Starting Doses
Before You Start
Get a baseline blood test including:
- Total T, free T
- E2
- CBC (especially hematocrit)
- Comprehensive metabolic panel
- Lipid panel
Doses below are for adults (18+).
Adolescent-specific guidance is provided in the section below.
Adolescent Dosing (Under 18)
Adolescent testosterone therapy follows a start low, go slow approach to mimic the gradual pace of endogenous puberty. These guidelines are based on WPATH SOC8 and Endocrine Society (2017) recommendations.
Important
This guide does not recommend DIY HRT for minors without medical supervision. Hormone therapy in adolescents ideally involves a multidisciplinary team including a qualified provider. The information below is provided for educational purposes and to help adolescents and families understand standard protocols.
General Principles for Adolescents
- Pre-pubertal children: Hormone therapy is not recommended — social transition and supportive care are the standard of care .
- Tanner stage 2+: Puberty blockers (GnRH agonists) are the first-line intervention if suppression of natal puberty is desired .
- Gender-affirming hormones are typically added around age 14–16, after a multidisciplinary team confirms persistence of gender incongruence and the adolescent has sufficient capacity for informed consent .
- The goal is to mimic pubertal hormone levels, gradually increasing over 1–2 years until adult doses are reached .
Testosterone — Pubertal Induction (Early to Mid Puberty)
For younger adolescents (<15 years) or those in early puberty (Tanner stage 2–3), testosterone is introduced at low doses and increased every 6 months. The protocol uses body surface area (mg/m²) to account for growth:
| Phase | Injectable T (Cypionate/Enanthate) | Duration |
|---|---|---|
| Starting dose | 25 mg/m² every 2 weeks (or 12.5 mg/m² weekly) | 6 months |
| Step 2 | 50 mg/m² every 2 weeks (or 25 mg/m² weekly) | 6 months |
| Step 3 | 75 mg/m² every 2 weeks (or 37.5 mg/m² weekly) | 6 months |
| Step 4 | 100 mg/m² every 2 weeks (or 50 mg/m² weekly) | 6 months |
| Adult maintenance | 100–200 mg every 2 weeks (or 50–100 mg weekly) | Ongoing |
For a typical 14-year-old (~1.6 m²), this translates to roughly: start at 20 mg weekly, increase to 40 mg, then 60 mg, then 80 mg weekly over 2 years.
Testosterone — Post-Pubertal Adolescents (Tanner Stage 5)
Adolescents who have completed natal puberty can increase doses more rapidly (every 3 months):
| Timeline | Injectable T (Cypionate/Enanthate) | T Gel |
|---|---|---|
| Months 0–6 | 75 mg every 2 weeks (37.5 mg/week) | 12.5–25 mg/day |
| Month 6–12 | 125 mg every 2 weeks (62.5 mg/week) | 25–50 mg/day |
| Adult maintenance | 100–200 mg every 2 weeks (50–100 mg/week) | 25–100 mg/day |
Age-Based Summary
| Age Range | Typical Approach |
|---|---|
| Under 13 | Social transition + supportive care. Puberty blockers at Tanner stage 2, if indicated. |
| 13–15 | Puberty blockers if not already started. Low-dose T (pubertal induction protocol). Increase slowly every 6 months. |
| 16–17 | May follow post-pubertal protocol (more rapid increase every 3 months). Full adult doses may be appropriate by age 17–18, guided by levels and response. |
| 18+ | Adult dosing as below. |
Dosing (Gels)
Here is a table of typical doses of testosterone gel used in transmasculine hormone therapy:
| Testosterone Gel Type | Low Dose | Initial — Typical Dose | Maximum — Full Dose | Additional Notes |
|---|---|---|---|---|
| Testosterone topical gel 1% (packet) | 12.5–25 mg daily | 50 mg daily | 100 mg daily | Usually comes in packet form |
| Testosterone topical gel 1.62% (packet or pump) | 20.25 mg daily | 40.5–60.75 mg daily | 103.25 mg daily | Comes in either packet/pump form. One packet/pump = 20.25 mg |
| Testosterone axillary gel 2% (pump bottle) | 30 mg daily | 60 mg daily | 90–120 mg daily | Comes in pump form only, one pump = 30 mg |
It is recommended that people start on ~50 mg of testosterone gel per day, up to a maximum of 100 mg/day.
Testosterone gel can be applied to the shoulders and upper arms, or the stomach area. Thoroughly rub in the gel, and wait until it is completely dry before putting on clothing or interacting with pets.
It is not recommended you go over 100 mg/day unless you have obvious signs of insufficient T levels after a year on that dosage (still having menstrual cycles, or a blood test showing inadequate levels).
Keep in mind the low dosage range described above will generally not induce the same extent nor speed of changes as what would be expected at higher dosages.
Calculating Gel Dosages
Gel that comes in a pump-style bottle will usually say exactly how much testosterone will be dispensed per pump (usually 20.25 mg or 30 mg).
With individual gel packets, some products clearly state on the box or packet how much testosterone each packet contains. However, some brands do not list this directly, so a simple calculation may be necessary. Gel packets usually provide the concentration as a percentage (commonly 1%) and the total amount of gel in the packet (typically 2.5 g or 5 g).
