Healthy Living Considerations for Testosterone Therapy

Free stock photo from Pixabay.com.

I’ve learnt to appreciate my body, because it’s taken me all the way here and will take me to the end.
––Clementine Desseaux

​For a transgender man, the first day on testosterone is the first day of a new life.
 
Hormone replacement therapy (HRT) can make a huge difference in a trans person’s quality of life, but it also comes with some health risks.

I want to point out first that testosterone alone would likely not cause conditions or diseases, but it can be a contributing factor, as it can be for an average person born in a male body.
 
If you were born in a female body, it may be that no one ever advised you about these potential issues, thinking you would never have them. So I hope my article sheds light on these topics, not put you off taking testosterone.
 
I’m not on HRT at the moment, but I plan to. In the UK, you have access to it for free through the National Health Service (NHS), but you have to be referred by a general practitioner (GP). Moreover, there are only a handful of gender clinics in the country and the wait lists are very long.
 
As an alternative, you can get private treatment, but the cost can be crippling.
 
I was referred to an NHS gender identity clinic in September 2018. The current wait for an appointment ranges from one to two years, so I have a long way to go, unless I can save up enough to fund private therapy.
 
The benefit of waiting this long is that I’ve had time to conduct research on the topic of transgender health.
 
I believe I owe it to my body to be as informed as I can about all the risks and, most importantly, all the ways to minimise them.
 
What I found enforced my belief that a healthy lifestyle may be even more crucial if you decide to take hormones than if you don’t.
 
In this article, I’m going to touch upon three of the most important aspects of healthy living for a transmasculine person.

1. Maintaining a healthy weight and body fat level
 
When you take testosterone, your health risk profile becomes more and more similar to that of a biological male over time, although the extent of the change may depend on individual factors.
 
For example, there is evidence that taking exogenous testosterone might contribute to:

• high blood pressure
• diabetes
• high cholesterol

 
All of these factors can in turn increase your risk of cardiovascular disease, which is the leading cause of death in the world.
 
Moreover, testosterone can make your blood thicker, resulting in heart attacks and strokes. Fortunately, it seems that this happens if your dosage is too high for your metabolism, so the best way to prevent it is to follow your doctor’s prescription to a T (pun intended).
 
High blood pressure, diabetes, and high cholesterol are usually associated with being overweight or obese. However, the opposite end of the weight continuum isn’t any better. Maintaining an excessively low level of body fat can weaken bones and immune function, which are both linked to the activity of sex hormones.
 
Testosterone and oestrogen play an important role in bone health, but HRT suppresses oestrogen production. So it may be better to keep taking testosterone once your oestrogen levels have decreased in order to decrease the risk of osteoporosis.
 
One of the many benefits of exercise is to strengthen bones, so physical activity will further reduce your chances of developing the condition.
 
Testosterone has also been associated with immune suppression, although this relationship has yet to be fully understood. As a result, being underweight andon HRT could constitute a double whammy to your immune system, like being slapped in the face twice in a row.
 
Whether you need to lose fat or gain weight, a combination of adequate nutrition and regular exercise appears to be the most effective way to achieve and maintain weight-related goals in the long term.
 
Another bonus of physical activity, in addition to bone health and weight management, is a positive impact on mental health, which can contribute to the benefits HRT has been shown to provide as well.
 
Furthermore, if you are keen on developing muscle mass as part of your process of masculinization, be aware that testosterone alone won’t allow you to maximise your potential for growth. For that, you will need resistance training, like any regular guy.
 
Moreover, if you had been training prior to taking hormones, testosterone will enhance the results of your hard work. That’s why you should consider making these positive changes to your lifestyle long before you start HRT.
 
Work hard early and you will reap the benefits sooner.
 
2. Quitting smoking
 
According to the World Health Organization (WHO), smoking kills about half of the people who make it into a habit.
 
It can also:

• cause high blood pressure
• cause your arteries to narrow over time, slowing down blood flow
• increase your risk of cardiovascular and pulmonary diseases, osteoporosis, and various types of cancer, including cervical cancer

 
As you can see, smoking and HRT have some side effects in common.
 
Obviously, HRT is not as bad as smoking.
 
But, if you’re taking hormones, you are already more likely to incur potential complications than before the therapy. If you’re taking hormones and you alsosmoke, that risk goes up a few notches. Why take a gamble when your new life is at stake?
 
Breaking a smoking habit can be life-saving for anyone, but it can be especially important for the transmasculine population.
 
3. Doing routine checks
 
No one likes to go to the gynaecologist and be reminded that, well, they have ovaries. It’s especially awkward if you’ve been taking testosterone for several months or years, you pass all the time, and no one even remembers you were born in a female body.
 
But, if you have the anatomy, you have to take care of it.
 
Yes, you may experience dysphoria. Yes, you may feel crappy about the whole ordeal for the entire week leading up to it and maybe even for the entire week afterwards.
 
But you may also save yourself from complications that can affect your chest, vagina, uterus, and ovaries.
 
Cisgender people don’t like these checks, either. I know a cis man who put off his colonoscopy for years, for example, and no woman I’ve ever met cries out in excitement when she gets a pap smear appointment. In fact, a lot of them don’t show up for it.
 
This is dangerous enough when you don’t have exogenous hormones changing your physiology in many ways that are still a mystery even to scientists. It’s likely impossible to estimate the risk increase when you do have exogenous hormones changing your physiology in many such ways.
 
It may be helpful to ask a loved one for help schedule the appointment and to go with you for support. They can also provide an objective point of view and remind you of the importance of these checks when dysphoria is doing its annoying thing in your head (boy, I know the feeling).
 
Final Thoughts
 
You might think that this article is stating the obvious: eat well, move, and go to the doctor.
 
That is the point.
 
I didn’t think I’d share anything ground-breaking, but rather remind us of the simple things we can do to take care of ourselves.
 
As trans men, we spend a lot of time hating our body.
 
And yet, our body is so wonderful that it’s willing to respond to testosterone to allow us to become the men we were meant to be. Don’t take that for granted.
 
Don’t take your body for granted.
 
In Future Episodes:
 
Lifters don’t usually like cardio, but could it have a place in your fitness journey? Check out next week’s article to find out whether you need to do cardio and how to implement it effectively, if so.
 
Your Turn:
 
Which aspect of taking care of yourself are you struggling with the most right now?