The Trannex

Health Guides

If you are thinking of managing your own healthcare, there are community-written resources on dosages and methods (for all genders) here. Highly recommended


For people who would like to understand the kinds of pre-treatment tests, dosing regimens etc used when taking transmasculine hormones. These are guides doctors use for learning to treat trans people.

Primary Health Care for Trans Patients: Masculinising (Rainbow Health Ontario). (archive link)

Hudson's Guide Community classic! Last updated 2017. (archive link)

Practical Guidelines for Transgender Hormone Treatment (Boston University School of Medicine) (archive link)

Overview of masculinizing hormone therapy (University of California) (archive link)

Endocrine Management of Gender Dysphoria in Adults (Welsh Health Service) (archive link)

Hormone management in Trans men from Trends in Urology

Clinical practice guidelines for transsexual, transgender and gender diverse minors (Anales de PediatrĂ­a Vol 96, Issue 4, April 2022) (archive link)

Anabolic Steroids: A Guide for Users & Professionals by Exchange Supplies

IPED info (Public Health Wales)

Self Med Community

Indviduals and groups who tweet about this and share knowledge!

You can also write to the Trans Healthcare Network: transmutualaid@protonmail.com . They are mostly active in Ireland and the Netherlands, but have general expertise.

Blood Tests

On the NHS, it is standard to get your baseline bloods taken before you begin; once you begin on HRT, it is impossible to recover this baseline data. However: in America, its not standard to get a pre-T blood test at all, so if you're on a budget it evidently isn't that important. I've discussed this with friends, and we decided that the NHS are being thorough and it's a reflection of a patrician attitude, whereas in the USA - because people are paying their own way - there's more of a culture of only doing what's actually needed.

The NHS test should measure:

This Body Transformation Test - a mail-order test which covers all the bloods taken by the Welsh Health Board - I suspect, tho they did not say this on the website, the target market is trans people.

Getting regular blood tests is essential to safe T use, and that's even more true if you are accessing your medication from a questionable source. 3 months and 6 months is the standard pattern on the NHS.

A common issue with getting blood tests done is, the service will assess if your bloods are 'correct' based in part on your expected gender, and not document that this is a trans person's blood test which needs interpreting in that light. I believe you want the blood test to be done 'as a man' to check T is in a ''male range'', and so it doesn't come back interpreted as if you were a woman. If you're nonbinary, then consider your goals and ask your provider to assess the bloods in that light. An effective health service should be able to record that you are trans, and therefore interpret the results in that light, however I've yet to hear of an effective health service except in long-lost legends of ancient days.

Admin Instructions

Introduction to Ampules and Vials - University of Manitoba Nursing Skills


Intramuscular Injection

đź“‘ How do I administer Sustanon - from Gender GP; intermuscular.


Introduction & Subcutanous Injection Training

How to Give Yourself a SQ Injection - Planned Parenthood


đź“‘ How to Open an Ampoule

Slow motion of an ampoule snapping

Draw from ampule

Illustrated guide to injection sites

Finding the Vastus Lateralis (it's sort of on the diagonal edge of the thigh, if that makes sense - not straight into the top, nor straight into the side, but a secret third place in-between)

Hormones: Let's go shopping!

Equipment used in the SC Polyclinic Video

1ML Luer Lock Syringe One per injection
Drawing up Needle - Sharp
Luer Lock | 18G gauge | 1 1/2" long
One per injection
Injection Needle
Differs based on method!
One per injection
Alcohol swabs Six per injection
Small Plasters Optional/one per injection
Sharps Container Lasts forever

PLUS an Injection Needle. Make sure it fits your selected syringe:

Method Gauge (thickness) Length
SQ 25G -30G 1/2" - 5/8"
IM 23-25G 1" - 1 1/2"

I think Exchange Supplies is cool - a social enterprise that's been running since the ~2000s with a mission of harm reduction for people who use injectable drugs (including those who do so illegally), and ships worldwide. You may be able to find a needle exchange, a trans mutual aid group, an lgbt or sexual health clinic that might help you access equipment for free if you are in need. Needle exchanges in the UK

