Starting testosterone as a trans man involves finding a provider, getting an assessment or going through informed consent, and choosing a delivery method that fits your life. The process can take anywhere from a single appointment to several months depending on where you live and which clinic model you use. Here’s what each step actually looks like.
Two Paths to Getting a Prescription
There are two main models for accessing testosterone, and which one you use depends on your provider and location.
The informed consent model skips the requirement for a therapist letter. A medical provider assesses whether you understand the risks, benefits, alternatives, and unknowns of testosterone therapy, confirms you can give informed consent, and writes a prescription. Many large-volume transgender care clinics have used this approach for years. UCSF’s transgender care guidelines recognize it as a valid pathway, and it’s how most standalone gender clinics and telehealth services operate. You can often get a prescription at your first or second visit.
The referral model requires a letter from a mental health professional before a prescribing provider will start hormones. Some providers, health systems, and insurance plans still require this. If your provider uses this model, you’ll need at least a few sessions with a therapist who can document your gender identity and readiness for hormone therapy. This can add weeks or months to the process depending on therapist availability.
Both pathways are recognized by the World Professional Association for Transgender Health (WPATH), whose Standards of Care were most recently updated in 2022.
Where to Find a Provider
Your options fall into a few categories. Planned Parenthood clinics in many states offer testosterone through informed consent, often at sliding-scale prices. Dedicated gender clinics at university medical centers (like those at UCSF, Fenway Health, or Callen-Lorde) specialize in this care. Telehealth services such as Plume, FOLX Health, and QueerDoc provide remote consultations and mail-order prescriptions, which can be especially useful if you’re in a rural area or a state with limited in-person options.
You can also ask your primary care doctor. Some family medicine and internal medicine providers are comfortable prescribing testosterone for gender-affirming care, particularly if they’ve had training in it. If yours isn’t, they may be able to refer you to someone local who is.
Age and Legal Restrictions
If you’re 18 or older, you can consent to hormone therapy on your own in most states. For minors, the landscape is complicated and shifting. As of mid-2025, 27 states have enacted laws or policies restricting youth access to gender-affirming care, affecting roughly half of all trans youth ages 13 to 17. The U.S. Supreme Court ruled in June 2025 that Tennessee’s ban on gender-affirming care for minors did not violate the Equal Protection Clause, leaving 25 state bans in place.
In states without bans, minors typically need parental or guardian consent. Some states, like Nebraska, extend restrictions to people under 19, meaning even 18-year-olds face additional hurdles. If you’re a minor or just turned 18 in a restrictive state, check your specific state’s current law, as these policies change frequently.
What Happens at Your First Appointments
Before prescribing testosterone, your provider will order baseline blood work. The key tests include a complete blood count (with attention to your hemoglobin and hematocrit levels, which need to be below 50% before starting), a metabolic panel, and a total testosterone level. Some providers also check liver function and lipid panels. These results give your provider a starting point to compare against once you’re on hormones.
You’ll also discuss your medical history, any medications you’re taking, and your goals for transition. Your provider should walk you through what testosterone will and won’t change, how quickly to expect results, and potential risks like elevated red blood cell counts and changes in cholesterol.
Choosing a Delivery Method
Most people starting testosterone choose between injections and topical gel. Each has tradeoffs.
- Injections are the most common choice. You self-inject every one to two weeks, either into the muscle (intramuscular) or into the fat layer just under the skin (subcutaneous). The testosterone is suspended in oil for slow, sustained release over 10 to 14 days. The two standard formulations, testosterone cypionate and testosterone enanthate, work identically in terms of results. Cypionate is suspended in cottonseed oil and enanthate in sesame oil, so if you have a seed allergy, that distinction matters. Most people learn to do their own injections at home after a nurse shows them the technique once or twice.
- Topical gel is applied daily to skin with minimal body hair, like the inner thighs, abdomen, or inner arms. It absorbs through the skin into the bloodstream. Gel gives more stable day-to-day hormone levels since you’re applying it every day rather than getting a larger dose every week or two. The tradeoff is that you need to avoid skin-to-skin contact at the application site until it dries, so it doesn’t transfer to other people.
Your provider will help you decide based on your comfort level with needles, your daily routine, and your insurance coverage. Injections tend to be cheaper out of pocket.
What Changes to Expect and When
The goal of testosterone therapy is to bring your levels into the typical male physiological range of 300 to 1,000 ng/dL. Changes happen gradually over months and years, not overnight.
In the first few months, most people notice their voice beginning to drop, increased oiliness in their skin, and changes in body odor. Menstrual periods typically stop within the first six months, though this varies. Over the first one to two years, you’ll see more significant fat redistribution (away from hips and thighs, toward the abdomen), increased muscle mass, and the beginning of facial hair growth. Full facial hair development is one of the slowest changes and can take three to five years or longer, similar to the timeline for cisgender men going through puberty.
Some changes are permanent even if you stop testosterone (voice deepening, facial hair growth, clitoral growth), while others reverse over time (fat distribution, muscle mass, skin oiliness).
Fertility and Birth Control
Testosterone suppresses menstrual cycles and lowers the ovaries’ ability to produce estrogen, but it is not reliable birth control. If you have a uterus and ovaries and have sex with someone who produces sperm, pregnancy is still possible even while on testosterone. If you want to avoid pregnancy, use a separate form of birth control. If you think you might want biological children in the future, talk with your provider about egg freezing or other fertility preservation before starting hormones.
Ongoing Monitoring
Once you’re on testosterone, expect regular blood work. Your provider will check your testosterone levels to make sure you’re in the target range of 300 to 1,000 ng/dL, and monitor your red blood cell count (testosterone increases red blood cell production, which can thicken blood if it goes too high). Most providers schedule labs every three months during the first year and then once or twice a year after your dose is stable.
What It Costs Without Insurance
Testosterone is relatively affordable even without insurance. The medication itself runs about $20 to $40 per month for injectable testosterone. Injection supplies (syringes, needles, alcohol swabs) cost roughly $40 per year. Lab work averages around $64 per panel, and most providers order about four panels in the first year, dropping to one or two annually once your levels are stable.
That puts first-year costs in the range of $500 to $800 total for medication, supplies, and labs, not counting the cost of appointments themselves. Prescription discount sites like GoodRx and Cost Plus Drugs can bring medication costs under $25 per month. Some patients find injection supplies for under $50 per year through veterinary supply retailers, which sell the same needles and syringes at lower prices.
If you have insurance, check whether your plan covers gender-affirming hormone therapy. Many private plans and Medicaid programs in non-restrictive states do, which can reduce your costs to standard copays.