Defense Secretary Pete Hegseth announced yesterday that the military will blood test troops over 30 for low testosterone and offer supplementation for those whose testosterone levels are low. Hegseth claims it’s well-established science that as we age, testosterone levels, often, naturally drop.” However, healthy men who aren’t experiencing symptoms of low testosterone would not normally be tested or offered weekly injections as part of a routine exam. Hegeth’s gung-ho attitude towards hormone injections contributes to an atmosphere of widespread misperceptions about supplemental testosterone and what it can do to the body. These inaccuracies have made their way into trans community discourse as well.
Between articles about how US men are increasingly obsessed with testosterone, hot takes about the Enhanced Games leaving people with the false impression doping doesn’t provide any benefit, the Trump administration’s “obsession” with it, and the grossly inaccurate assumptions running rampant on social media, people are left with false impressions about what supplemental testosterone does to the body. It’s difficult to lay blame solely at the feet of cisgender people when influencer culture, popular media and news media have collaborated to feed an atmosphere of ignorance and credulity.
Let’s shine a light on this mysterious hormone and debunk some common myths.
Before we get to the fun parts, we need to define some terms.
When discussing puberty, we are going to use the terms used by medicine and in research: endogenous and exogenous puberty. If you are not familiar with these terms, I can’t blame you. The anti-trans terms “male” and “female” puberty are still widely used.
An endogenous puberty is one that is brought on by a person’s gonads. They are often thought of as either estrogen-driven or testosterone-driven. But thinking of puberty in terms of the primary hormone erases intersex people. An exogenous puberty, by contrast, is one caused by supplemental hormones.
Gonads are a gender-neutral medical term for the sex glands that create these hormones. Fun fact: Testicles and ovaries are each both an organ and a gland. Sperm and egg production make them an organ. Hormone production makes them an endocrine gland. The more you know.
There are two types of supplemental testosterone use: therapeutic and non-therapeutic. Therapeutic use has medical guidelines, and the doses are typically small compared to doses for non-therapeutic use. These larger doses are used by some athletes for performance enhancements, and referred to as PEDs or “gear”. These larger doses are also popular in the manosphere for non-athletes.
Cisgender men on non-therapeutic doses, either for sport or for manosphere reasons, take anywhere from 500 to 1000 mg of testosterone per week, plus other drugs. Cisgender women who are bodybuilders take 300 to 500 mg per week, plus other drugs. The max dose for a transmasculine person is 100 mg per week, with a typical dose at 50 mg per week.
We also need to define the two distinct types of hormone therapies. The first is for cisgender men and is colloquially called Testosterone Replacement Therapy though the technical term is Androgen Replacement Therapy. The second, for transmasculine people, is called Gender-Affirming Hormone Therapy.
It is important to not conflate the two. Each therapy has different dosing, protocols, effects, and desired outcomes.
The goal for testosterone replacement is to maintain the status quo of a pre-andropausal body for late middle-aged and senior cisgender men who have gone through a typical endogenous puberty. Andropause is colloquially referred to as “male menopause” or “manopause”. Andropause is similar to menopause with many of the same negative effects on health, including premature osteoporosis, anemia and increased cardiovascular risks.
Until recently, cisgender men were underdiagnosed and undertreated with medical authorities viewing testosterone supplementation very negatively. Now that cisgender men are beginning to receive proper medical treatment, panic has set in, with articles about how they are “addicted” to this necessary hormone. It certainly doesn’t increase clarity that some members of the manosphere are abusing it.
A typical TRT dose starts at 100 mg per week, which is the upper limit of a GAHT dose, and is increased up to twice that dose at 200 mg per week. Because the goal of testosterone replacement is to maintain the status quo and stop andropause, cisgender men who supplement the hormone become stronger than their peers of similar age who do not.
The goal for affirming therapy is to suppress endogenous gonadal function and bring on an exogenous puberty with a goal to masculinize the body. The dose begins small at 10 to 20 mg per week and is slowly increased to reach the lowest dose necessary to achieve desired effects without surpassing 100 mg per week.
If a transmasculine person starts early enough not to experience an endogenous puberty, they develop similarly to their cisgender peers. If a transmasculine person has completed an endogenous puberty, then their journey is much different and takes well over a decade, despite the common misconception that puberty only takes five years. Many things—like muscle growth, facial and body hair growth—take much longer to finish. Just ask any cisgender man still building strength and filling in their beard well into their 30s.
While transmasculine people who are on affirming therapy may look like their cisgender peers, there are limits to what hormone treatments can do. Study after study demonstrates that transmasculine people who first experience an endogenous puberty never catch up in size and strength to their cisgender peers, with strength maxing out somewhere between that of cisgender women and cisgender men. The reason for this is that muscle strength is largely limited by tendon and bone size, which do not significantly increase if the growth plates close before starting testosterone.
Before beginning a sport, if a transmasculine person is receiving affirming therapy they must receive a Therapeutic Use Exemption before competing because testosterone is a banned substance in all organized sport. If the transmasculine person is already in sport and has yet to begin hormone therapy, they must get permission in the form of a TUE before starting testosterone.
While it may have once been innocuous to conflate affirming therapy with replacement therapy, it has now resulted in transmasculine people being banned from sport—even transmasculine people previously granted exemptions—as governing bodies have now adopted the term TRT for all forms of therapeutic use. Outside of specific forms of hypogonadism that are not the result of aging, the World Anti-Doping Agency has never recognized testosterone replacement for andropause as a reason for issuing an exemption while it has long recognized it for affirming care.
