I started testosterone (depo-testosterone, cypianate) on December 1, 2005 -- 9 days before my 25th birthday. The process I went through to get on testosterone was fairly simple. I knew I had a better chance at finding a therapist to write me a letter than I did at finding a doctor (without health insurance) who would prescribe via informed consent. I hated the very idea of the Standards of Care, but I didn't want to waste any time. Three months was a long time to me, but wasting even a day would just prolong the time it would take for me to start testosterone. I attempted two different ways of starting testosterone before a third and final one was successful.
The first thing I did was check out the Tom Waddell clinic in San Francisco.
I live in San Jose and have no car, so I had to find a ride down there. My ride wasn't reliable and we ended up going 2 hours later than planned, which was one half hour before they stopped the intake process. At first I was upset because I was told they were stopping early. Then it really hit me that it may have been a good thing. The place was dirty, smelly, and I couldn't bring myself to think about having to ever come back. I realize that it is a free health clinic that is open to everyone in SF and that free health clinics are not generally very clean for that reason... but if they couldn't afford to hire someone to keep the place clean, I wondered what the nurses qualifications were. I certainly did not want anyone going near my body with a needle in such a dirty environment. I walked out and never came back. I would have rather waited the three months than go to that clinic.
The next option I tried was meeting with a counselor at the local GLBTQ community center - the Billy DeFrank Center located in downtown San Jose.
He informed me that he was required by the center to follow the "three months of therapy recommendation" from the Harry Benjamin Standards of Care before he could write me a letter to start testosterone. It didn't seem like much of a problem to me since he was my only option at the time. It was frustrating, but I was able to be patient for three months time. However, two problems arose which put a huge roadblock in the way of those three months.
First, the counselor I saw was extremely polite and very friendly, but he did not ask me any questions about my gender identity. He didn't say much at all. He would say, "so..." and then shrug his shoulders a bit and sort of point to me and it was up to me to start the conversation, continue the conversation, and offer every bit of information to him about my life. This is a pretty common tactic for therapists as well as police -silence forces people to feel the need to continue the conversation, thus offering more information that wouldn't otherwise be offered. Only, it has the opposite effect on me when I am discussing my personal life with strangers. I only found myself talking about my rats, my job, my hobbies and musical interests, and the projects I am working on regarding violence prevention.
The room was so small it had to have been 6' X 10' with no insulation. It was cold, it echoed, the chair was hard and uncomfortable, and there was a giant clock on the wall incessantly ticking away at my nerves. I don't like clocks, and their ticking is just about the only thing that actually causes me physical frustration. I couldn't possibly take three months of "therapy" in that environment.
Three months of therapy was considered 6 sessions by their standards. The problem with this was that I had to take two buses to get there, and had no choice for what days I could go. He was the only counselor available at that time and was only open on Saturdays at 10:00 a.m. which conflicted with my work schedule. I would only be able to make it to one session per month, thus turning those three months into six. The thought of that made me sick to my stomach. I went to exactly two sessions with him before I decided that it wasn't worth the extra effort, especially since I wasn't comfortable with him.
I had heard of people getting their letters from therapists on the first visit, even if they had no history with the therapist. At the time, I didn't think I would be that lucky, but I convinced myself that I would find one. My goal was to start testosterone before my 25th birthday.
I went on the internet to look up as many doctors and therapists I possibly could -- determined to find someone willing to start me sooner than three months. Out of all the emails I sent out, I only received a response from one therapist on the East Coast. He normally did phone and internet counseling, but said he had to see his patients in person in order to give them letters to start hormones. He referred me to a friend of his who is a therapist near San Francisco, however, and so I emailed him about my situation. I told him about my frustrations with past therapy and asked for his advice. He told me that he doesn't follow the HBSOC strictly, and that he decides when a patient is ready. Since he was an hour away from me, and I wouldn't be able to get there regularly, he agreed to give me a letter on my first visit provided he felt comfortable doing so. I managed to get my mom to drive me out there later in the month.
The therapist I saw is transgendered himself, which made things a lot easier for me. He asked the right questions, and was very good at keeping the conversation going. I didn't have a problem opening up to him. He told me he would write my letter as soon as I had a primary care physician he could address the letter to. It took me a couple of months, but I enrolled with Kaiser Permanente for $180/month -- got a PCP -- got my letter -- and gave it to my PCP during my first visit with him. My PCP made a referral for an appointment with an endocrinologist who was qualified to prescribe testosterone and monitor me. It only took a couple of weeks to start testosterone from there. It took me about eight months to start testosterone, though, from the time I first began the journey to the Tom Waddell Clinic. Even if I had completed therapy at the DeFrank Center, I would have had to wait until I could afford health insurance and while the letter would have been in my hands earlier, I wouldn't have been able to give it to anyone until many months later.
