Dear Dr. Eva,

I am a 20-year-old trans man. I’ve been on testosterone for close to three years. I’ve developed a lot of facial and body hair, but my voice hasn’t changed much. How long do you have to be on testosterone before you get a significant voice change?

Still High-pitched

Dear High-pitched,

Many trans guys do not experience significant voice change from testosterone. Any voice change a person does get will be complete in the first 18 months on testosterone. However, there are things you can do to make your speech sound masculine without having a lower-pitched voice. For example, men tend to use a smaller range of tones with their voices. Men tend to end their sentences with a drop to lower pitch, while (in our culture) women’s sentences tend to rise in pitch at the end of the sentence. There are many changes you can make just by observing male speech and adopting some of its characteristics. A speech therapist also can train you in ways to use your voice so that it sounds more masculine. You’ll know you’re on the right track when strangers on the phone stop calling you Miss and start calling you Mister

Dear Dr. Eva,

I am a man in my mid-50s taking testosterone for fatigue and bone strength. I take 100 mg by shot every two weeks. I have a transgender son who is 16 and much smaller than me. He has been prescribed 200 mg every two weeks. Do these doses sound reasonable? It’s hard to believe that my five-foot, 120 pound son would need twice the dose that I do at six-feet-two and 200 pounds.

Big Dad

Dear Dad,

You’re missing one factor in your analysis – that unless you have had your testicles surgically removed they are still producing testosterone, even though it’s not the normal level for your age. Men who are treated with testosterone tend to have pre-treatment levels of 150 to 200. Your son, whose body does not make testosterone (except for a very small amount in the adrenal glands) is starting from a testosterone level of 40 or less. I hope you can see, then, that regardless of body size, the presence of natural testosterone in your body allows you to take a lower dose, while your son who has minimal natural testosterone, requires a higher dose.

Dear Dr. Eva,

I am a trans man planning to start testosterone. I hate the idea of injections (I’m afraid of shots and needles.) But from what I’ve heard, the testosterone cream isn’t as effective. Can you comment?

Needle Shy

Dear Needle Shy,

Testosterone cream does not deliver the high blood levels of testosterone that injections do. For that reason, the physical changes associated with testosterone (facial and body hair, Increased upper body muscles) will happen more slowly if you use cream. Regular use of testosterone cream will cause the same changes but it can be much slower, as much as twice the time the changes would take with injections. If you do decide to use testosterone cream, keep in mind that it can be transferred from your skin to another person’s skin and cause them to have masculinizing changes that they may not want. If you are using testosterone cream, it’s a good idea to wear a T-shirt if you come in contact with another person’s skin. t

Eva Hersh, MD, is a Baltimore family physician. Please send questions and comments to her by email at dr.eva@baltimoreoutloud.com

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