All of this has also led to a misconception that there are fewer transmasculine athletes than transfeminine athletes when the reality is, transmasculine athletes aren’t allowed on the field.
Another myth that prevails is that therapeutic doses of testosterone will turn you into The (Red) Hulk. This is not the case. Even if you lift weights six days a week for an hour and a half a day, you won’t hulk out. Just look at any drug-tested natural bodybuilder who has spent years building their physique next to a bodybuilder taking performance enhancing drugs. Yes, you will gain some muscle mass simply by having extra testosterone in your system. But if you want those broad shoulders and big muscles, you must work for them and support it with proper nutrition high in protein like any cisgender dude.
In fact, doses of testosterone slightly higher than 100 mg per week won’t create The Hulk—which is quite different than the 10-to-20 times therapeutic dose, plus other drugs that cisgender male athletes on PEDs take. These slightly higher doses are often needed for those who had their gonads removed, as well as supplemental estrogen because gonads appear to be necessary to convert testosterone into estrogen.Estrogen is also a vital hormone for men’s health.
The WADA also recognizes that transmasculine athletes may need these doses up to 125 mg per week as well as have a need to maintain slightly elevated blood testosterone levels because our underlying physiology is not the same as our cisgender peers who have gonads.
If you want the red skin and freakish-looking muscles associated with the manosphere and athletes on PEDs, then you must consume significantly higher doses, often with the help of other banned substances.
Which brings us to roid rage: a myth—that the L Word helped to create—that transmasculine people become violent rage monsters the moment they take their first injection.
Many think it is testosterone that makes cisgender men violent and not toxic masculinity perpetuated by patriarchy. If typical testosterone levels made men violent, then transmasculine people would be the perpetrators of violent crimes on par with cisgender men instead of remaining the largest demographic to experience physical, sexual and intimate partner violence.
It doesn’t help that mainstream medicine has long perpetuated this myth in its efforts to deny cisgender men TRT for andropause and transmasculine people GAHT by not being clear that all studies linking testosterone to violence, testosterone levels were elevated well beyond the typical range and mainly involved animal studies.
While it’s true that roid rage is not real at therapeutic doses, it is a real thing for cisgender men on those larger PED doses. It is not helpful to deny this reality. Unfortunately, it is often denied on social media anytime a new article demonizing testosterone is published, with a common cry in the transgender community of, “Let them juice!” “Juicing” is a colloquial term for taking performance enhancing drugs.
It is difficult to tell if this call to let everyone “juice” and deny the real harmful effects of high doses of testosterone is because people are unaware of the real differences between therapeutic and non-therapeutic doses and the different effects of each, or if it is done to protect transmasculine people’s access to GAHT. Whatever the reason, the harm of doing so is real, including perpetuating the myth that transmasculine people are violent rage monsters and denying them access to competitive sport.
Another use of testosterone is erectile dysfunction. TRT and GAHT have very different outcomes on this front.
For transmasculine people on GAHT, with the second puberty comes bottom growth and frequent erections. Like cisgender boys experiencing puberty, transmasculine exogenous puberty can bring erections if the wind blows. It will also increase sex drive, if you had one to begin with. Some asexual people report an increase in erections without the increase in sexual attraction that others experience.
Cisgender men don’t have the same results. While testosterone replacement does also increase libido for this population, it does not always fix erectile dysfunction.
One side effect of increased libido transmasculine people must also keep in mind is pregnancy. Or rather, pregnancy can occur with penile-vaginal intercourse, regardless of gender or trans identity. While it’s true that supplementing testosterone can cause cisgender men to become infertile, this is not true of transmasculine people on GAHT.
Transmasculine people with intact reproductive organs can and do become pregnant while taking testosterone. This is why they should use a non-hormonal contraceptive. While it’s true that fertility decreases while on affirming therapy, this change is temporary with full fertility often returning within three to six months after ceasing hormone therapy. Widespread anti-trans propaganda claims the opposite, but the science is clear, testosterone does not permanently impact fertility
Finally, let’s talk about depression. Many anti-trans people believe that transmasculine people are simply depressed women; the reason we are no longer depressed after supplementing testosterone isn’t because the distress of constantly being misgendered is resolving, but because testosterone can treat depression. This myth has recently been amplified by articles about cisgender women that discuss what supplemental testosterone has done to their moods.
However, studies show that testosterone supplementation is not beneficial for women with major depressive disorder, while it may have other benefits for post-menopausal women. Also, low testosterone in cisgender men does not cause depression though it may mimic its symptoms.
While some cisgender women benefit from supplemental testosterone, it is important to stress they will experience non-reversable effects, even at low doses, such as clitoral/glans growth, unwanted facial hair, and vocal changes.
When considering testosterone, cis women should be warned about the potential for extra facial and body hair and vocal deepening. A lot of non-drug tested cisgender women bodybuilders regret taking the doses they take. While those doses are larger than what post-menopausal women take, some report taking doses larger than transmasculine people. With that comes all the masculinizing effects transmasculine people seek when taking GAHT, many of which are not fully reversable, plus other unwanted side effects, like possible increases in anger at those above GAHT ranges.
The bottom line is that while GAHT will make you look and sound masculine, you will not become an Adonis who turns into the Red Hulk at the smallest annoyance, unable to bear the fruit for which you were destined. Testosterone is not a miracle drug. It’s simply a hormone that at therapeutic doses has effects that are both annoying and wonderful. Welcome to the human experience.
Jules Sherred is a trans man who works as a freelance journalist, author, and commercial food photographer. He’s also a drug-tested competitive natural bodybuilder.
