Transmasculine Guide: Dosing
Dosing (gels):
Section titled “Dosing (gels):”Here is a table of typical doses of testosterone gel used in transmasculine hormone therapy:
| Testosterone Gel Type | Low Dose | Initial - Typical Dose | Maximum - Full Dose | Additional Notes |
|---|---|---|---|---|
| Testosterone topical gel 1% | 12.5-25 mg daily | 50mg daily | 100mg daily | May come in pump or packet form |
| Testosterone topical gel 1.62% | 20.25mg daily | 40.5 - 60.75mg daily | 103.25mg daily | Usually comes in packet form. One packet = 20.25mg |
| Testosterone axillary gel 2% | 30mg daily | 60mg daily | 90-120mg daily | Comes in pump form only, one pump = 30mg |
I recommend people start on ~50mg of testosterone gel per day, up to a maximum of 100mg/day.
Testosterone gel can be applied to the shoulders and upper arms, or the stomach area. Thoroughly rub in the gel, and wait until it is completely dry before putting on clothing or interacting with pets.
I would not recommend you go over 100mg/day unless you have obvious signs of insufficient T levels after a year on that dosage (still having menstrual cycles, or a blood test showing inadequate levels).
Keep in mind the low dosage range described above will generally not induce the same extent nor speed of changes as what would be expected at higher dosages.
Dosing (injections):
Section titled “Dosing (injections):”Here is a table of typical doses of injectable testosterone used in transmasculine hormone therapy:
| Type | Low Dose | Initial - Typical Dose | Maximum - Full Dose |
|---|---|---|---|
| Testosterone Cypionate | 20 mg/week | 50 mg/week | 100 mg/week |
| Testosterone Enanthate | 20 mg/week | 50 mg/week | 100 mg/week |
I usually recommend people start on 50mg/week. You can either choose to slowly ramp up your dosage, or you can start at a high dose. There is no evidence that either method is clearly better than the other.
I would not recommend you go over 100mg/week unless you have obvious signs of insufficient T levels after a year on that dosage (still having menstrual cycles, or a blood test showing inadequate levels).
Keep in mind the low dosage range described above will generally not induce the same extent nor speed of changes as what would be expected at higher dosages.
Dosing (testosterone undecanoate):
Section titled “Dosing (testosterone undecanoate):”| Type | Low Dose | Initial - Typical Dose | Maximum - Full Dose |
|---|---|---|---|
| Testosterone Undecanoate in castor oil (ie. Nebido or anything pharmacy sourced) | 50mg every month | 125mg every month | 250mg every month |
| Testosterone Undecanoate in MCT oil (will usually be from steroid sellers) | 40mg every 3 weeks (21 days) | 100mg every 3 weeks (21 days) | 200mg every 3 weeks (21 days) |
With longer lasting esters like testosterone undecanoate, the carrier oil it is in can greatly impact the amount of time it lasts in your body, hence the separate dosing recommendations depending on what oil it is is.
Also, testosterone undecanoate can be difficult to source, and the only options available may be in a single use glass ampule format, instead of the standard multi-dose vial.
These ampules usually contain 1000mg per dose. This would most likely be too high of a dose, and would cause very high levels and level fluctuation throughout a dosing cycle, so it’s highly recommended you do not buy testosterone undecanoate if it only comes in ampule form. The 1000mg dosage ampules would also require injecting 4mL of fluid, which can be potentially painful.
Keep in mind the low dosage range described above will generally not induce the same extent nor speed of changes as what would be expected at higher dosages.
Calculating Injection Dosages
Section titled “Calculating Injection Dosages”Vials of testosterone are usually compounded at either 200mg/mL, 250mg/mL or 300mg/mL. This means that for a 200mg/mL vial, every 1mL of liquid will contain 200mg of testosterone. A 10mL vial will then contain a total of 2000mg of testosterone.
We will unfortunately be doing some math here.
The formula to calculate how much liquid to inject is:
(amount you want to inject) ÷ (concentration of the vial) = amount to inject per dose in mL
Dosing examples:
Section titled “Dosing examples:”| Desired Dose | Vial Concentration | Calculation | Injection Volume |
|---|---|---|---|
| 20mg | 200mg/mL | 20 ÷ 200 = 0.1 | 0.1mL |
| 50mg | 200mg/mL | 50 ÷ 200 = 0.25 | 0.25mL |
| 100mg | 200mg/mL | 100 ÷ 200 = 0.5 | 0.5mL |
| 50mg | 250mg/mL | 50 ÷ 250 = 0.2 | 0.2mL |
| 50mg | 300mg/mL | 50 ÷ 300 ≈ 0.17 | 0.17mL |
Not too complicated now, hopefully!
