Transgender Teen Survival Guide

Lee says:

Yes!! I can’t emphasize how normal that is!! Some people experience changes faster than others do and it’s all normal!

You also might just not be noticing when you’re experiencing changes because they’re so subtle and occur so slowly. Children generally don’t wake up one day and say “hey, I’m taller and bigger than I was last month!” but somehow we do grow up and grow taller without being aware of it, and one day the clothes that used to fit us just don’t fit anymore. Taking pictures of yourself and recording your voice can help you compare your changes more objectively. But even if you haven’t experienced any changes at all, it’s totally normal and there’s not necessarily anything wrong!

I’m not sure what guides you’re reading that say you’ll be noticing a lot of differences by 1 month on T; it’s certainly not what our Testosterone FAQ says! That page has more info about this, but I’ll restate it again below.

Here’s a table from the WPATH-SOC:

The table says:

As you can tell, there isn’t a single change listed that is expected to start occuring only within the first month! There are no expected onset ranges of 1 month-1 month!

The onset (start) of the change that’s expected first, acne and skin oiliness, is expected to happen within 1-6 months. That means it might happen in month 1 for one person, and it might happen in month 6 for another person. 

Some people start noticing changes a lot earlier than what the chart lists as the average onset, but there are a lot of people who don’t experience changes right away, as the ranges in the chart indicate, and that doesn’t mean that they’ll never happen. 

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.

So 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.

Being on an “average” dose doesn’t necessarily mean that your T levels are in the right range; some people need a higher-than-average dose (or a lower than average one) which is why an average dose is just an average. That’s one of the (numerous) reasons why you typically get blood work done at 3 months on T, at 6 months on T, then yearly after that (unless you change your dose and then have to do blood work 3 months after the change).

It sucks to have to wait, but I’d recommend just being patient for now! Make sure you have an appointment in 2 months to get your blood work done, and if you haven’t had any changes by then and your blood work shows there’s room to raise your testosterone dose, you should talk to your doc about raising the dose.

Again, more info on T changes is in our Testosterone FAQ.

Lee says:

Hmm that’s an interesting question! And I don’t know the answer- I haven’t really heard much about how testosterone impacts the ribcage so what follows is only my speculation on the topic (aka you should ask your doctor for more info!)

Wikipedia, our favorite unreliable source, says “Expansion of the rib cage in males is caused by the effects of testosterone during puberty.” 

So if that’s true, I’d guess testosterone might cause an increase in growth hormone, and that would trigger growth in your ribs which would cause your rib cage to be wider and larger if you start testosterone at a younger age, but I honestly don’t know enough info on this to say yes or no for certain.

However, it is certain that your bones are pretty much fully done developing by a certain point in your life, which is why you don’t grow taller when you start testosterone at an older age, and I would guess that the changes to your ribs (or the lack thereof) would follow the same principle.

As our Testosterone FAQ says, the younger you are, the better your chances are at growing taller, so if you were on puberty blockers first, or you start testosterone when you’re younger than 16, you have a better chance of growing taller (but it’s a chance and not a guarantee).

There’s an x-ray test that doctors can do to tell if your growth plates have fused. If they have fused, then the chance that you’ll grow taller is slim. 

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 extremely unlikely you'll grow any taller with or without T.

I would assume that the growth of your other bones is the same- if you start testosterone when you’re younger, your bones will grow a little bigger & longer than they would have otherwise (depending on your genetics and nutrition level and so on).

From Hudson’s FTM Guide:

Anyhow, I’m not sure how testosterone would specifically affect your rib cage or at what age your ribs typically stop developing (if you are not on puberty blockers), but this is a good question to ask your endocrinologist/testosterone prescriber!

Followers, does anyone have more info on this?

Lee says:

The Adam’s apple is formed when your voice lowers- it’s a chunk of thickened cartilage around the larynx, and once your vocal cords thicken that’s what creates the Adam’s apple. 

Some people on T get a more prominent Adam’s apple than others, it depends on your body. So no, you’re not guaranteed to get a super visible Adam’s apple on testosterone, but it’s certainly possible.

There’s also a surgery that can make a more visible Adam’s Apple if you don’t develop one after being on T: 

And the reverse is possible too. If you don’t want to get an Adam’s apple on T, after you’ve finished developing, you can get a tracheal shave which is a procedure that can reduce the size of your Adam’s apple:

Lee says:

Definitely, yes! I personally do a little “manscaping” now that I’m almost 3 years on T. My partner thinks it’s a little funny because I don’t have an excessive amount of hair in the first place, but uh I’m gay and also vain? 

I trim pretty much everything with an electric razor- pubic hair, thigh hair, happy trail, chest hair, armpits- pretty much everything. I don’t shave or wax it so the hair is still visible, and I don’t mind having body hair, but I like to be neat and trimmed!

I have one clipper for cutting my hair and another one for trimming my body hair, and the body hair trimmer one came with an attachment for trimming nose hair.

I don’t use the nose hair trimmer myself because my nose hair seems under control for the time being, but my dad has one of his own which he uses now and then. I think older men tend to have longer nose hair for some reason, but that’s just something I’ve noticed and not a Fact™ that I have data to support.

T does give you more hair, which means more hair on your face, legs, arms, more pubic hair, more armpit hair, more hair on your chest and stomach, and sometimes even hair on your back. It’s just like it is for cis men though- some people are really hairy, and others just aren’t. It depends on your genetics. 

You just kinda gotta roll with whatever happens- you can sometimes guess how much hair you’ll get by looking at your brother and father, but everyone is different, and even two brothers don’t always end up with identical hair patterns. 

I went from being mostly hairless to seeming to have a little more body hair than my brother and about the same amount of facial hair (ie both of us have sad-looking scruff that really can’t turn into a beard yet) and I haven’t noticed a big change in my eyebrows either way. For context, he’s cis & 19 and I’m transmasc & 20 right now, and I think we’re both still going through changes.

More info on T changes is in the Testosterone FAQ.

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:

[Screen-reader accessible version of table on page 43 here] 

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.

Lee says:

Testosterone will not change the shape of your hip bones, but it does help redistribute the fat in your hip area, so there’s a chance that waiting for testosterone to change your fat distribution could de-emphasize your hips.

A former, mod, Jay said: “My hips, thighs, and butt have basically melted away. In 1 year on T I’ve dropped 1-2 pants sizes, which is about 4 inches around the waist and at least 6 around the hips without changing my lifestyle. I had narrow hips pre T, again because of my hyperandrogenism.”

However, I (mod Lee) am currently 2 years and 8 months on T myself, and I don’t think I’ve had much of a noticeable change in my hips- but I also don’t think I had much fat there to redistribute and T won’t noticeably reshape the bone that’s already in place, so there just wasn’t much room for change in that part of my bod.

So as you can tell from the difference in mod Jay’s experience and mine, the amount of change you’ll experience isn’t standard and it’ll vary by person.

Compression shorts like these ones by Underworks can slim your thighs and squish down some of the fat on your hips. Here’s a post about that. You can also get more sports type ones, if you need to have something more discreet.

There’s also women’s shapewear like Spanx that compress the hips/butt if you aren’t out and need to explain your purchases to family, so you have safer alternatives to using ace bandages.

And there’s liposuction (also called “mansculpture”). In the meantime, check Our Dysphoria Tips Masterpost, and maybe go shopping- certain styles of pants can also help disguise your hips.