Testosterone

Testosterone is used as a form of hormone replacement therapy for transgender people seeking to masculinise their appearance.

Types of Testosterone
Three types of testosterone are widely prescribed in Ireland for transgender people - a gel, and two forms of injection.

Testosterone Gel
Testosterone gel is available under various names, such as Testogel, Tostran, Testarzon, and Androgel. Testosterone gel is applied to the skin on the upper arms and shoulders, or sometimes the stomach. It is not meant to be applied to the genital area nor to the chest area. The gel is similar in appearance to hand sanitiser. It dries into the skin and testosterone is absorbed this way over the course of the day. Gel is usually taken daily as a result. Gel costs roughly €40-€60 per month.

Sustanon Injections
Sustanon is a short-cycle testosterone injection. It is administered every 3-4 weeks approximately. It is an intramuscular injection, meaning it is done in an area with thick muscular tissue such as the butt or thigh. Sustanon costs roughly €20 per dose, with additional cost if paying for a nurse or GP to administer the injection.

Nebido Injections
Nebido is a long-cycle testosterone injection. It is administered every 10-14 weeks approximately. It is an intramuscular injection, meaning it is done in an area with thick muscular tissue such as the butt. Due to the volume of Nebido per dose, and the viscosity of the liquid itself, it is often done as two separate injections. Nebido costs around €100 per dose, with the additional cost of paying for a nurse or GP to administer the injection, as due to size it is not advised to self-inject Nebido.

Gel Doesn't Work
There has been a persistent myth that gel does not work as effectively as injections. This myth may originate from the fact that many providers have preferred to prescribe gel first in early transition, and initially offering a low dose. The combination of low dose and early stage of transition may lead to individuals feeling that the gel was not as effective as they did not see as much change in that time. There may also be more variation in the rate of absorption through the skin from person to person, which may mean doses are harder to perfect.

Testosterone Causes Infertility
While many are cautioned before starting testosterone about preserving their fertility, there is no conclusive evidence to suggest that testosterone causes infertility. Many transgender people have taken testosterone for prolonged periods of time, stopped taking testosterone, and reverted to previous levels of fertility. In addition, several transgender people have become pregnant while taking testosterone unexpectedly. As a result, anyone taking testosterone should be aware that it is not a form of contraception and other methods need to be used to ensure safety.

You Must Get a Hysterectomy
Many transgender people have been advised that after a few years on testosterone, they will have to get a hysterectomy as the testosterone causes significant negative effects to the uterus. This has not been conclusively demonstrated. While testosterone is known to cause cessation of menstruation, as well as vaginal atrophy, there is no evidence that testosterone causes such severe effects on the internal reproductive system that all persons on testosterone for a prolonged period would require a hysterectomy.