Is Testosterone replacement therapy the only path to be more masculine FTM?
Transitioning is a deeply personal journey for any transgender folx.
It’s not just about tinkering with the external physical changes, though more so about having internal peace about who you are and how you show up in the world.
Gender transitioning aka gender affirming care, is the process transgender folks in Vancouver and beyond go through en route to living as the gender they personally identify with.
There are three main aspects to gender transitioning for transgender folx: physical, social, and legal.
Some transgender folx feel that changing name and pronouns suffice,
while others feel that they want to alter their appearance as well.
Some other transgender folx feel strongly about not identifying with the sex assigned
to them at birth, so they felt they need to seek medical treatment and get on testosterone replacement therapy.
Wherever and whichever camp you are in,
gender affirming care and support is an essential part of many transgender folx’s transition.
One thing for sure: there is no one-size-fits-all
transitioning rule, story, process, or experience.
So, what’s the big dealio with testosterone replacement therapy?!?
Of the 3, I will focus on talking about the physical aspect
to transitioning to being more masculine in this article..
From the intel that I gathered from talking to transgender folx in Vancouver, physical changes can happen via testosterone replacement therapy OR surgery…
And, gotta say that one route is no better than the other.
We will know which option would be the best one for you by exploring it together.
That is my jam as a gender therapist in Vancouver, doing hormone readiness assessment for transgender folx in Vancouver.
What follows, I will share some of the most commonly asked questions transgender folx bring up about the physical aspect of transitioning into being more masculine.
Do all transgender folx who want to be masculine get on testosterone replacement therapy or have surgery?
Not necessarily! Many transgender and non-binary folx completed their testosterone replacement therapy and fully transitioned WITHOUT surgery.
Some transgender folx in Vancouver feel the physical changes from testosterone replacement therapy are enough.
Some transgender folx have no desire to pursue surgeries or other medical treatment.
Again, there is no one-size-fits-all answer.
Just because most folx do not see the need to pursue surgery, does not mean that you can’t! That’s why it is super important to have people to bounce ideas off of.
If you’re curious about what good hormone therapy can do for you, I did a deeper dive on this topic in another piece.
How expensive is testosterone replacement therapy for transgender folx in Vancouver?
For those of you residing in Vancouver or anywhere in the province of BC, prescriptions for testosterone replacement therapy are not covered by MSP provincial health funding.
There are a number of ways to get testosterone replacement therapy partially covered:
Extended benefit plan – some employer benefit plan, income assistance, or disability assistance may cover the cost of hormone therapy medications
Fair PharmaCare program – this program provides eligible BC residents with coverage for hormone therapy medications depending on level of income.
Special Authority – if you cannot access your extended benefit or the Fair PharmaCare program, your health care provider can advocate on your behalf to have your hormone therapy medications covered.
First Nations Health Authority (FNHA) – the cost of medications for your hormone therapy may be covered through the FNHA. It is best to reach out to the organizations as the amount of coverage and eligibility criteria may change over time.
If you do not have an extended benefit plan or social program, you will need to pay out of pocket for your testosterone replacement therapy. Based on what I have heard from the grape vine, the cost you have spent for your testosterone replacement therapy may be eligible for tax deduction, though this point is best confirmed with your accountant.
Roughly, what’s the cost for testosterone replacement therapy?
There are so many factors to consider when we figure out the budget for testosterone replacement therapy. The cost may fluctuate on a monthly or weekly basis, depending on the testosterone replacement therapy dosage and your goals.
Testosterone injections are typically seen as the most cost effective testosterone replacement therapy. It may range from $40 all the way up to $400 ish, depending on the dosage and frequency.
Oral testosterone tablets are another good option for testosterone replacement therapy, though some experts raised concerns about its effectiveness and side effects on the liver. Prescriptions typically cost anywhere between $100 to $400, depending on dosage and frequency.
Gels, creams, patches, and dermal adhesive are seen as a middle of the pack testosterone replacement therapy option (it all depends, though). From what I know, they have similar price points between $200 and $500.
