Editor's note: This article is not medical advice. Consult a healthcare professional regarding questions about diagnoses and treatment.
This article was originally published in 2021. It has been included in Insider's 2022 Pride series,"We/Us/Ours."
With the heaviness of the wave of anti-trans legislation on my mind, I felt fortunate to have access to an endocrinologist after nearly a year of back-and-forth with insurance and several attempts with less trans-competent doctors.
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I wanted to start testosterone-based HRT to treat my lifelong gender dysphoria, or extreme distress related to my body and gender, that has affected me as a transmasculine nonbinary person. I started testosterone therapy to deepen my voice, make myself a little more muscular, and overall become more comfortable in my body.
As someone who has insurance that covers gender-affirming care and lives in a major city, I am incredibly privileged.
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I microdose HRT, meaning I take a smaller amount of testosterone for more gradual changes over a longer period of time. When I told my endocrinologist in New York City that I wanted to stay on a microdose long-term, he said he could write me the prescription but had to be transparent about the lack of research available on it. When I asked him what changes I could expect for my body, he told me he didn't know, even after I pressed for more information.
The only place I've been able to turn to for concrete answers on how to achieve the results I wanted — like a deeper voice and larger muscles — was online platforms like Reddit.
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Doctors like mine don't have enough research on HRT's effects to give concrete answers
Hormone replacement therapy as a form of treatment for the gender dysphoria that trans people experience has been around since the 1920s. But treatment protocols have been slow to shift.
Because of a lack of research on the effects of different HRT options, even trans-competent medical providers are left with few concrete studies to cite when patients ask questions, and physicians receive few hours of LGBTQ+-specific training.
One of the first questions I asked my doctor was which kind of injection I should opt for to get the most dramatic effects, which for me included a deeper voice, more muscle definition, and fat redistribution.
While small studies have suggested that subcutaneous injections (injection into the fat) could help retain testosterone in the body for longer between shots, my doctor told me there wasn't enough conclusive data to confirm this. I ended up opting for intramuscular injections and was dissatisfied with how long it took to see physical changes.
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In the first month of taking HRT, the skin around my jaw thickened. When I went back to the doctor and asked how long it would take for my jawline to reemerge, he told me there wasn't enough research out there for him to give me a timeline.
Online forums like Reddit and word of mouth offered information my doctor didn't have
Puffy-faced and feeling lost, I turned to the internet for understanding.
My friends who had started HRT before me recommended going on Reddit to find specific answers about where I should inject my T for the most effective results.
There I found several subreddits, like r/FTM and r/genderqueer, where people shared similar concerns and got their questions answered by a community of trans people who had taken testosterone. That's how I found out about the small study suggesting subcutaneous injections could keep testosterone in your system longer than intramuscular injections. So I switched, and I am much happier with the results.
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My only sense of understanding about my body during this process came from other trans people willing to share their experiences with HRT.
Even close friends who have been on testosterone have been more helpful in some ways to my transition than my doctor.
One of my friends has a more radical endocrinologist willing to talk about experimental treatments that have anecdotally worked on patients, so I often chat with them about what they've learned so I can take questions back to my own doctor. My other friend lives on the internet and can name trans subreddits at the drop of a hat, so they offer their knowledge.
My friends and I doctor one another in many ways, trading information like playing cards.
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Trans Reddit forums became a haven of support for me when so many of my medical concerns went unanswered through official channels. While I can only take the experiences of others with a grain of salt, they have been a huge comfort during a nerve-wracking process.
