Testosterone Dosing

Updated: Jul 17, 2018

Kyan Lynch, MD, MA

Queer Health Question: What's the general starting dosage for testosterone in trans men?


There are several protocols providers can follow when initiating and continuing hormone replacement therapy for trans and GNC folks (see resource section for a list of protocols for HRT).


My doctor, for example, follows the Endocrine Society Guidelines. These guidelines recommend a dose of 100-200 mg of testosterone enanthate or cypionate every two weeks, taken as a shot into muscle (most commonly thigh), or half that dose if taken into the layer directly under the skin, called subcutaneous (in the belly, butt), weekly.


Now when you are dealing with shots, it's important to know that the amount you draw up is dependent upon the concentration of the medicine. Fair warning: I'm about to talk about math.


A company I like very much, Point 5cc, is named based on "a common dosage of hormones that a trans person on HRT (hormone replacement therapy) is prescribed". However, point 5cc (also known as half a milliliter) refers to a volume, not the amount of drug. Sometimes, testosterone can come in a concentration of 100mg/mL, but it can also come in a concentration of 200mg/mL. Depending on the concentration, point 5cc can either mean you are injecting 50mg (if the concentration is 100mg/mL) or 100mg (if the concentration is 200mg/mL) - that's a big difference!


Alternatively, a trans guy can opt out of the shot game, and go with topical T. There are two choices here: T gel or the patch. According to the Endocrine Society, the dose for the gel should be 50-100mg per day, and 2.5-7.5 mg per day for the patch.




Alrighty, so what do some other protocols say?


Fenway Institute: "Many providers will start at a half dose and then quickly increase to a full dose at the first follow-up visit or later depending on the patient's response and goals for treatment."


Injectable:

Testosterone cypionate or enanthate:

May start at 40-80mg intramuscular weekly and increase in increments of 20-40mg, until the usual dose is reached.

Usual dose is 100mg intramuscular weekly or 200mg intramuscular every 2 weeks.


Long Acting Injectable:

750mg intramuscular for the 1st dose, 750mg intramuscular four weeks later, and then 750mg intramuscular every 10 weeks.


Topical:

Androgel, Testim, and Axiron:

50mg of testosterone applied daily to upper arms or thighs.


Androderm patch:

4mg patch applied daily to upper arm, thigh, abdomen, or back, changed every 24 hours.

(May start at 2mg, increase after 2-4 weeks).


Callen-Lorde:

Injection:

Testosterone Cypionate or Testosterone Enanthate:

Starting dose: 100mg intramuscular every 2 weeks


Testosterone Gel or Patch:

Starting dose: 2.5mg daily


If you made it to this line, congratulations, that was a lot!


You may have noticed that there are some differences between protocols. That's true. That is also why I couldn't just answer this question in a sentence or two (also I'm long-winded 🤓).


Last, but certainly not least, while a lot of hormone replacement therapy has been protocolized, it is still true that EVERY PATIENT IS DIFFERENT. Every person starting hormone therapy has a different medical history, set of circumstances, and goals. Therefore, providers have to be thoughtful about the medications they prescribe, and how much to prescribe. Providers will also use their clinical judgement to decide if they want to follow the guidelines exactly, or if they want to alter them slightly. For example, many providers will start off at a half dose and increase from there.


Happy masculinizing, everyone!

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