Lifestyle Tips

Weightlifting

The FTM's Complete Guide to Looking Like a Hot Dude - specifically recommended for the section on weight training! But the clothing guide is also very good. Note that this guide discusses (and advises) weight loss. There's also a community reddit: r/FtmFitness

Vocal Training

Transmasc Voice Guide - vocal training is one of these things often associated with trans women & only (occasionally!) funded for trans women in the UK on the basis that T drops your voice anyway. But you might not want to be on T/or, it might not do the trick. Plus a Discord Community; and there's a reddit for voice with a transmasc tag; and look on youtube for videos

Singing

A common worry! Here's a study on the Singing Voice In The First 2 Years Of T by Tessa Romano, a singing tutor; and there's a lot of resources here.

Hair Growth

I Will Teach You To Be Hairy - community-made guide to growing hair while not on T. Author intends to update soon, as putting hairdye on newly grown hair can cause them to burn and you shouldn't.

What about preventing hair loss? There's community rumblings about minoxidil, and topical finasteride (the latter can counteract your progress from T so...it's a fine art). Basically, people are experimenting with these but I've not done any real research: ask about.

Dick vanity

Why yes, there are absolutely people researching how to get more length without surgery. You can visit r/growyourTdick, or the sister sub r/GrowYourClit for ideas.

If you're window-shopping for silicone, there's reviews and discussion at r/transmascdicks.

FAQ

Is self-medicating safe?

Yes and no. There are four main concerns: police, supply, gender clinics and your ability to treat yourself

If you're able to go private, look into it. Maybe there is a local mutual aid who can help you fund treatment?

the Law

T is used as a performance enhancement drug by athletes, hence it tends to be slightly illegal the world over. Check your local context to find out how illegal it is, and what the consquences of using it might be. Typically, your risk as a user is very low. Law enforcement targets and prosecutes dealers and manufacturers, and relies on fear of arrest to police the rest. However, the risk isn't zero - so you should take sensible precautions like, say, not carrying your meds with you in the car in a way that's visible.

Supply

Trans women who self-medicate are, basically, misusing birth control and menopause pills. These can be bought over the counter in many countries, and are rarely illegal. Unfortunately for us, we are typically buying something that was cooked up in a basement. It may or may not be horse piss, and manufacturers may or may not have followed medical cleanliness best-practice. In this, we are in the same boat as other drug users who are put into unecessary extra danger (from police and to our health) by criminalisation and stigmatisation.

One study done in the Netherlands found that 50-60% of steroids bought on the black market are dodgy: too much or too little of real medicine in the substance, bulked out with random shit, actively dangerous, or containing nothing of value at all. People do die from this, and it sucks; I enjoyed Reggie Yates documentary on cis men in the UK with body image problems, seeing a lot of overlap in needs, but it includes people who became ill or died as a result of their medical choices and it's hard to know if this was cis men dosing unwisely or dangers in the supply itself.

There isn't a way for everyday users to test their drugs to assess whether they are of good quality or not (as is the case with some substances). Trans Harm Network have recently bought equipment to evaluate drugs from popular self-med sources and find out more about which are safer!

The website eroids is a community crowdsourced list of reviews of products from other users (but with advances in AI, it's perhaps tricky to be sure if such sites contain real reviews). Traditionally, you make some buddies at the gym and find out who they rely on. Friends, cis or trans, might have a legitimate prescription they can split with you; you should hold these people dear.

Gender Clinics

Those fuckers. In some countries, self-medicating might make "official" gender care sources unwilling to work with you in future (the Nethelands, apparently). In others, self-medicating can reportedly encourage real doctors to start you on hormones as a harm reduction measure (supposedly, the UK)

But there's a harm reduction angle here where, anti-drug campaigns can overstate the level of risk and requiring trans people to live without life-saving medication can also be a serious source of harm. It can also be cheaper to go black market than going private, and the only option in countries without a legal pathway.

Treating yourself

At this stage, I'm ready to say you're probably better off doing this than relying on your doctor. Gender doctors are notoriously hopeless, and will arbitrarily muck up your dose, refuse to experiment, be years behind best practice, find reasons to deny care...they also disempower, causing you to invest false hope in their competence which can be more dangerous. You'll need to be doing your own research anyway. And, of course, discussions of the danger of self-medicating do not take into account the dangers of being unmedicated, which are considerable.