When I saw the endocrinologist for the first time, he said he required his trans* patients to be in continued therapy due to the fact that there will be a lot of changes happening. I immediately became agitated, although did not show my frustration. I explained to him that I was unable to see my therapist since he lived an hour away and I had no car. He suggested that I see a therapist from Kaiser. Now, don't get me wrong, I appreciate what therapists do for people and I have many friends in the mental health field who work wonders with people... but I don't need therapy to deal with the issues in my life. Non-trans* boys aren't required to see a therapist as soon as they start going through puberty, and I didn't see any reason for me to, either.
My endocrinologist insisted that I be in therapy, or he would not start me. I understood where he was coming from, being non-trans and also unaware of my personal situation and stability, so I told him that I would get in touch with the therapist who gave me my letter and do phone sessions with him. He agreed with that and everything was set.
He gave me a card to give to the injection clinic, a form for getting my blood work done right before my second shot, and instructions to see a gynecologist within the next couple of months for a pelvic exam.
With Kaiser, my testosterone is covered 100%. I go in to the injection clinic to get my shots. I don't have to purchase anything, bring anything or co-pay even a penny. I literally just walk in, get my shot and walk out. I started testosterone on December 1, 2005 and I had my pelvic exam sometime in April. I started with 50mg/week for the first five months and then my dose was increased to 300mg/3 weeks -- the equivalent of 100mg/week. I get my blood work done every six months, and get a pelvic exam every year.
Looking back, I can't even believe how much time has flown by. When I was frustrated with not being able to find someone to write me a letter or prescribe testosterone, the days went by like years. But now as I write this, I've been on testosterone for 13 months and it's amazing how fast those 13 months have passed. I don't regret it, as it was the best decision I have ever made. I finally feel completely comfortable with myself.
And for those who repeatedly tell FTM people that testosterone won't "solve all your problems" -- for me, it did. The only problems I had in my life centered around people responding to me and interacting with me as a female. Even issues that didn't seem like they stemmed from that, did in fact come from being perceived as a female. All of my confidence problems disappeared, I have high self-esteem, I am not afraid to laugh or cry or live my life the way I believe I should.
The challenges and obstacles that come my way are not "problems" for me. Not in the sense that the rest of society would believe, anyway. This is purely a subjective and personal definition. Not everyone views things this way, though. I don't like the implications that come with the word, "problem," therefore I prefer to use a different term.
There will always be challenges and obstacles in everyone's lives, and testosterone may not "fix" the external problems (job issues, financial burdens, family crisis, etc.) but it can and does mend the emotional, internal issues that FTM people face. Some of these problems can't be articulated properly, and it is nearly impossible for non-trans people to understand. Testosterone may not be a panacea for all of life's problems, but that isn't any reason to not take it. It isn't intended to be a cure-all, nothing on planet Earth is a cure-all. Not even therapy and medication. The "problem solving" aspects of testosterone aren't chemical, but rather they come from the ability of someone on testosterone to feel comfortable in their own skin. When a trans* person can feel normal during every day events that non-trans people take for granted -- that starts the process of self-healing and problem solving. It puts them in an environment where they don't have to constantly be defensive when they perform simple tasks like going to the store to buy some milk. It allows the person to breathe, and focus on their life as a whole.
The changes brought on by testosterone are very different for everyone. It's literally like going through a second puberty. The changes I will be discussing are relevant only to me. Other people experience a wide variety of changes at different times throughout their transition.
The first change I noticed was my voice cracking. For the first few weeks I did not notice any changes at all, but as soon as three weeks rolled around I felt my voice starting to change. It sounded mostly like I had a cold. It cracked periodically for the first 5 months. I had noticeable changes with my voice deepening every week until about 10 months. From 10 months to 12 months it was about the same. Now, at 13 months I noticed another change and it has deepened since last month. The strangest part is that I can now sing in a higher range than I could before I started testosterone. I can also sing in a lower range, obviously.
The first place I noticed more body hair was on my stomach and upper thighs. This was after a month and a half. My arm hair slightly thickened but it's not noticeable unless I compare photos side by side. Same with my leg hair -- I barely have any. I think I have more on my upper thighs than I do my shins. The hair has filled in nicely on the upper part of my legs, though. But even at 13 months it's not very thick.
