romantic encounters, etc., must be planned with the time of gel treatment in mind. All in all, despite all of these issues, I have been pleased with the results I've seen from my treatment thus far, and I appreciate having been able to forgo intramuscular injections. Although all hormone treatments are highly individual and others might see very different results than the ones I've seen, I hope this information is useful for others who are trying to decide on the testosterone treatment that might work best for them.