HRT Delivery Methods for Trans Men

FTM HRT (hormone replacement therapy) may be delivered by intramuscular injection, sub-cutaneous injection, testosterone implants, testosterone gels or testosterone patches

Testosterone HRT is most commonly given by intramuscular injection

Testosterone can be given as:

• An intramuscular injection, usually the glutes or thigh (most common);
• A sub-cutaneous injection;
• A non-invasive patch or gel;
• A transdermal implant placed under the skin, usually the abdomen or buttocks (more expensive); or
• An oral tablet (not recommended because of liver toxicity)

The most common HRT method of delivering testosterone is by intramuscular injection. However, intramuscular injection is not the only was to receive HRT.
Many patients opt to receive testosterone via an implanted pellet, by applying a gel or a cream, or by using a testosterone patch. In some areas, it is not unknown to insert a pellet under the skin that will slowly release the testosterone.
Testosterone is no longer used in pill form in the United States because of liver toxicity.

Intramuscular Injection of Testosterone

The most common—and typically the most economical— method of delivering testosterone HRT is by intramuscular injection. The injection of is given in timed intervals of specific doses, generally for the rest of the patient’s life. The reason for this is that testosterone is not stored in the body and released intermittently, rather the body begins to rely on the injection for this purpose. The injection is generally given in the buttocks (glutes) or in the upper thigh, though it may be administered in any muscle. The injection is administered every 1 to 4 weeks, though dosage and administration vary by patient.
The injection may be a little painful and it is not uncommon to develop a knot at the injection site that feels like a bruise with a hard lump underneath it. Warming the testosterone before administering it will lessen the discomfort. It may also help to massage the area for about 60 seconds immediately following the injection.
Missing or skipping a dose may cause a drop in energy levels. Patients who have undergone a hysterectomy/oopherectomy may experience hot flashes since the body will become hormone-depleted. These symptoms are consistent with the experience of menopausal women.
The two forms of testosterone HRT by intramuscular injection are testosterone cypionate and testosterone enanthate. They are generally administered ever 7-14 days, with injections every 7-10 days being the average. The average dose is 100mg or 250mg per injection. A full dose is considered 100 mg per week. The active ingredient is suspended in an oil- generally sesame seed oil or cottonseed oil. Some individuals may experience an allergic reaction to certain oils, which requires them to choose one or the other.

Testosterone Cypionate

Testosterone Enanthate

Delatestryl

Delatestryl is a brand name for testosterone enanthate suspended in a sesame seed carrier oil that is taken every 10-14 days . Compounding pharmacies can suspend Delatestryl in either cottonseed oil or sesame seed oil for a lower price.

Non-invasive Patches and Gels

Application of testosterone HRT through the skin is almost always a daily activity, whether through gel, cream, or patch. It is meant to apply a small steady dose of testosterone every day, allowing there to be less highs and lows that the injections can allow. Disadvantages include risk of transferring medication to someone in close physical contact, greater expense than injectables and skin irritation. Generally, Androderm and Androgel are more expensive than intramuscular administration of testosterone. However, they remain a preferred method to those with an uneasiness around needles.

Androderm

Androderm is a non-Invasive, trans-dermal patch that is placed on the skin. It is also known as a Testoderm TTS patch. Androderm may cause skin irritation. Many FtM’s eventually switch to the T injections because of skin irritation and slow masculinization.

Androgel

Androgel is a testosterone gel placed on the skin.

Trans-dermal implants

Testosterone implants are advantageous because they slowly release testosterone into the body, however they are rarely a cost-effective delivery method (i.e., trans-dermal implants usually cost more). As a result, testosterone implants encourage stability of testosterone levels in the bloodstream. Levels peak about one month after implantation and they remain consistent for roughly 4-5 months. They are associated with a low incidence of side effects and are almost always successful. The implants are approximately the size of a wheat grain. Dosages may range from 100mg to 600mg depending on the patients’ needs. A blood test will indicate whether the dosage needs to be adjusted.
The pellet is implanted in a minor outpatient procedure. The doctor will usually administer a local anesthetic to numb the area. The procedure is not painful, although the needle prick from the local anesthetic may be uncomfortable. The implants are placed under the epidermis within the underlying fat layer by a small straw-like device. Recipients may feel a painless amount of pressure. After the pellet is implanted, the doctor will close the area with adhesive strips and ask you to put pressure on the area to stop any residual bleeding. Less commonly, the doctor may suture the area with a small stitch that will dissolve on its own.
As with all cuts to the skin, there is a small possibility that the wound may become infected. Notify your doctor immediately if any pain, redness, swelling, or discharge occurs.

Testopel

Testopel is an implantable pellet that is manufactured to delivery a slow, steady release of testosterone into the body. However, Testopel is associated with an increased risk of serious adverse effects. Though Testopel is effective for conditions causing low T levels, it does not seem to be a common choice for hormone replacement therapy due to the nature of the known side effects.

Oral Testosterone Pills

Many of the oral methods of delivery have been discontinued, particularly in the United States, because of an increased chance of liver disease. Oral administration requires regular blood tests to evaluate the effect on liver function, which are expensive. Patients taking oral testosterone should keep in close contact with their doctor, have regular blood tests, and be on the lookout for symptoms of liver disease.
Tablets or capsules cause a rise in testosterone levels in the blood. Testosterone levels peak 2-4 hours after being taken and steadily decline over 8-12 hours.  They are usually taken with both morning and evening meals. Regular blood tests should be required to continually monitor for signs of liver toxicity. High blood pressure has been reported in a high number of FTMs who have received testosterone orally.
* The information contained herein is not a replacement for medical advice and should not be used for medical treatment or hormone replacement therapy without the supervision of a licensed physician. femaletomale.org seeks to provide relevant information about gender reassignment, but under no circumstances should the information provided challenge or take the place of the authority of a medical professional. Disclaimer