Tracking transition with testosterone

As of the start of 2018 I identify as non-binary: neither female nor male. Recently, I started taking testosterone. When deciding to do this, I benefited a lot from reading and watching information others shared.

I’d like to record what’s happening, in turn: to understand the effects on myself, share insights with others, and potentially help inform someone considering a similar choice in the future. :slight_smile:

About testosterone therapy

I started therapy on August 14th with 0.15 ml of 200 mg/ml testosterone cypionate, which I take via intramuscular self-injection once a week. It’s standard to start with a lower dose, to check tolerance; trans men typically move to 0.3 to 0.5 ml weekly. I might go to “full dose” so after three months, I might stay at “low dose” – no rush to decide.

The half life of this drug is 8 days. That means I experience a weekly cycle: each dose I’m jumping from 50% to 150%. (Trans men sometimes dose every two weeks, but often report that this cycling significantly messes with their emotions.) I do worry a bit about and the “erratic” absorption reported for IM injections. On the other hand, cis men’s T varies a fair amount over the course of a day, so maybe it’s not so unusual to have this level of variation biologically (just predictable, in my case).

What I knew to expect

Testosterone generally acts like puberty does for cismen, but much more artificially. The results vary individually, but include: lower voice, beard and body hair, and (potentially) male pattern baldness, increased strength, and redistribution of fat – overall, resulting in a more masculine appearance.

There are potentially emotional changes, effects on mood, especially around the dose cycle. And there are sexual changes (physical and behavioral) that I’m probably not going to discuss much here.

Some effects are “permanent”: they will remain if I stop T (voice change, new hairs, and hair loss). Others would likely revert (fat distribution, skin texture, emotional changes).

About me

I think folks might be curious about the context – so here’s a bit. I’m 40, I was born female, I’ve identified as heterosexual, and I started to ID non-binary at the start of 2018. I’m married to a cis male guy, and we have three kids – all starting as male, coincidentally! The youngest was born last December, and was conceived knowing I was considering T. (We decided it was better to do it in this order; T has to be stopped to allow pregnancy, and might affect fertility.)

I also recently lost a bit over 60 pounds between December 2017 and this summer (BMI 33 → 23). (I did take a break for the pregnancy!) I think my gender identity and transition probably helped motivate that.

What I’m doing to track

So far I’m recording the following daily (or attempting to):

  • Using my phone to take a photo of my face: I go against a white wall and hold it straight in front of me to try to get a standard position.
  • Using my phone to record my voice daily, and daily notes. I’m using a survey I created for myself in surveylex, recording myself saing “aaaah”, a couple phrases, singing highest/lowest notes.
  • My daily survey also has a 30 second response to the question “How are you feeling?” which I’m using to note various changes as I notice them.

I’m also:

  • Taking occassionally longer videos, just holding the phone
  • I took a photo of my legs
  • I’m hoping to share observations and learnings in this project log

It’s been three weeks already, and I’ve noticed various changes. I’ll share those in an update post on this topic. Feel free to ask questions! I don’t feel much dysphoria, I like learning in this process, and I enjoy sharing this process.

Update week 1: it’s harder to cry

(I’m going to retrospectively report on insights from the past weeks; this is the first.) My first dose was done with help at the clinic. A couple hours later, I felt weird – spacey, hot.

I was really happy the couple days after that. It’s hard to know if that’s just the relief at having started. Another common phenomenon is euphoria – many transfolks report a “high” immediately after T, especially when starting. On day two, I noticed it was very difficult to cry. The ability to cry came back a couple days later.

This was a surprise for me. I had honestly thought differences in crying were due to socialization. It’s genuinely more difficult to produce tears. I went online and discovered this is pretty common, lots of trans men report missing crying (and trans women report gaining the ability).

“Crying” was not in the clinical literature about what to expect! I felt a bit upset about the apparent loss. But it’s almost certainly reversible, and I decided to see how I adjust.

It’s worth noting that masculinizing/feminizing hormone therapy are package deals! Transfolk don’t always feel positively about all changes hormones bring, but one can’t pick and choose.

Update week 2: oily skin

At the end of week two, I noticed my skin was really oily! I had a lot of acne in high school so… not surprising.

If there was a weekly cycle to hormones, it was unclear – I didn’t have euphoria immediately after the second dose. I wondered when T is actually absorbed. It was a tiring week, and I did generally feel happy about changes.

At some point I started worrying and wondering if I’d somehow lost an emotional instinctive “worry about others” reflex. It felt like I cared about people differently, with T. I went so far as to worry I couldn’t love people – and my spouse rolled his eyes at my melodrama.

Generally speaking: sometimes emotions feel muted (and I feel more stable), but other times it seems I’m having mood swings. Chatting with @Agaricus, one reflection we had was this: my physiology is changing. Emotions are names we have for physiological states, and my ability to identify my own emotions may be trying to keep up.

Update week 3: got a zit

I’m near “steady state” now, and still feeling generally happy about the physical and emotional effects.

I noticed some acne on Sunday – a zit! Skin remains oily (yuck).

Physically, I wondered if I’m getting stronger. I got my spouse to arm wrestle me – knowing that in the past he would easily best me – it seemed a lot closer. He’s very skin & bones; it’s likely I’ll become stronger than him on T. It seems like I can see muscles in my arms more, but hard to know if I’m imagining that.

Some additional things that could be interesting to track (if you aren’t already):

  • body composition (using an impedance weight scale, maybe even before/after DXA scans)
  • body shape (tape measures, not sure if any of the photo-based app work)
  • strength (ideally through an exercise you already do regularly)
  • music listening habits

@ejain I should try the tape measure! I have one handy. that’s a good idea!

