The Effects of HRT (part 2)

The Effects of HRT (Part 2)

Welcome back to Queering the Narrative!

Last week, I talked about the effects of HRT, or hormone replacement therapy, that one might expect from “feminizing” therapies, as well as some of the various different forms HRT can take. This week, I’m going to continue that discussion by delving into the effects of HRT one might expect from masculinizing therapies.

Again, however, I’d like to make it clear that I am not a medical professional — I am writing this guide based on my own research and anecdotal evidence, for the purpose of helping folx better understand how to write trans characters. If you’re hoping to pursue HRT yourself, speak to a medical professional!

Masculinizing HRT

image of a glass medical vial filled with a yellowish clear liquid, the words "testosterone proprionate injection, 100mg/mL, for IM or SQ use only" printed on the label
Testosterone commonly comes in vials and is injected

As I mentioned last week, masculinizing HRT involves using testosterone to achieve more visibly “male” or “masculine” characteristics, and is most often utilized by trans men and other transmasculine (or “ftm,” “female to male”) individuals.

Unlike feminizing HRT, many of these effects aren’t very reversible, in much the same way that there are aspects of testosterone puberties that feminizing HRT can’t change on its own. I’ll make a note of which of these are irreversible as I mention them. 

Also, as I mentioned last week — a person cannot pick and choose which of these effects they get from HRT. And, again, these are listed in the order they generally occur (though there is some variation on that!)

Effects of Masculinizing HRT

Voice Change

One of the first and most striking changes masculinizing HRT can achieve is the deepening of one’s voice. Like a teenager experiencing a testosterone puberty, this change can cause a trans person’s voice to crack for a few months while the vocal cords change

This change is irreversible — once the voice drops, stopping T will not cause it to go back up.

Skin and Body Odor changes

In the reverse of the feminizing effects I talked about last week, the skin will become more coarse and oily, and body odor will become more sharp and pungent. This will also lead to more acne, especially early on before the pores adapt to the increased oiliness of the skin.

Fat and Muscle Redistribution

Testosterone promotes muscle development, and many folx find it much easier to develop and tone muscle mass after starting T. Fat will also tend to gather at the belly and waist instead of the breasts, butt, and hips. 

This may also cause the face to subtly change, giving the face a sharper or narrower appearance.

Hair Growth

Body and facial hair will grow thicker and darker, and new hair follicles will develop, especially on the face, arms, chest, and stomach This will make someone on T gradually more hirsute over time.

This is another irreversible change. Once the follicles form, they’re there forever — facial hair in particular isn’t going anywhere. The hair may thin or lighten, but there will always be generally more of it, and it likely won’t return to pre-T appearance

Male Pattern Baldness

As I mentioned last week, “male pattern baldness” is driven by testosterone — so if a transmasc person has the genes for it, T may cause their hair to thin around the scalp and temples. This is technically irreversible — once the hair is gone, it’s gone — but the process can be halted by stopping HRT

Cessation of Ovulation/Menstruation

The addition of exogenous testosterone can cause a trans person to stop ovulating and menstruating, but this is not universal. Many trans folx on T, even relatively high doses, may still experience ovulation, menstruation, and PMS symptoms, and can even become pregnant. 

Even those who do continue their monthly cycles, however, may find that their symptoms are easier to manage and their periods lighter than usual, which can be a big relief in its own right.

Bottom Growth

I’m going to stick to my policy of not going into too much detail with these things, because I don’t think we should be hyperfocused on trans folx’s genitals in fiction.

However, for the sake of completeness, “bottom growth” is the enlargement of the clitoris stimulated by testosterone. This can be painful for some, and the amount of growth varies from person to person. This is also something that can happen surprisingly early in HRT (despite being at the end of this list) and is irreversible.

What Can’t Masculinizing HRT Do?

Though breasts may get a bit smaller due to fat redistribution, they will not go away entirely due to the effects of HRT — which is why many transmasc folx opt for top surgery.

Testosterone also can’t change existing bone structure. If someone already has wide-set hips or a narrow chest, the underlying bone structure will stay the same (though fat redistribution and muscle development may make them less apparent). Notably, this also means that going on T won’t cause someone to grow taller.

Behavior Changes

There’s a stereotype that trans men become angry or aggressive once they start testosterone. These behavior changes are sometimes used as a plot point in queer media, often painting the decision to go on T as a harmful one in and of itself (which also can lead to some hesitancy in those who are considering HRT).

Image of Max Sweeney from Showtime's "The L Word"
Max from “The L Word” is a classic example of this negative trope.

This stereotype is not founded in a lot of science and is harmful to the transmasc community, as it paints a negative picture of those who go on T.

There are, however, some possible behavior changes associated with T, including an increase in libido. Shifts in hormone balances are liable to cause mood swings and emotional outbursts in anyone, and so a trans person on T may have a bit of a temper until their body gets used to the changes (similar to how I used to burst into tears for no reason during my first month on E!)


There’s a lot of ground to cover here, as the way the body responds to exogenous hormones is nuanced and varied. However, getting a good understanding of how these things work is important to writing realistic and respectful trans characters!

That’s it for this week! I’ll be back next week to talk about some “intermediate” effects of HRT, but until then stay safe, stay healthy, and keep writing!

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