The concept of just dosing yourself with something is scary, but in practice you'd have to be pretty unlucky for taking hormones to make you ill. It does happen occasionally, but I've never heard of it. Look at the health guides, and look up the medication leaflet online for the substance you're about to take: these will list 'Don't Take If' and 'Take Caution If' for T. If you are in those categories, then you're the sort of person for whom the actual health safety of being your own doctor is a concern.

It's important to get regular blood tests on T, because it can cause difficulty with your liver. Make sure you've budgeted for blood tests: your GP may agree to do them as a harm reduction measure, or you may have to order a private service blood test. Every three months initially is a good pattern.

T Administration methods

There are two ways of administering injectable T; and there is also gel, which you put on a muscle, but is more expensive and trickier to find.

Which method should I choose?

Studies demonstrate that both methods are viable, but people tend to prefer SQ. The Trans Healthcare Network seem to think that SQ is easier to do than IM and, consequently, a better option for people administering their own healthcare. For, say, a weekly 50mg injection either will work.

IM tends to be preferred for if you are injecting a large amount because it can hold more. Some T preparations will 'sit' in the muscle and disperse over a period of time (Sustanon, Nebido, i.e. things designed to work over three weeks, three months or more) and for these, IM is the correct choice.

I find SQ less psychologically intimidating (much smaller needles, that go diagonally into the surface of the fat, instead of really long needles that go deep into the muscle) - but I have at least one friend who has the other experience, who finds the thigh you do IM with is less difficult than fatty areas like the tummy you use for SQ.

Do IM and SQ produce different results (for weekly shots)?

In terms of effects: IM and SQ are the same. However, IM peaks faster and then has a more dramatic trough at the end of the week; SQ can be a smoother ride, being more consistent throughout the period. What I found was that IM made me a lot happier than SQ - and that was an indication that I needed to up my SQ dose by a tiny fraction (0.2ish); in other words, that "peak" sensation was correct for me, and I just needed to adjust so that higher level was my baseline. The joy of self medicating is you can just do this.

You can also adjust how often you take a dose - once a week is standard, but you can make that 5 days...7 days...two weeks...whatever is feeling right. T slowly leaves your body after you take it, and it'll be a bit individual how long it takes. In general, there's no fear to be had of taking less or more infrequently, so be wild and free with that; but any time you're taking more or more often be cautious and methodical and go very gradually. You can definitely do yourself serious harm with T, so don't go outside the parameters rashly.

On Gel

I've tried gel and I hated it. I guess my skin just absorbs badly. My healthcare provider insisted that the opposite could be true: that I was absorbing so fast that it was converting to estrogen. A big issue on gel is executive function - taking it once or twice daily and then waiting around for it to dry. Additionally, what I found was that it has a 'cycle' of a few hours and so I'd be falling into trough twice a day (most gel absorbs in the first 4 hours). It's unclear if I'd have stabilised on it if I persisted - I just got so ill I never waited to find out.

How do I improve my results on gel?

If I put the gel on my dick, will it grow faster?

The standard T gel you get for transitioning with is not location-based, i.e. it will not cause more T Effects on the place it's put on the body. The gel is alcohol based - it stings, it dries you out, you don't want it on your sensitive bits.

What you're thinking of is a topical DHT cream - discussed below, but typically very hard to get your hands on even legally

On Dosage

What dose should I choose?

Look at the health guides!

The 'male range' for T is actually really large. 'More' does not mean faster, manlier, or more serious: it's very individual what the right point is for you, and some people get very intense changes on low doses where others will need more for the same effect. I make my guide that right is when I feel really, really good. T can theoretically be a bit dangerous so - again - do not worry about putting your dose down, but only ever go up slowly and gradually. Your need to go up may be authentic and therefore doing it is a health need, and remaining where you are the danger: do not be afraid. But don't be rash or do a big jump.

What if I have to change method?

'Translating' doses between T methods are hard, because each one functions slightly differently. If you swap methods, you may need to re-learn your dose.

On Being A User

What is the history of medical T?