The hair on my chest and stomach really started to be noticeable around five months. It has been gradually filling in at about the same rate since then. I started growing some pretty wild shoulder hair at 10 months. Back hair has always been minimal. Of course there is the infamous butt hair that everyone dreads. It's really just fuzz on my lower back that gradually grows into longer hair on the inside of my cheeks. As a guy who has no shame in shaving his crotch and armpits, I don't know if the hair there has gotten thicker since I don't allow it to grow -- but my leg hair has grown into my crotch hair pretty much.
The first time I noticed facial hair growth was around 5 months. It was still light in color but it was coarser and stuck out in prickles. Realistically I shaved it off every 10 days just about. My sideburns were the first real hair growth I had -- starting at around 6 months. But only on my right side really grew in a line. the left side grew wild hairs sporadically. It is completely normal, though, for one side to grow faster than the other. Eventually they should catch up. Even at 13 months it is still sparse, but it's presentable and that's all that matters to me. I still do not have hair on my cheekbones and the hair under my chin is nowhere near full. I have spots where nothing has grown yet, but it's only noticeable when someone is looking directly at the underside of my chin. Since no one does that, I don't shave it off. From a front and side view it looks just fine. My left side burn is now growing in a complete line, about where my right one was 4 months ago. I have absolutely no visible mustache.
My body fat distribution has changed, and I first noticed this at around 4 months when I dropped an entire pants size (2"). My hips exist, obviously since they are bone, but the fat around them has gone mostly to my belly. Not too happy about that, but such is life. My chest, however, has shrunk considerably due to the redistribution of fat among other factors. Let's just say I went from what would be a D, to a B. And it's still shrinking.
I had what you might call normal teenage acne from 4 months on, just a few here and there on my face and jawline. Then at 10 months it exploded on my shoulders and back. It's not too severe, though, and I am working on clearing it up.
As far as smells go I noticed a slight change in body odor, but it was barely anything. I actually went from needing to use massive amounts of deodorant my whole life, sometimes 4 times a day, to not needing to use deodorant at all. I really only use it when I feel like it. I don't sweat and I don't smell. (Yes, I've asked other people). I can't say if it was the testosterone that caused this change because from everything I know about it, it should have made me sweat more and increase my body odor drastically. But it didn't do either, and I am thankful for that.
My menses ceased 2 weeks after my first shot and I have not had any indication that they want to come back, thankfully.
Emotional and mental changes have not really been a part of my transition. Not as a result from the testosterone, anyway. Some people experience a calming effect and others say they experience aggression. Physically speaking, it isn't possible for the testosterone alone to cause an increase in aggression. That's a horrible myth that has yet to be laid to rest. I do believe in the power of our minds to enact changes within our bodies even at the cellular level, and what those people experienced was probably in line with their beliefs that it would make them more aggressive. It is, however, physically possible for the testosterone to calm you down. Estrogen is the unstable hormone that fluctuates and the testosterone evens it out. I had one major stress factor in my life that I eliminated at the time I started testosterone -- so I am unable to determine how much of my increased calmness was due to the testosterone, or the fact that I finally got out of an abusive situation and decided I wasn't going to be anyone's victim anymore.
People always talk about sex drive and "dick growth" and the like. And that's usually what they love about testosterone. For me, its the only effect I dislike. I am basically asexual, and never had a sex drive until I started testosterone. Even now it is slim to none, and would not even qualify as a normal drive for someone with an extremely low sex drive. But considering the fact that I started out without one -- it's a huge increase for me. I don't care about sex, though, and am not sexually attracted to people of any gender. Yes, things have grown a bit down there, and at first it was annoying when it was growing (from about 2-10 months) but now I don't notice it.
That's pretty much all...
When I started testosterone through Kaiser, my endocrinologist told me that I absolutely had to receive my injections at the clinic and was not allowed to self-inject. That was fine with me because I absolutely HATED needles. Getting the shots was no big deal, but to do it to myself seemed impossible. I almost passed out just thinking about it. But then I lost my health insurance and the only way to get my T was either by paying $380/month for Androgel - or paying $60/year for injectible T and doing it myself. I just bit the bullet and scheduled an appointment to learn to self-inject from the nurse at Kaiser, and that was that.
Short disclaimer here - I am not a doctor, and this information is not meant to be anything but my experiences. Your doctor may tell you something completely different.
