FTM Community Knowledge

Trans people have been figuring out testosterone together for decades, long before any guidelines caught up, and often more carefully than the clinicians writing them. This page is a map of that knowledge.

The community was right first

Again and again, transmasc community knowledge preceded formal medicine by years.

Community practice/report	What the community said	Where medical papers caught up
SubQ injections	Belly/thigh fat injections with small needles work and hurt less (standard since the 2000s, off-label)	Olson 2014; Spratt 2017; UCSF endorsement; FDA-approved SubQ device (Xyosted, 2018)
Weekly dosing	”Shot-day crash” at the end of 2-4 week cycles; weekly shots fix it	Endocrine Society TRT guideline (weekly preferred); WADA 2023 guidance
Trough testing	Draw blood right before your shot to catch low points	Formalized in Endocrine Society/UCSF/WADA timing guidance
Pelvic pain on T	Forum reports for years pre-2015; dismissed as rare	Now documented at 23% (adolescents), 36% (clinic sample), up to 69-72% in community surveys; dedicated UCSF guideline section
”T voice”	Persistent cracking/instability in year 1; some voices never fully settle	Nygren 2016 (F0 drops regardless of levels); >60% instability on long-interval undecanoate; “entrapped voice” concept

Validated practices

Subcutaneous/SubQ (into the fat under the skin) injection works and people prefer it. In the key study (Spratt 2017, n=63 trans men), weekly SubQ cypionate/enanthate (the two common injectable forms of T) put all participants in the male range, 51/53 achieved amenorrhea (periods stopping), and 22 of 22 who’d tried both routes preferred SubQ.¹ UCSF now lists SubQ benefits (smaller, less painful needle; avoids decades of IM scarring).²

Weekly beats biweekly. Injectable esters every 2-4 weeks produce supraphysiologic peaks and sub-physiologic troughs (levels spiking above the natural range, then crashing below it); guidance for cis and trans patients alike says to shorten the interval when people report end-of-cycle fatigue, low mood, irritability, or return of bleeding.³

Amenorrhea is dose- and interval-dependent. Menses (periods) stop faster at adequate levels: in adolescent SubQ data, cessation was 54% at 140 mg/month vs 97% at 200 mg/month; in Deutsch 2015, 16% still menstruated at 6 months.⁴⁵ The community heuristic is “if your period comes back before shot day, your interval is too long or your dose too low” which matches studied evidence.

Underdosing

Community forums are full of stories of very low starts, slow titration (gradual dose increases), and providers refusing increases:

• In a prospective (following people forward in time) study of 31 trans men on guideline-typical starting regimens, only 68% had male-range testosterone at 6 months so roughly a third were sub-therapeutic (and only 29% had male-range estradiol, the main estrogen).⁵
• UCSF itself warns that skipping level checks “runs the risk of a suboptimal degree of virilization.”²
• Symptomatic underdosing: breakthrough bleeding and pelvic pain are associated with lower T levels.⁶
• Monitoring tempo: New Zealand’s PATHA protocol deliberately doesn’t check the first T level until 9-12 months (“it takes time for levels to stabilise”) while UCSF checks at 3-6 months and community practice is a trough draw (blood taken just before shot day) at ~3 months. Under the slow model, a non-responder can spend a year sub-therapeutic.⁷

If your levels are low and you’re not seeing changes, you’re allowed to ask for a level check and a dose review that’s not being a “difficult patient”, it’s vital for your health. More at Underdosing and FTM Blood Testing.

Info with less professional data

Genital T/DHT cream (“bottom growth cream”). 10% DHT (dihydrotestosterone, which is a stronger hormone made from testosterone) cream applied for ~3 months before metoidioplasty (a type of bottom surgery) is an established surgical protocol (Belgrade school; pediatric DHT data exist too).⁸ for non-surgical cosmetic growth: no trial shows compounded cream adds growth beyond what systemic T does, genital skin absorbs systemically.⁸

Minoxidil for beard growth. Exactly one trans-specific case report (a 17-year-old who grew pigmented facial hair in 3 months on 5% minoxidil with body-hair growth beyond the application site, suggesting systemic absorption), one 16-person cohort showing significant gains, and one small cis-male RCT (randomized controlled trial).⁹¹⁰ The case report’s authors explicitly credit online forums with using it first. Whether gains persist after stopping is unknown (cis data suggest regression within 3-4 months). keep minoxidil away from cats (it’s lethal to felines) and expect a shedding phase.

