--- title: "Testosterone Guide | The Gender Hormone Clinic" description: "A clear guide to testosterone therapy: what it does, how it's taken, and what to expect." url: https://thegenderhormoneclinic.com/patient-resources/medication-guides/testosterone-therapy/ --- [Home](https://thegenderhormoneclinic.com/) / [Medication guides](https://thegenderhormoneclinic.com/patient-resources/medication-guides/) / Testosterone TRANS-MASCULINE HRT · MEDICATION GUIDE # Testosterone therapy, a clear guide. Testosterone is the primary masculinising hormone we prescribe. It's available as a daily gel, a long-acting injection, or a deep-muscle implant. Your clinician will help you choose the form that fits your body, your routine, and your embodiment goals. [Begin your journey](https://thegenderhormoneclinic.com/make-an-enquiry/) [See payment plans](https://thegenderhormoneclinic.com/patient-resources/payment-plans/) (image: Testosterone therapy, clinical reference image) Drug class Androgen / anabolic steroid Used for Masculinising HRT Routes Topical, IM, SC, implant Frequency Daily → 12-weekly Prescription Specialist initiation WPATH SOC 8 Aligned On this page[Overview](#ma-overview)[How it works](#ma-how-it-works)[Forms & dosing](#ma-forms)[Effects timeline](#ma-timeline)[Side effects](#ma-side-effects)[Cost](#ma-cost)[Patient voices](#ma-stories)[FAQ](#ma-faq) OVERVIEW ## What testosterone does, in plain English. Testosterone is the hormone responsible for most of the physical traits we associate with male puberty: a deeper voice, body and facial hair, increased muscle mass, and a different fat distribution. When you take it as part of gender-affirming care, your body undergoes a second puberty. Most changes start within the first three months and continue for several years. Some changes are permanent (voice, facial hair, bottom growth). Others reverse if you stop: muscle mass, skin texture, fat distribution, libido. Knowing which is which helps you make the choice that's right for you, and we'll talk through it together at your initial consultation. Affirming, not gatekeeping. We follow our normal informed-consent pathway. You don't need to prove anything to access testosterone. What you need is a clinician who listens, and a plan that's safe and right for you. HOW IT WORKS ## The way it actually works. Testosterone binds to androgen receptors throughout your body: in skin, hair follicles, muscle, fat, vocal cords, and the brain. Over time, those tissues respond by changing the way they grow and behave. Our job is to get and keep your serum testosterone in a typical adult-male range (roughly 10-30 nmol/L), then adjust based on how you feel and how your body responds. Suppresses oestrogen Testosterone shifts the hormonal balance, so your body produces and responds to less oestrogen over time. Stops menstruation For most patients, periods stop within 3-6 months. If they don't, we adjust the regimen. Triggers second puberty Voice, hair, fat redistribution and muscle development all flow from sustained therapeutic levels. Steady levels matter Big peaks and troughs cause mood swings and acne; smooth, steady levels are the goal. FORMS & DOSING ## Multiple ways to take it. Your choice, our guidance. There's no single right answer. What matters is what fits your life. Most patients start on the simplest option and switch later if it suits. Topical · Daily Testosterone gel Testavan · Testogel · Tostran A clear gel applied once daily to clean, dry skin on the inner thighs or lower abdomen, not the upper arms or shoulders, even though the product leaflet says upper body. Applying to the wrong site can give a misleadingly high level. Testavan is our usual default; new starters begin on one pump a day (one bottle to start with) and titrate up once it is tolerated. Typical dose: 40-80 mg per day, titrated to bloods. New starters begin low (one pump daily) and build up. Pros Steady daily levels, no peaks or troughs Easy to stop or pause if needed No needles Watch-outs Transfer risk: wait an hour and cover skin before close contact Daily routine required Testavan can cause skin reactions more often than older gels IM injection · 2-3 weekly Sustanon (intramuscular) Sustanon 250 A blend of four testosterone esters in oil, given as a deep intramuscular injection, usually self-administered into the thigh or glute. Typical dose: 250 mg every 2-3 weeks (typical). Pros Well-established, widely available Lower cost than long-acting depot Self-injection after training Watch-outs Levels peak then trough between doses Some patients feel “off” in week 3 Needles: needs comfort with the technique IM injection · Every 10-14 weeks Nebido (testosterone undecanoate) Nebido A long-acting depot injection, typically administered by a clinician. Releases testosterone slowly, giving very stable levels over months. Typical dose: 1000 mg every 10-14 weeks after loading. Pros Smoothest, most stable levels Only 4-6 doses per year No daily routine to keep up Watch-outs Higher unit cost Usually clinic-administered Slow to adjust if levels drift SC injection · Weekly