Gum and cheek or testosterone bucal systems are patches that stick to your gums or inside your cheek. You need to apply it twice daily, every 12 hours, and for the most part may cost anywhere between $200 and $500.
Pellet might be seen as the costliest of all testosterone replacement therapy. It is a 3mm x 9mm pellet, implanted under your skin, near your hip, to slowly release testosterone over the course of 3 to 6 months. Cost typically starts at $500 and may increase depending on the dosage.
All in all, the cost for testosterone replacement therapy may amount to approximately $1500 to north of $3500 per year. And of course, this number all depends on your prescription.
There is an article form a reputable local organization, Transcare BC, that features a deeper dive into this topic.
From my years of experience as a gender therapist, I can definitely share that for some transgender folx in Vancouver, testosterone replacement therapy is an essential part of their gender identity journey through transitioning.
How can transgender folx access testosterone replacement therapy?!?
Testosterone replacement therapy is only available with a prescription.
If you live in Vancouver, a nurse practitioner, family physician, pediatrician, or endocrinologist can prescribe your hormone therapy.
Your testosterone levels may fluctuate depending on your activity levels and diet,
so in some cases, doctors may request blood samples to monitor how your body responds to the testosterone replacement therapy.
Wondering how permanent is testosterone replacement therapy permanent? What if you change your mind…
Words of wisdom I have heard from the medical grapevine: If at any point, you are having second thoughts and consider taking a break from testosterone replacement therapy, DON’T STOP COLD TURKEY
Give your body some time to readjust and recalibrate from whatever impact from the testosterone replacement therapy
Meet and speak with your prescriber first about weaning the prescription gradually.
While you’re on testosterone replacement therapy, your body is changing. A lot.
A few last pointers for transgender folks monitoring testosterone replacement therapy…
If you choose to get on testosterone replacement therapy or puberty blockers, you need to have a follow-up appointment with your prescriber.
In some cases, more than one health care provider –eg, a pediatric endocrinologist and a nurse practitioner – is involved in monitoring the effects and trajectories of the testosterone replacement therapy.
The frequency of your follow-up appointment may vary, depending on your health situation. Though, generally speaking, you may expect to have more frequent follow-up when you first start hormone therapy.
Things will taper off once you have a stable dose for your hormone therapy.
Your prescribing provider may request blood work done during some of your follow-up appointments.
Blood work may be needed when you first start your hormone therapy treatment or when dosage is adjusted. Once dosage is stable, you may expect less blood work.
Hello, I’m Nita Agustin
Registered Clinical Counsellor based in Burnaby, BC
My jam is helping curious and questioning queer youth and young adults move from confusion to clarity.
Most of my clients shared feeling overwhelmed by the messages the world told them how they’re supposed to be. They do not want to be defined by what society told them about themselves.
In our work together, I guide clients in figuring out who they are, who they want to be, and how to get there. We do this by processing how their past impacted the way they live out their life today. From our work together, I noticed clients develop better self-awareness and experience improved quality of life as they can show up differently in their relationships.
I offer virtual and in-person sessions in Brentwood, North Burnaby. In the summer I also offer walk-and-walk in Confederation Park.
I am licensed to practise in BC, as well as all across Canada, so I support clients all over BC, all the way from Vancouver to Kitimat. Other than working with clients who reside in BC, I also can support clients who reside in Yukon Territories, Northwest Territories, Nunavut, Saskatchewan, Manitoba, and Newfoundland.
Check out my About me page to learn more about what I do and have to offer for you. Also, explore my Services page to see how I can guide you in making shifts in your life today. If you feel ready to discover ways to live life on your own terms, I welcome you to book an initial intake session. I am so stoked to meet you and start figuring out how you can show up as your best self!
Throughout this pandemic, I witnessed telehealth virtual sessions become more of a norm, and it has been super transformative seeing clients can access mental health services from the comfort of their home.
There are lots of different stereotypes out there, and society tells us who we are supposed to be and what we are supposed to do in the world. It can feel very overwhelming and confusing to compare our personal experience against those ideas. The thing is, you no longer have to be defined by what society tells you. It is your life to live, and you get to decide who get a say about your life.