How to perform a T injection
Section titled “How to perform a T injection”Needles can be bought from any pharmacy over the counter in most countries without a prescription (you may have to ask the pharmacist directly). Most countries also have online sites that sell appropriate injection needles. Amazon is a popular source for those in America.
Injection Supplies
Make sure to buy 1mL syringes, as the small amounts of fluid we are using for each injection are only easily measured with 1mL syringes. The more common 3mL syringes will still work if you cannot find 1mL syringes, but are not ideal. It is fine to use 3mL syringes if you are using testosterone undecylate due to the high injection volumes.
There are two methods for a T injection, subcutaneous/subq³ (injection into the layer of fat under the skin), and intramuscular/IM (injection deep into the muscle underneath the skin and fat). Both methods result in identical absorption rates and levels of the drug, whether you prefer subq or IM is mostly personal preference.
Homebrewed injections typically contain benzyl benzoate (a safe solvent that is also commonly used in prescription grade medications), which can cause some minor irritation if injected subcuaneously. Usually there will be less post-injection pain if injected intramuscularly.
Appropriate gauges (needle thickness) for a subcutaneous injection are 25-30g, for intramuscular, 23-25g. Subq needles are thinner than IM needles, which some people will find less intimidating.
Recommended needle lengths are as follows: 1”-1 ½” (IM, 1 inch is better for thinner people and 1 ½” for thicker people) ½”-⅝” (Subq, up to personal preference)
There are many online videos and guides for how to administer an intramuscular or subcutaneous injection, here is a decent one:
- Guide by Plume: https://support.getplume.co/support/solutions/articles/72000544742-all-about-injections Very detailed video guides on both IM and subq injections, with the downside that they are split into multiple long videos.
Note that around 0.1mL of fluid will be lost with each injection due to needle dead space.
Note on finasteride and dutasteride usage
Section titled “Note on finasteride and dutasteride usage”Some trans masculine people choose to take medications like finasteride or dutasteride to prevent male pattern baldness and hair loss.
These medications work by preventing testosterone from naturally converting into another hormone called DHT (dihydrotestosterone). DHT is the main hormone responsible for male pattern hair loss.
DHT also plays an important role in developing body and facial hair growth and bottom growth. If these changes are desired, it may be recommended to not take finasteride or dutasteride until you are satisfied with your level of facial and body hair growth and bottom growth. If finasteride or dutasteride is started too soon, these changes may be limited.
Male pattern hair loss is generally very rare in the first year of T, though if you are still concerned, minoxidil (brand name Rogaine) can be used as a topical hair loss prevention medication, and will not inhibit other desired changes.
Blood testing:
Section titled “Blood testing:”Check out our blood testing page for sources near you:
Blood Test Sources
Get your estradiol (E2) and total testosterone (T) tested every time. Get your blood taken as close as possible to your next scheduled injection/dose (Test your blood as far away as possible from a previous dose, right before your next scheduled dose. Preferably the day of your shot, or the day before). Your blood levels of estradiol and testosterone when taken at this time are called ‘trough levels’, because they are the levels of E2 and T that are present in your body at the lowest point in your HRT dosing regimen.
What should my total testosterone (T) reading be?
The Endocrine Society’s 2017 clinical guidelines for transgender HRT recommend that trans men maintain “testosterone levels in the physiologic normal male range”, a range which is typically given as 300–1000 ng/dL. Slightly higher or lower testosterone levels above or below this range are not something to worry about unless your estradiol levels are also too high.
What should my estradiol (E2) reading be?
The typical range for adult males is 10 – 50 pg/ml although this varies due to age and individual factors. Try to aim within this range, although slightly higher levels are not something to worry about. Try to keep your estradiol under 70pg/mL
Occasional testing of Complete Blood Count (CBC), Liver Function Tests (LFT)/Liver enzymes, Clotting factors test, and Lipid profile test (cholesterol, triglycerides) can be useful to monitor certain health risks associated with testosterone therapy.
Hormone therapy in general is very safe and effective as long as you take reasonable doses.