I do use a Withings scale which attempts to capture composition – caveats about accuracy, of course.

  • music listening habits

hahaha :joy: I do have that via Spotify, but it’s all just a weird mix of music for the kids. …but relatedly, I’ve been tracking my mood with iMoodJournal and I’ll keep doing that. I should have mentioned that – one thing I might discover is a weekly mood pattern.

I guess I could try going to the Y and use the equipment to test strength in some way. (It’s hard to find time for it though.) “Arm wrestling with my spouse” isn’t very quantitative.

Such a relative measure of strength might actually be perfect, because if you started doing pushups or some other exercise, you’d get better at it regardless, and you wouldn’t know what gains to attribute to the testosterone…

This of course only works if neither of you do any extra-marital arm-wresting :wink:

Maybe test/track grip strength (each hand) using an inexpensive hand dynamometer?


oh, that sounds much easier. I’ve ordered one, thank you!

Update week 4: emotions and muscles

I’ll probably update less frequently going forward, but this week feels like some significant observations. Also, thanks for ideas from @ejain & @QuantifiedBob I’ve gotten a grip strength tester and did measurements with tape. I already blew away my spouse with grip strength but that’s because he’s got the grip strength of a 14-year-old.

Chris probably assumes I’m going to be stronger than him pretty soon, and he might be right. I’ve had some nights/mornings where I’m feeling muscle pain – like I have the flu, or working out. I’ve felt like it’s a lot easier to lift things. And looking in the mirror, my biceps are really clear. (Then I start posing, and then I remember this animated gif.) It feels like cheating, I haven’t worked out at all.

It’s still a lot harder to cry. (Maybe easier at the end of the week when T is low.) My behavior isn’t so dramatic now when upset, but when I record it, I’m clearly unhappy – like I’m “bottling it in”? Recently I almost never feel “good”. I feel slightly anxious all the time. It might just be some recent events got me down, but look at this mood tracking data – it’s pretty striking! I’m wondering if I need to learn how (some) men handle emotions (everyone is different, this is just “me on androgens” not a universal truth) – sorry, this all sounds like I’m making some misandrist joke, but … yeah. I’ve read some (trans)guys recommend exercise.

I’ve been recording when I inject (day and approximate time), because I wondered if there’s any mood effects.

Today I put together a notebook in Open Humans analyzing my iMoodJournal mood tracking against the injection times.

TLDR: the signal doesn’t seem to be very strong. Maybe there’s something there, but not dramatic and probably not statistically significant. (I’m not clear on how to test for significance, I’m not very expert on analysis.)

Here’s a link to the notebook in case anyone would like to re-use or adapt code from it:

And here’s the graph:

If I squint, maybe there’s a shift of one level up, post injection? The mood data is very noisy. There’s also a potential confounder regarding any other weekly cycles (since injections are roughly weekly, although I’ve shifted the day of the week a bit over time).

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Plotting the averages (and perhaps also the variances) for each day could help make the data a bit less noisy…

Right – I did try one form of averaging, the dotted line is a rolling average with a window size of 8. (Assuming I used that pandas function correctly! I’m pretty novice at using it.)

But… I could increase the window size, that’s easy. Smoothing with n=40, it does look like there’s a mood shift. :thinking:

(I’ve shared the updated notebook with an addendum – thanks for the nudge!)

I’m skeptical because there could be a different weekly rhythm explaining it. So… I’m going to deliberately nudge my injection timing in upcoming weeks! I had been timing injection to Sunday to deliberately aim the “low T” to non-workdays, but – hah – as a result I can’t disentangle causality (mood could be lower just because weekends are exhausting, we have three young kids :sweat_smile:).

I guess there really might be a mood change!

I updated the notebook again, adding the same plot against the start of each Monday to see if there’s a weekend low (I usually inject at the start of the week). That doesn’t seem to be present. So… I don’t think there’s a weekly rhythm that explains it.

Have you tried simply aggregating by day, rather than using a rolling average?

If you were already tracking mood prior to starting the injections, you could check the averages for each weekday (and compare before and after)…

These graphs are available on open humans?

@rain8dome9 I’ve shared the notebook, which can be loaded and run via Open Humans. :slight_smile: a link to that is here:

The graphs come with the notebook, although they will be overwritten upon running it again. My mood log data is private, so you can’t run it again on my data. But it could be run on another dataset from iMoodJournal, which can be uploaded here:

The injection schedule is embedded in the notebook itself and you could replace it with whatever events are of interest. I’m becoming interested in medication/treatment tracking now & wondering what the best tool is to be tracking that.

Could I download the notebook and and run it on my computer without ever uploading data? I am much better with R than python. Can OpenHumans run R notebooks?
Why is injection scheduled embedded rather than data?

Ah, it looks like we didn’t add a link for direct download, but it’s available –

Yup, Open Humans runs R notebooks too. (Basically, those two languages. Not sure if we support Julia, the third language founding “jupyter”, it’s not nearly as popular.) A recent example @gedankenstuecke made:

I could just upload a file, it didn’t seem to matter much either way with such a small list. I think I figured if hard-coded it might be clearer for someone that wants to re-use this and replace with their own target events.

Would there be any interest in adding a regular ‘download’ button for the notebooks to the front end? Most of the notebooks make pretty specific use of the Open Humans API at least for getting the data, but if people want to adapt them for local use we could offer that!

Yep, We have Julia, Python & R kernels available for the notebooks. If there’s interest in additional kernels, that would be possible too, but so far there hasn’t been any request for those.

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