this post was submitted on 05 Feb 2024
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Do you have a source on the topical/DHT connection? It kind of fits my experience, but I would love to see actual data there, as I am waffling about whether to stay on gel or go back to injections myself.
I started on injected, ramped up until it actually caused me problems (turns out my family history of epilepsy and migraines around puberty is androgen-sensitive, and I started having difficulty with light triggering awful headaches). Sustained at I think 50-60 mg after that, took about two years break and back on injections at 60 until I switched to gel about a year ago. The reason I say the DHT matches my experience is because I had a definite increase in hair growth and possibly bottom growth after switching and getting the dose right. (I had very little bottom growth before, and I still don't really notice it.)
The whole process has been a little frustrating for me. Voice change, hair growth and muscular development were what I most wanted from T, but I turned out to be a tenor, got the genetics for just enough facial and chest hair to make it obvious how little I have, and my ability to get muscle definition is worse than the women in my family still. Like, I feel good on T, but it hasn't been what I dreamed of as far as transforming my body.
"Disproportionate increases in serum DHT are reported after administration of all transdermal testosterone products with the higher DHT/T ratio attributable to the strong expression of 5-alpha reductase in skin structures which foster the conversion of testosterone to DHT during transdermal passage." https://onlinelibrary.wiley.com/doi/10.1111/andr.12357
"transdermal TRT elevated serum DHT (5.46-fold, 95% CI: 4.51 to 6.60) to a greater magnitude than intramuscular TRT" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245724/
How much have you experimented with injections? You may want to try alternative esters (e.g. cypionate, enanthate). Some people find subcutaneous better than intramuscular or vice versa. It can also help to increase frequency, like splitting a weekly dose into 2 or 3 times a week. Injecting weekly was giving me issues (e.g. headaches, bad skin) that have resolved since switching to 2x/week.
For facial/body hair growth, I would suggest minoxidil if you haven't tried already. A lot trans guys/mascs have had success with it. Muscle growth might just be unlucky genetics, but many people underestimate the power of a bigger calorie surplus, more protein, and/or a more targeted fitness plan.
Transition can be really frustrating for sure, and for some more than others. I would also recommend a trans affirming therapist or support group if you don't have one already. My therapist has helped me a lot with managing expectations/frustrations/patience.
Very interesting links, thank you!
I did intramuscular cypionate at varying levels for most of my time on T, every two weeks, so not a lot of experimentation except for the dosage. Sounds like I should definitely talk to my prescribing doctor about options, whether I end up switching back from gel or not....
My therapist is actually a nonbinary trans woman, so I'm in good shape there; obviously her personal experience doesn't include T delivery methods, but they also work with a bunch of other trans folks of all types, so there's some tribal knowledge being filtered through there. I still learn more from the community than from medical professionals, though. Many thanks for the information and advice today!