Getting testosterone as a trans man typically involves either visiting an informed consent clinic or getting a referral from a mental health provider, depending on where you live and which healthcare model your provider follows. Both paths lead to a legitimate prescription, but they differ in how many steps you’ll need to complete before starting hormone therapy. Here’s what the process looks like, what to expect from treatment, and how the different options compare.
Two Main Paths to a Prescription
In the U.S., there are two widely used models for accessing testosterone: the informed consent model and the mental health referral model. Which one you encounter depends largely on the clinic or provider you choose.
Informed Consent
The informed consent model allows you to begin hormone therapy without a letter from a therapist. Instead, your prescribing clinician discusses the risks, benefits, and expected changes of testosterone with you directly. You’ll still be asked about your mental health and how gender dysphoria affects your daily life, but the model treats you as the authority on your own gender identity. Many Planned Parenthood locations, LGBTQ health centers, and telehealth platforms operate this way. For many people, this is the fastest route: an initial appointment, blood work, and a prescription, sometimes within a single visit or two.
Mental Health Referral
The referral model follows guidelines from the World Professional Association for Transgender Health (WPATH). Under this approach, a mental health professional evaluates you for gender dysphoria and writes a referral letter confirming your readiness for hormone therapy. The process often involves several therapy sessions before a letter is issued. Some providers, especially those connected to university hospital systems or certain insurance networks, still require this letter before prescribing. If your insurance requires a diagnosis of gender dysphoria for coverage, a therapist’s documentation can also help with that.
What Happens at Your First Appointment
Regardless of which model your provider uses, the first visit generally covers a health history, a discussion of what testosterone will and won’t do, and baseline blood work. Your provider will check your blood cell counts, liver function, cholesterol levels, and existing hormone levels. These labs establish a starting point so your dose can be adjusted over time.
Testosterone is classified as a Schedule III controlled substance by the DEA, which means it requires a prescription and is tracked more closely than most medications. You’ll typically need to pick it up from a pharmacy in person, and refills follow stricter rules than non-controlled prescriptions. Some pharmacies may need to order it, so calling ahead can save you a trip.
Types of Testosterone and How They’re Used
There are several delivery methods, and the right one depends on your comfort level, lifestyle, and insurance coverage.
- Injections are the most common method for trans men. Testosterone cypionate or enanthate is injected either into muscle or under the skin, typically once a week or every two weeks. Most people learn to self-inject at home after a quick training session. A longer-acting injectable form (testosterone undecanoate) is given every 12 weeks but must be administered in a clinic.
- Topical gel is applied daily to the skin, usually on the shoulders or upper arms. It delivers a steady, low dose throughout the day, which can mean fewer mood swings compared to the peaks and valleys of weekly injections. The downside: you need to avoid skin-to-skin contact with others at the application site until it dries, and it’s generally more expensive.
- Patches are worn on the skin and changed daily. They deliver between 2.5 and 7.5 mg per day. Some people find them convenient, but skin irritation at the patch site is a common complaint.
Oral testosterone undecanoate exists but is not available in the United States. For most U.S. patients, the choice comes down to injections or a topical option.
What Changes and When
Testosterone triggers a range of physical changes, but they don’t all happen at once. Think of it as a second puberty: some things shift quickly, others take years to fully develop.
Voice deepening is often one of the first noticeable changes. It can begin within a few weeks as a scratchy or hoarse feeling in your throat. Your voice may crack or fluctuate for a while before settling into its new range, typically within one to two years. This change is permanent.
Body and facial hair usually starts increasing in thickness and darkness within three to six months. Full facial hair development, however, can take three to five years and is heavily influenced by genetics. If the men in your family have sparse beards, testosterone won’t override that pattern.
Fat redistribution shifts over time, moving away from the hips and thighs toward a more typically masculine pattern around the abdomen. Muscle mass increases, and your skin may become oilier, which can lead to acne, especially in the first year or two.
Menstrual periods typically stop within the first six months, though this varies. Some people find that periods become irregular before stopping completely. Genital changes, including clitoral growth, begin within the first three to twelve months and reach their full extent by about one to two years.
Ongoing Monitoring
Once you start testosterone, you’ll have follow-up blood work to make sure your levels are in the target range and that your body is responding well. In the first year, most providers check labs every three months or so. They’re looking at your testosterone level (to adjust your dose), red blood cell count (testosterone thickens the blood, which can raise cardiovascular risk if it goes too high), and liver function. After the first year, if your levels are stable, blood work is typically done every six to twelve months.
Your provider will also monitor cholesterol. Testosterone tends to shift cholesterol profiles in a less favorable direction, raising LDL and lowering HDL over time. This doesn’t mean heart disease is inevitable, but it does mean that the usual heart-healthy habits (staying active, eating well, not smoking) carry extra weight.
Fertility Considerations
Testosterone suppresses ovulation, but it is not a reliable form of birth control. Pregnancies have occurred in trans men who were actively on testosterone. If you’re having sex that could result in pregnancy and you don’t want to become pregnant, you need a separate contraceptive method.
Long-term testosterone use can reduce fertility, and for some people, the effect may be permanent. If you think you might want biological children in the future, egg or embryo freezing before starting T is worth discussing with your provider. Some people who stop testosterone do regain ovulatory function, but there’s no guarantee.
Cost and Insurance
The cost of testosterone itself is relatively low. Generic testosterone cypionate for injections can run as little as $20 to $50 per month without insurance. Gels and patches are more expensive, sometimes several hundred dollars a month without coverage. Many insurance plans, including Medicaid in a growing number of states, cover testosterone for gender-affirming care when prescribed with a diagnosis of gender dysphoria. Check with your insurance before your first appointment to understand what documentation they require, since some plans still ask for a therapist letter even if your clinic uses informed consent.
If you’re uninsured, informed consent clinics and telehealth services that specialize in transgender care often offer sliding-scale fees. Manufacturer discount programs and tools like GoodRx can also reduce pharmacy costs significantly.
Finding a Provider
If you’re not sure where to start, a few practical options can narrow your search. Planned Parenthood locations in many states offer testosterone through informed consent. LGBTQ community health centers, often listed in directories maintained by organizations like the Fenway Institute or GLMA, are another reliable option. Telehealth platforms like Plume and FOLX Health specialize in gender-affirming hormone therapy and can prescribe in most states. For those who prefer an in-person endocrinologist, university-affiliated gender clinics tend to have experienced staff, though wait times for a first appointment can stretch to several months.