Click to embiggen! Source: 'Testosterone Therapy With Subcutaneous Injections: A Safe, Practical, and Reasonable Option' by Maria Gabriela Figueiredo, Thiago Gagliano-Jucá, Shehzad Basaria

Should I aspirate?

'Aspirating' is - you put the needle into your body, but before you inject, you then draw back the needle a tiny bit. If the syringe floods with blood, you've hit a vein or artery. You should remove the needle at once and do NOT inject - discard everything, start again. Putting substances into the bloodstream is very dangerous and this is true of T which you do not want in the blood but in either a muscle or fat.

Apparently, it's no longer recommended to aspirate for either SQ or IM injections. I suppose the logic is that if you're following instructions correctly for administration and location, there's no veins or arteries in those areas so you're unlikely to hit them (there are no veins or arteries in the skin or muscle, I guess?)

But 'if you're doing it right' is a big if for an amateur. I always aspirate for IM, and prefer to for SQ - there's no reason not to, IMO.

Oh god i did my shot and now there's blood everywhere

Don't worry! That's fine, you're not in danger, it's normal. I'm told this is the answer. I will never believe it. Press the site with tissue or gauze; pop a little plaster on it; wash your hands because blood can carry infections; and then give yourself a little treat for being brave.

On Bubbles

You may have heard that injecting air bubbles is very dangerous. This advice is for intravenous (into-the-vein) drug users. T goes into either the muscle or skin - i.e. not into-the-vein.

That said, you do want to avoid massive bubbles if you can. Don't shake the bottle, go slowly with drawing up (T is gloopy), repeating if you got a big bubble, and then knock any tiny bubbles you have to the plunger-end of the shot before you take it.

On Scars

Scars will build up in your tissue over time if you inject a lot, making it more painful. To reduce this from happening, rotate your shot site, and after taking your shot, massage the site to prevent scar tissue building up.

What's an ester?

Pure T gets used immediately by the body. Different esters of T break down and release at different speeds. T Cypionate, T Undecanoate etc are all the names of different esters. This gives you a clue as to how frequently that form of T needs to be taken. The speed a chemical breaks down is called half-life (the amount of time it takes for half the remaining substance to go - so it's a graph, not an absolute number.) Sustanon contains several esters, because it's for three weeks so it needs some T that works immediately and some which persists.

My IM shot sight is in pain but it's been a few days, and also I'm feeling cranky

Charmingly, my weatherwitch friend, IM shots will act as a kind of barometer. The liquid sits in the muscle, and disperses slowly. It's heat sensitive, and moves faster when it's warm (one reason not to store your T in the fridge, or to let it warm up to room temperature or roll the bottle between your hands before use). If your IM site is painful out of the blue, you're feeling unexpectedly dysphoric, and the sky is ponderous and grim, you're probably sensing the coming storm. Try thermals.

Medication Safety

Should I keep it in the fridge?

No, not if it's oil-based. If the oil is cold, it'll flow more slowly - which will be more painful and take longer. It should be room temperature. Holding the vial or ampoule in a closed hand for a few minutes or by holding under a tap of warm NOT hot water can help, say if your house tends to be cold.

My bottle of T says for IM only??

I've been told by several sources that the little bottles of T which say "for intramuscular injection only" can, in fact, be used for SQ as well; and my results with this have been good.

Can I reuse this bottle or ampoule? I didn't use the whole quantity

If it's a 'multi-dose vial' then yes; the standard treatment in the US is to give you one little bottle for like eight months or so. This is judged sufficiently safe - the piercing in the rubber lid isn't entirely sterile and, over time, little bits of rubber/metal/grit will appear in the T and you'll have to try and dodge them and hope the injection needles are small enough to filter it out. By the end of my last prescription of this I was getting very uncomfy and wishing I could get a new prescription. Opened preparations of T will go off, gradually losing potency and potentially becoming nasty; I've heard 28 days, but that seems to be like the 'Best Before' labels on food at the store because, again, these multi-dose vials are the norm in the USA. But American healthcare is notoriously shit so...

Using a separate drawing up needle than injection needle as part of your routine likely increases the safety here (esp if you're sharing your prescription with a boyfriend), because the needle touching the liquid will always be maximally sterile.

