im almost 6 months on t and im on 40mg/0.2ml per week which is a low starting dose but due to corona i cant go back to my endo until january. i haven't had as much changes as i would like. im afraid that after i pass 1 year my voice won't change any more because i wasn't able to raise my dose within a normal timeframe. if i went on a higher dose after a year would i get the changes i was supposed to get in my first 6 months? is this going to permanently make my voice higher than it would be?
Lee says:
When I started testosterone, I was on a really low dose of 12.5 mg. I stayed on a low-dose for about a year. Then, on year two, I started to increased my dose to an “average” dose of T. Now I’m almost 3 years on T, and my dose is 80 mg.
Disclaimer:
This really helpful table lists low doses, starting doses, and the maximum doses. You shouldn’t change your own dose, but you can use this as an idea of what to expect and you can talk to your endo if your dosing is higher or lower than what’s listed on the chart to make sure that your bloodwork has testosterone levels in the normal range. This other guide also has a few example starting doses listed!
Doses aren’t universal though, it varies by the person. People who have a higher dose of T don’t necessarily experience changes faster than people on a lower dose- it all depends on how your body processes the T. The important bit is what your blood work shows your T levels to be, not the dose of T.
Two people on the same dose of T might have two different T levels after their first bloodwork, and one of them may have to do a higher dosage while the other may decrease their dosage, but in the end they’d both end up with the same levels even though they’re taking different amounts of T.
So this means that when I say “average dose” or “low dose,” what I really mean is the level of testosterone in your blood and the speed of the changes you get because one person’s low dose is another person’s average dose. But we’re going to say “low dose” as a shorthand for this.
Ok, back to it!
Being on a low-dose means you’ll get changes slower than if you were on a higher dose, but it doesn’t mean you’re going to be prevented from getting those changes later.
This expected time frame for T changes is based on someone who is on an average dose. But that doesn’t mean that the window listed for changes to happen is the only time in which they can occur!
You may have seen this image on our blog before:
You mentioned your voice, so let’s use that as an example. The voice typically starts getting deeper when you’re around 6-12 months on T, and continues to get deeper for 1-2 years.
Okay, so let’s say you’ve been on a low dose of T for 2 years, and your voice hasn’t changed much. You might be thinking “oh no! The chart says the voice only deepens in the first 2 years on T, and now I’m screwed!” But have no fear- that isn’t the case! You’ll be fine, this window is more of a “this is when changes often happen” and not “this is when changes have to happen”.
Here’s a metaphor to explain:
If you’re taking a low-dose of testosterone, you’re slowly adding water to the cup. Over the years, your cup will eventually get full- it’s just going to get full a lot slower.
If you’re on an “average” dose of testosterone, you’re pouring more water into the cup, and because you’re filling the cup faster it’ll get full quicker. So in the same number of years, you’ll have experienced more changes.
Now imagine you start pouring a little water into the cup, and it’s only a bit full after the first year. Next year, you decide you want your cup to be 100% full so you start pouring water into the cup faster. You’re still going to be able to fill your cup!
Even if you stopped pouring for a bit when you lost access to T, when you started T again the same amount of water would be in there so you’d just pick up where you left off. (This is true for vocal changes, which is what we’re discussing, but other changes like body fat redistribution is more like a leaky cup because it’ll start to revert back if you stop pouring).
Being on a different dose of T doesn’t change the size of your cup (ie the amount of masculinization that your body can go through), it just changes how fast you’ll get there. Now I’ll note that this metaphor and the really bad image I drew above are an oversimplification, it’s just to get the concept across.
Okay, so let’s get back to the voice thing. I’ll note here that your voice gets deeper because testosterone physically thickens the cords. If you’re on a low dose, maybe your body hasn’t reached the T level needed to start vocal changes. But being on that low dose hasn’t somehow made your vocal cords immune to getting changed by T. So when you raise your dose, you’ll reach that point where the testosterone level in your body is high enough to make changes, and then your voice will start to deepen.
Eventually, your vocal cords will finish developing. Going back to the cup metaphor- when you’ve filled the cup all the way to the top with water, even if you add more the cup can’t get any fuller. The water will just pour off the top and it won’t do anything to increase the amount of water in your cup because if the cup is full, you’ve reached your max. At that point, your T changes will be complete and you won’t experience more.
Continuing the metaphor, all cups are different. So some people will have really deep voices and other people won’t, and there isn’t anything to be done about that- you can’t change your cup to a different cup because you are the cup.
Ok, the metaphor is getting old. No more cups. There is one thing you can do when you’ve reached the extent of your T changes, and that’s surgery. You can do vocal training with a speech pathologist to train yourself to speak in lower pitches and in a more masculine way, or get a vocal masculinization surgery.
Of course, there is an exception to the above:
There are a few things that can only happen if you start HRT at a younger age, like growing taller. If your growth plates have already sealed, you won’t grow any taller on testosterone or without it. So if you’re 18 or older when you start T, it’s unlikely you’ll grow any taller with or without T.
The younger you are, the better your chances are at growing, and younger than 16 is the ideal time for you to have a chance of growing taller so if you start T before you’re done growing you may end up taller than you would have been if you didn’t start HRT until 18 or older.
That means if you’re not on T, or if you’re on a lower dose during all of your teen years, it’s possible you won’t reach the full height you’d have reached if you started on an average dose at a younger age.
But in general, with some things like clitoral growth, you can max out the androgen receptors at any point so it doesn’t matter when you start T.
TLDR; You don’t have a narrow window for T changes. Once you’re an adult, you still will be able to get the same changes no matter when you start or how long it takes you to go to an average dose.
More info on testosterone in in our Testosterone FAQ.