At QueerDoc, most of our patient care is about changing the physical body to better align with the person’s sense of self, and our most common prescriptions to do this are testosterone and estradiol. If you’ve had an introductory appointment with me, you’ve probably heard me say, “at the first medical appointment, we’ll do an in-depth gender history to find out what your goals are, and then we’ll create a plan to help you achieve them.” We see gender as an infinite set of possibilities, so we try to mirror your language for your body and gender. We try to put this into action by refraining from using words like “transmasculine,” “transfeminine,” and “man, woman, female, male” until we know if they apply to you and you want us to use them.
We try to use language that describes what happens to the body during treatment. Talking about the specific changes you want is how we create your plan.
All bodies are different.
And hormones aren’t as simple or as binary as estrogen or testosterone.
Hormones can be described as messages to cells. Some cells have mailboxes that accept only certain types of messages. Some cells love getting mail and will accept many kinds of mail. Each hormone – or each piece of mail – has a specific shape that fits in specific receptors (mailboxes.)
Many years ago, it was thought that sex steroid hormones like androgens, estrogens, and progestins only affected tissues in the reproductive organs, but now we know that they have mailboxes are all over the body. That’s why so many different changes in so many different places happen when taking T or E – including changes to hair, skin, muscles, fat distribution, genitals, and the vocal cords.
In general, some of the changes that happen when adding testosterone to the body include:
- Thicker, darker hair on the face and body
- Skin texture gets rougher, and oil production increases
- Voice deepens and lowers
- Muscles are easier to build and keep
- The layer of body fat under the skin gets thinner while
- More body fat is stored abdominally
When adding estradiol to the body, these changes are common :
- Finer, lighter hair on the face and body
- Skin texture gets smoother, and oil production decreases
- Muscle bulk may reduce, and muscles may be harder to build
- The layer of body fat under the skin thickens while
- More body fat is stored in the hips and thighs (and breasts.)
To make it easier to talk about gender affirming care with hormones and not use binary terms, we’ve started using “Gettin’ Square” and “Gettin’ Curvy.”
Earlier this year, we published a Gettin’ Curvy series of blogs: we described what kinds of changes to expect when adding estrogen (in the form of estradiol) to the body. We also talked about progesterone and SERMS. We provided a rough timeline for expected changes and the risks and benefits of these medications. We included information about gender expression tools (including prostheses, makeup, and exercises!) that aren’t hormonal.
And we’re gonna do it again, but this time, about testosterone. The next few weeks are all about Gettin’ Square, The QueerDoc way.
Important (to us, and maybe to you):
The most common language usage about taking testosterone is “masculinization” and talking about “masculine” traits. If these words fit for you, awesome. But they don’t have to for you to start testosterone.
About masculinity:
There is no one way to be masculine. Your definition of masculinity (or whatever term you use for gettin’ square) and how it is carried in and by your body is your way, and it is valid AF. We believe that all the ways of being masculine are equally valid and are to be celebrated.
We also recognize that the Western/Euro-centric ideal of masculinity is rooted in racism, classism, and colonialism. We strive to think critically about how oppressions are reinforced or deconstructed through our practice, and if this is part of your journey, we are honored to travel alongside you.
Previous Blogs About Testosterone and Gettin’ Square
We love talking about bodies! Check out Building a Broader Physique by the fabulous Jessie Rard, and read up on Changes to Genitals, Libido, and Orgasm, and Testosterone and Cardiovascular Disease Risk. We also have previously published All The T and Oral T? Nasal T? Whaaaat?
Next week, we’re going to Get Nerdy About Gettin’ Square. We’ll talk about the medications we use to help people get square, the risks and benefits of those medications, and provide a general timeline of gettin’ square. We’ll also throw in some biochemistry and look at how testosterone mail and mailboxes work in the body.
Blog 2 in the Gettin’ Square series is on hair and contraception.
Testosterone-related body and facial hair growth might be your idea of bliss. But what happens if you start balding? If this concerns you, you have options!.
Also, while testosterone may stop ovulation in people with ovaries, it isn’t guaranteed, so we gotta talk about contraception if you’re sexually active and sperm might be in the equation.
We’ll finish off the series with tips on non-hormonal tools for a squarer, more angular appearance, like binders, packers, and clothing styles.