Subcutaneous testosterone Various ester preparations An off-label but well-tolerated route used by many patients: small weekly doses injected just under the skin with a fine needle. Typical dose: 50-100 mg weekly, titrated. Pros Stable weekly levels Less painful than IM Smaller needle, easier to self-inject Watch-outs Off-label in the UK Weekly schedule Some skin reactions at injection site EFFECTS TIMELINE ## Changes over time. Timelines vary between individuals. This is a typical picture of what most patients experience. Phase 1-3 Months Skin & oiliness Increased sebum production; skin becomes oilier, which may lead to some acne (typically temporary). Libido A notable increase in libido is often one of the earliest and most pronounced changes. Bottom growth Clitoral enlargement begins and continues gradually over 1-2 years. Energy & mood Many patients report increased energy and a greater sense of emotional stability and wellbeing. SIDE EFFECTS & RISKS ## What to watch for, and what to tell us. Most patients tolerate testosterone well. The effects below aren't guarantees. They're things to watch for, and most are manageable with dose adjustment or simple care. Severe reactions are rare. Always tell your clinician if something doesn't feel right. Common Acne + Especially on the back, shoulders, and face during the first year. Usually settles. Skincare and, if needed, a GP referral for topical treatment helps. Vaginal dryness + Atrophy of vaginal tissue is common. Topical oestrogen can be safely co-prescribed if it bothers you. Mood swings + Most often linked to peaks and troughs in injection regimens. Switching to gel, weekly subcutaneous, or Nebido often resolves it. Increased appetite + Many patients feel hungrier, particularly in the first 6 months. Weight redistribution + Body shape changes. This is the intended effect, but it may catch you off guard. Less common / serious Erythrocytosis + A modest rise in haematocrit (thicker blood) is expected on testosterone and is usually nothing to worry about. We check it every 6 months and only act, by reducing the dose, advising hydration, and sometimes blood donation, if it climbs above the safe threshold (around 0.52). It rarely means stopping testosterone. Skin reactions (gel) + Testavan, our default gel, causes rashes or irritation at the application site more often than older gels like Testogel. If your skin flares, tell us. Rotating the site, or switching to Testogel (which costs roughly double), usually settles it. Sleep apnoea + Testosterone can worsen pre-existing sleep apnoea. Tell us if you snore heavily or wake unrested. Cardiovascular risk + Long-term effects on heart and lipids are still being studied. We monitor cholesterol and blood pressure as part of routine care. Liver enzymes + Mild rises are sometimes seen. We check LFTs at baseline and during monitoring. Hair-line recession + If you have a family history of male-pattern baldness, you may experience scalp-hair thinning. Finasteride is an option for some. Monitoring schedule We catch things early. Here's the routine you can expect. Most of the testing is front-loaded while we fine-tune your dose. Once your levels are stable, it's usually just once a year. Baseline Full hormone panel FBC, U&E, LFTs HbA1c, lipids Blood pressure 3–6 months Testosterone trough/peak FBC (haematocrit) LFTs 6-monthly while adjusting Testosterone level FBC, LFTs Lipids Yearly once stable Full panel BP, weight Symptom review COST ## What testosterone costs you, monthly. Your monthly plan with us covers the clinical side: appointments, calls, prescriptions, letters. Medication is paid separately at the pharmacy, and the price varies by form. Once your GP enters NHS shared care, the medication cost typically drops to the standard NHS prescription charge. Testavan (private) ~£105 per 3 months Usual default gel Testogel (private) ~£180 per 3 months Private prescription Sustanon (private) £6-£8 per dose 1 dose every ~3 wks Nebido (private) £130-£150 per dose Professional admin only Once on shared care £9.90 per item Standard NHS Rx charge [See full payment plan](https://thegenderhormoneclinic.com/patient-resources/payment-plans/) PATIENT VOICES ## In their own words. " I was nervous about needles, so we started on gel. Two years in I switched to Nebido and the steadiness is honestly life-changing. Sam On testosterone for 2 years " My voice broke around month four. I cried the first time I heard it on a recording. It was the right kind of crying. Theo Started gel, switched to subcutaneous " The clinic talked me through every option. I never felt rushed and I never felt judged. That mattered as much as the prescription. Ari Non-binary, low-dose regimen FREQUENTLY ASKED ## Questions, answered. This guide isn't a substitute for clinical advice. We'll talk you through everything at your appointment. [Make an enquiry](https://thegenderhormoneclinic.com/make-an-enquiry/) ## Ready to take the first step? Send us an enquiry and we'll be in touch within two working days. [Make an enquiry](https://thegenderhormoneclinic.com/make-an-enquiry/)