In short: if it's a multi-dose vial, use it for multi-doses. But if it changes colour, has been open for over a year, is past the expiry date on the bottle, or you can see stuff floating in it, get a new one if you possibly can.

If the bottle is marked 'single dose' it won't have been designed with preservatives or bottle-features to keep the medication sterile. If it's a single-use glass ampoule with a snappable neck, you cannot use it more than once. Many people in the bodybuilding and diabetic community advocate drawing up all the medication into syringes and then leaving the needle and needlecap on until you need them; this seems to be wildly unsafe. The only reason why these people say you can is desperation - a system which deliberately creates medical poverty for disabled people and creates a black market forces these kinds of desperate choices and makes them very, very tempting. Avoid it, little one. We need you in future.

Can I reuse this syringe or needle?

Duckie, no. Discord me and I will send you some money. Or, approach your local needle exchange, trans mutual aid, or anarchist collective for some cash. This equipment is extremely cheap, and so no matter how dire your straits, you will be able to find someone with good in their heart to mail you some money or kit (in the UK, under the Misuse of Drugs act 1971, it is not an offense to supply needles and syringes)

On Injection Kit

What needle size do I choose?

The bigger the gauge number = the smaller the needle. Reportedly, this chart is for these methods period rather than these methods for T specifically. Bigger needles, the medication will move faster (and T is an oil, so it is quite slow) - but may hurt more. In a pinch, any needle will do: these are just the ideal ranges.

What are Luer-Lock and Luer-Slip syringes?

The Polyclinic video recommends the Luer Lock system of syringes because it ensures the needle "locks" firmly onto the syringe, with a twist. Luer Slip needles just slip straight onto the end. Some needles and syringes are one or the other, and some are both: ensure yours is a match. I've done ok with either.

What is a Low-Dead-Space Needle or Syringe?

Look out for needles advertised as "low dead space": these enable you to get more doses out of multi-dose bottles, and may reduce the risk of bloodborne disease (HIV, Hepatitus etc) if you are sharing needles with others (which - to clarify - you should definitely never do, if you can possibly help it).

How do I safely use ampoules?

If you're using snappable glass ampoules, you want filter needles for drawing up with. This is because ampoules will occasionally shed tiny bits of glass into the medication. Fucking yikes, what a godawful design. I was in two minds about the necessity of this - after all, it seems like people pretty widely use normal needles and are fine - but I changed my mind after viewing this this video. Those little shards going everywhere are substantial enough to see, and not using a filter needle is reason enough to fail nursing school.

Ampoule-snapping is terrifying, and you can potentially get glass in your thumb or spattered about your space, as well as just shattering your precious bottle. You can buy an Amp Snapper for next to nothing, which will safely and effectively help with all that. In real medical contexts, they advise you throw the snapper away after 1 use (i.e. to prevent cross-contamination) but exchange supplies notes they are good for around 100 uses, so i'm sure if it's just you and the same substance the safety of reuse is tolerable.

If you don't have a snapper, you need a 2x2 gauze pad or just some gauze, and preferably, gloves, because you are about to snap glass.

The Law in the UK

Cops 101

It's important to know your rights because police will frequently lie or misrepresent the law to get you to incriminate yourself in some way. The basic advice is to say absolutely nothing and keep stonewalling any kind of information until you're released. Be uncooperative.

Testosterone is an anabolic steroid - a Class C drug, under the Misuse of Drugs Act 1971.

This is A Crime

This is Not a Crime

Noodly T Science

I'm curious to learn more about the specifics of different T preparations and methods, esp in terms of varying results. As far as I can tell, the assumption is that they're identical - they produce some masculinisation which is presumed to be what all transmasculine people ultimately want. But they don't - we're individuals - and so I'm interested to learn what, if anything, we can do to customise our outcomes more

All of these studies are of cis men, unless otherwise stated; some are cis men with particular conditions, or who are elderly, or part of particular groups. This may or may not be applicable to us. At the level I'm capable of, I can't say whether these impact transmasc people significantly or at all - but they are interesting, let's say. Experiment with as you wish.