A note from Aria

Verrin used a little Minoxidil for his beard growth, I will have him write about it soon!

The harm-reduction testing gap

Black-market steroid analysis finds ~36% of products counterfeit and ~37% substandard.¹¹ Community harm-reduction orgs lab-test grey-market hormones to catch this such as Trans Harm Reduction publishes its results but their published testing has been almost entirely estradiol. Testosterone’s public testing footprint is essentially one vial ever (a 2023 testosterone cypionate sample measuring 233 mg/mL vs 250 advertised, with impurities).¹² Transmasculine people who self-source rely on steroid UGLs (underground labs) that trans harm-reduction barely tests. If you self-source, blood monitoring through a GP matters even more; see FTM Access for harm-reduction pointers, and the diyhrt.wiki transmasc guide for the community’s practical safety rundown.

What community knowledge can’t do

Community wisdom is strongest at describing lived experience and weakest at estimating risk. It told us about pelvic pain, trough crashes, and T voice and was right. But only studies could show that a third of people whose periods have stopped still ovulate, that 11% develop erythrocytosis (too many red blood cells). Use both kinds of knowledge for what they’re good at and be wary of any source (clinical or community) that claims certainty the evidence doesn’t support. More on that in FTM Evidence Gaps.

Further reading

No single website - this one included - should be your only source; these are reputable places to keep reading.

• Trans Harm Reduction - HRT source testing - lab results for grey-market hormones (mostly estradiol so far - the gap this page describes).
• diyhrt.wiki - Transmasc HRT - the community-maintained DIY reference for testosterone.
• Hudson’s FTM Resource Guide - Testosterone and health - the classic community T handbook (older, but foundational).
• UCSF Transgender Care - Overview of masculinizing hormone therapy - where a lot of community practice ended up clinically validated.
• Spratt et al. 2017 - Subcutaneous vs intramuscular testosterone in trans men (PubMed) - the study that proved the community right on SubQ.

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Related pages: FTM HRT | FTM Dosages | FTM Blood Testing | FTM Risks and Side Effects | FTM Access | FTM Resources | Genderal Resources

Footnotes

1. Spratt DI et al., Subcutaneous vs intramuscular testosterone in trans men, JCEM 2017 - https://pubmed.ncbi.nlm.nih.gov/28379417/ ↩

2. UCSF Transgender Care - Overview of masculinizing hormone therapy - https://transcare.ucsf.edu/guidelines/masculinizing-therapy ↩ ↩²

3. WADA TUE Physician Guidelines - Transgender Athletes v2.1 (2023) - https://www.wada-ama.org/sites/default/files/2023-12/tue_physician_guidelines_transgender_athletes_-_version_2.1_-_october_2023.pdf ↩

4. Subcutaneous testosterone in trans adolescents, 8-year cohort - https://pmc.ncbi.nlm.nih.gov/articles/PMC8664110/ ↩

5. Deutsch MB, Bhakri V, Kubicek K., Obstet Gynecol 2015 (as quoted in UCSF guideline) - https://transcare.ucsf.edu/guidelines/masculinizing-therapy ↩ ↩²

6. Grimstad et al. 2023 via ISSM - pelvic pain prevalence & lower T levels - https://www.issm.info/sexual-health-headlines/what-is-the-prevalence-of-pelvic-pain-in-transgender-men/ ↩

7. PATHA / RNZCGP - Primary Care GAHT Initiation Guidelines (NZ, 2023) - https://genderminorities.com/wp-content/uploads/2023/03/Primary-Care-GAHT-Guidelines_Final_Web.pdf ↩

8. FOLX Health Library - Testosterone and Bottom Growth (surgical-prep DHT protocols; systemic absorption cautions) - https://www.folxhealth.com/library/testosterone-and-bottom-growth ↩ ↩²

9. Pang KC, Nguyen TP, Upreti R., minoxidil facial-hair case report, Front Endocrinol 2021 - https://pmc.ncbi.nlm.nih.gov/articles/PMC8511680/ ↩

10. Marinelli L et al., topical minoxidil for beard growth in trans AFAB people, J Endocrinol Invest 2024 - https://pubmed.ncbi.nlm.nih.gov/38644453/ ↩

11. Black-market anabolic steroid quality meta-analysis (2022) - https://pmc.ncbi.nlm.nih.gov/articles/PMC9288681/ ↩

12. Trans Harm Reduction - HRT source testing results - https://transharmreduction.org/hrt-testing ↩