It's very easy to self-inject. I'll break it down for you. In the example, I'll be using an 18gauge need to draw with. You first wash your hands, then grab your vial of T, gauze, a bandaid, alcohol pads, your needles and syringes and lay them all out on a clean paper towel. Pull up your shorts/pants/whatever. Wash your hands again. You must wash your hands after you pull up your clothing! Avoid touching anything until you're done. Pull out the alcohol pads so you can access them easily. Make sure they're on something sterile like the inside of the package they came from. Take an alcohol pad and wipe down the top of the vial of T where the needle gets inserted. Prepare the syringe with the 18gauge needle (most usually just twist and lock in) but DO NOT touch any part of the plastic with your hands. Do all needle changing while it's still partially inside the package. You want this to be as sterile as possible.
Pull back on the plunger of your syringe to take in as much air as you are going to inject T. DO NOT INJECT AIR INTO YOUR BODY, this should be obvious but it has to be said. For example, if you are supposed to inject 1cc, you fill the syringe with 1cc of air, and then poke the needle into the top of the vial of T, and inject that air into the vial. This helps the T go into the needle with better pressure. So now you've got your needle all the way in the vial and the plunger is all the way down. Now turn the vial upside down at a 45 degree angle and slowly pull back on the plunger until you see the T start to fill it. Fill a little more than you're going to be injecting. Holding the vial straight up in the air with the syringe underneath, tap the sides of the syringe gently to release any air bubbles to the top. Then since your needle is still in the vial, and you've drawn some extra T, you can push the plunger a little in order to push some of that T back into the vial, taking the air bubbles with it. Then pull the needle out of the vial. Hold the syringe with the needle pointing up, and get rid of any other air bubbles you may see by gently tapping on the sides of the syringe. When all air bubbles are gone, it's time for the next step.
Using the 18 gauge needle's packaging as a sheath so you don't touch the needle, remove the 18gauge needle from the syringe. Now open the package of the needle you're going to inject with and without touching it, use the packaging outside of it as a sheath again and twist the needle into the syringe. Now you've got your needle ready to go. So where do you inject?
Using your hands as a guide, find the middle third of your thigh. Place one hand with your wrist at the crease of the top of your leg, and the other with your fingertips at your knees. You must only inject into the middle part of the thigh! And it's easiest to do it toward the outer side of your leg - it hurts less. Anyway, once you've got the target spot, use the other alcohol pad to prep it and clean it really well. Clean a large area, though, just in case you can't pinpoint the exact spot you want.
So your leg is clean, you've got the needle and you're ready to go! So what you want to do is just say, "1, 2, 3" and quickly push the needle into your leg, all the way. The more hesitation you have, the harder it will be. If you line it up with your skin and slowly push it in, you will feel pain. If you do it fast, you won't. Now, when it's in, you want to slowly pull up on the plunger just a VERY LITTLE BIT and pay attention to the bottom of the syringe to make sure there is no blood. This is called aspiration. You want to make sure you are in the muscle, and not a vein. Now, with a needle 1.5" long, chances are slim that you will be in any kind of blood vessel or vein, but you need to err on the side of caution. If all is good, push the T into your muscle, all the way and then pull out the needle. Do this quickly, though. And make sure that you keep your hands steady with the needle. Do not move it around when you pull out. You will feel it. It doesn't feel pleasant! When the needle is out, grab the gauze and apply pressure for about 30 seconds, and if you're still bleeding keep applying pressure until it stops. Then apply the bandaid. If you use a smaller needle like the 25 gauge, you may never really bleed. But anything bigger and you will.
My advice to anyone who wants to self-inject is that it isn't hard at all, and you really don't feel it if you use the right gauge needle. When I first started injecting, I was using 23gauge 1.5" long needles to inject, and 18gauge needles to draw with. You want to make sure you do not use the same needle to draw and inject with. Each time the needle punctures something, it gets dull. I use 18gauge to draw with because T is very thick, and 18gauge is big enough to make the process go a little faster. The first time I injected, I was pretty freaked out. It took me a long time to actually do it. My hands were shaking, and I was scared. But then I applied a technique to the situation that I apply to everyday life when I am faced with things that make me anxious - I stopped thinking. Yeah, it was that simple. I stopped my thought process and JUST DID IT. And it was a success.
The 23gauge needles were okay for a while, but they always made me bleed a bit and sometimes I could feel it coming out of my thigh. So I switched to 25gauge needles and I was surprised at how smoothly it went. Yes, it takes a LOT longer to complete the injection, but it is well worth it.