Facts about Testosterone Therapy

So I’ve said before, I’ve been a pharmacy technician for almost 15 years. I briefly considered pharmacy school (but cannot afford a half million in student loans) and eventually decided to go for my nursing degree. If all goes well, I’ll start that next fall. So while researching transitioning to male, especially starting testosterone, I’ve found lots of information about it that is basically in medical-ese. While I understand a lot of this terminology, for those without a medical background, I suspect that this gets really difficult to understand and annoying. So I decided to use my knowledge to try to break down some stuff to hopefully make someone else’s research and transition a little easier. So let’s get started, shall we? Please keep in mind that since I am located in the US, product-specific information is in regards to U.S. products.

Testosterone is a hormone produced in the body. Testosterone is primarily responsible for the development the male reproductive system. Simply put, testosterone is what makes males males. It exists in both sexes, but in drastically different concentrations – 15-70ng/dL in females and 270-1000ng/dL in males. Simple translation, men have 4-14x more testosterone than women.

There are a variety of testosterone products available on the market – all of them with the goal of supplementing the natural decline of testosterone levels in men as they age. They all carry the warning that they will cause masculinizing effects in women and even accidental contact should be avoided. Side effects of accidental exposure in women include increased muscle mass, deepening of the voice, thickening of facial, underarm and body hair, and enlargement of the clitoris – generally a more male appearance. Which is exactly what most transguys are looking for. Not so great if you’re a woman whose husband is supplementing his T levels, but one girl’s side effects are another boy’s dream, right?

As far as actual side effects for us transguys? We become more at risk for some of the diseases that are more common in men than women – heart disease, high cholesterol, stokes and deep-vein thromboses (clots), liver damage and the like. Your endocrinologist should monitor liver and kidney function as well as cholesterol and testosterone levels regularly.

Another consideration we have to make is our families. For those of us using a cream, gel or patch – we have to be careful that our partners and children are not exposed to the product while it’s wet – or to the sticky side of the patch. Please see the aforementioned less-than-desirable side effects for women who want to stay women. Other side effects can include a rash or reaction at the injection site, or application site if you’re using topical option. Another important note: the Androderm patch may react in an MRI machine, causing severe burns – take them off!.

I’m going to continue to stress this: always discuss all of your medications, treatments and allergies with all of your medical professionals, including MRI techs and radiologists…every time. Seriously – it’s important. Tell your doctors, pharmacists, dentists about everything you take, no matter how unimportant you think it is. Remind them no matter how many times you think you’ve told them. Example: ibuprofen (Motrin, Advil) can thin your blood and taking it regularly before a major surgery (for example, top surgery) it can seriously increase your bleeding risk. Over-the-counter multivitamins with iron can increase your clotting risk. Testosterone can increase red blood cell counts, resulting in an increase in clotting risk as well. See? Tell them about everything! Remind your healthcare provider about any allergies you have, too. A lot of people feel like if they tell their doctor or pharmacist once, they should always remember it, or at least flip through their chart and remind themselves. I agree, that the doctor, pharmacist, etc should do this, but they aren’t perfect. But the bottom line is your health is your responsibility and doctors have a lot to juggle. Why not step up and help them out a smidge for your own sake? This would have saved me a world of itching if I’d remembered to remind my surgeon that I’m allergic to dissolvable stitches. Instead I had to suffer because I was an idiot.

Anyhow… nowadays there are a number of products available for transitioning. When I first started working in pharmacy, the only option for testosterone supplementation was an injection. The injection is still available; it’s a thick oil which requires a deep intramuscular injection with an 18 gauge (1.270mm diameter) needle. To be clear, an insulin syringe is usually 27-30 gauge (0.413-0.311mm). The smaller the gauge, the larger the needle diameter of the needle. So let’s sum that up: big, fat, long needle. Now I might be a little biased because I’m terrified of needles. You can click here to see a side-by-side comparison, but I won’t post the picture here for those that have a real phobia of needles. Advantages here are injections every 2-3 weeks, so nothing to remember every day, and it’s one of the cheaper options.

For those of you that do have that phobia of needles, there’s still hope. There are a whole array of topical options – AndroGel, Axiron, Testim. These are applied directly to the skin. The manufacturers may beg to differ, but aside from differences in strength, these are mostly the same. As I’ve mentioned in a previous post, the AndroGel is the only one that is available in an AB rated generic right now. AB rated means that the FDA has determined the product to be biologically identical to the parent product. Because of differences in strength and formulation, the generic for AndroGel is not a generic for Axiron or Testim. Some of these products may contain soy, benzyl alcohol, or castor oil and you should, again, discuss all of your allergies with your healthcare professionals before deciding on a product. Prices on these products are likely to stay high ($200-300/month without insurance) until more generic manufacturers begin making the product. Multisourced generics (when more than one manufacturer is in on the creation of a product) bring the consumer cost down quickly.

Androderm is a patch, applied once daily, and the testosterone is absorbed through the skin (like the gels). It carries the least risk (of the topical options) of accidental exposure to others. It also may contain aluminum and may burn you in an MRI. Androderm’s exclusivity (the government-granted right to have no one else manufacture the product) expired 10/2014 – generics may be coming soon, but as of yet, I haven’t heard any rumblings.

There are also sub-dermal pellets, Testopel – little pellets injected under the skin and absorbed slowly over time (usually needing to be re-implanted every 3-4 months). It involves a small incision and the placement of pellets under the skin. This is technically a small surgical procedure, though it’s usually performed in the doctor’s office rather than a hospital or surgery center. It’s done with local anesthetic rather than general, so there’s no need to have someone available to take you to or from doctor’s appointments. There is a small risk of infection, or the pellets falling out, requiring re-implantation. Another problem with the pellets is that it’s much more difficult to adjust the dose midway through the month, including in the event of a reaction. These may be more of an option once you’re established on a dose and your body’s individual adjustment to testosterone has been made. Advantages are that there’s no need for appointments all the time and nothing to remeber daily and the pellets deliver a steadier dose than some other options.

Disclaimer: I am not a doctor, pharmacist, nurse or medical professional. This isn’t intended to be medical advice and cannot and should not replace talking to your doctor. The sole intent of this information is to provide you with a base of information with which to proceed, not to replace a conversation with your medical professionals. 

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