To calculate the amount of testosterone in a packet, use the following formula:
(gel packet volume in grams) × (concentration of gel as %) × 100 = amount of testosterone contained in each packet
Dosing Examples
| Gel Packet Volume | Concentration | Calculation | Testosterone per Packet |
|---|---|---|---|
| 1.25 g | 1.62% | 1.25 × 1.62 × 100 = 20.25 | 20.25 mg |
| 2.5 g | 1% | 2.5 × 1 × 100 = 25 | 25 mg |
| 5 g | 1% | 5 × 1 × 100 = 50 | 50 mg |
Not too complicated, hopefully!
Dosing (Injections)
Here is a table of typical doses of injectable testosterone used in transmasculine hormone therapy:
| Type | Low Dose | Initial — Typical Dose | Maximum — Full Dose |
|---|---|---|---|
| Testosterone Cypionate | 20 mg/week | 50 mg/week | 100 mg/week |
| Testosterone Enanthate | 20 mg/week | 50 mg/week | 100 mg/week |
You can either choose to slowly ramp up your dosage, or you can start at a full dose. Neither method is necessarily better than the other.
It would not be recommend you go over 100 mg/week unless you have obvious signs of insufficient T levels after a year on that dosage (still having menstrual cycles, or a blood test showing inadequate levels). It is still highly recommended you get blood testing though, as having very high T levels can increase polycythemia risks.
Keep in mind the low dosage range described above will generally not induce the same extent nor speed of changes as what would be expected at higher dosages.
Subcutaneous (SC) vs Intramuscular (IM)
Both T cypionate and enanthate can be given subcutaneously using a smaller needle (25–27G, 0.5–0.625 inch). Many people find SC less painful and easier to self-administer. Absorption is slightly slower but trough levels remain in target range for most. If switching from IM to SC, the same dose and frequency is a reasonable starting point; confirm with a trough blood test after 4–6 weeks.
Dosing (Testosterone Undecanoate)
| Type | Low Dose | Initial — Typical Dose | Maximum — Full Dose |
|---|---|---|---|
| Testosterone Undecanoate in castor or grapeseed oil (e.g., Nebido or pharmacy-sourced) | 80 mg every month (28–31 days) | 200 mg every month (28–31 days) | 400 mg every month (28–31 days) |
| Testosterone Undecanoate in MCT oil (usually from steroid sellers) | 60 mg every 3 weeks (21 days) | 150 mg every 3 weeks (21 days) | 300 mg every 3 weeks (21 days) |
::: caution Testosterone Undecanoate Testosterone undecanoate requires larger injection volumes, so you may need a 3 mL syringe or split the dose into multiple injections. Intramuscular injections are highly recommended, as subcutaneous injections don't tolerate high volumes well. Keep each injection under 2 mL. If needed, divide into two separate injections.
With long-acting esters like testosterone undecanoate, the carrier oil can affect how long it stays in the body, which is why dosing may vary by formulation.
It can also be hard to source and is often only available in single-use ampules rather than multi-dose vials. These typically contain 1000 mg, which is usually too high, leading to excessive levels and large fluctuations. They also require injecting about 4 mL, which can be painful. For these reasons, ampules are not recommended, and vials are preferred instead.
Keep in mind the low dosage range described above will generally not induce the same extent nor speed of changes as what would be expected at higher dosages.
Because testosterone undecanoate builds up slowly, an initial loading dose of up to 2.5× your regular dose can be used to reach stable levels faster. For example, if your intended dose is 300 mg every three weeks, your initial loading dose may be 600 mg (300 × 2.5). :::
Calculating Injection Dosages
Vials of testosterone are usually compounded at either 200 mg/mL, 250 mg/mL or 300 mg/mL. This means that for a 200 mg/mL vial, every 1 mL of liquid will contain 200 mg of testosterone. A 10 mL vial will then contain a total of 2000 mg of testosterone. Keep in mind that higher concentrations of T may cause more post-injection pain, due to a higher ratio of solvent used in the vials.
We will unfortunately be doing some math here.
The formula to calculate how much liquid to inject is:
(amount you want to inject) ÷ (concentration of the vial) = amount to inject per dose in mL
Dosing Examples
| Desired Dose | Vial Concentration | Calculation | Injection Volume |
|---|---|---|---|
| 20 mg | 200 mg/mL | 20 ÷ 200 = 0.1 | 0.1 mL |
| 50 mg | 200 mg/mL | 50 ÷ 200 = 0.25 | 0.25 mL |
| 100 mg | 200 mg/mL | 100 ÷ 200 = 0.5 | 0.5 mL |
| 50 mg | 250 mg/mL | 50 ÷ 250 = 0.2 | 0.2 mL |
| 50 mg | 300 mg/mL | 50 ÷ 300 ≈ 0.17 | 0.17 mL |
Not too complicated, hopefully! If you still need help with calculating dosages, this is a useful tool. It's intended for transfems but is equally usable for calculating testosterone vial dosages.
How to Perform a T Injection
Needles can be bought from any pharmacy over the counter in most countries without a prescription (you may have to ask the pharmacist directly). Most countries also have online sites that sell appropriate injection needles. Amazon is a popular source for those in America.
Injection Supplies
Make sure to buy 1 mL syringes, as the small amounts of fluid we are using for each injection are only easily measured with 1 mL syringes. The more common 3 mL syringes will still work if you cannot find 1 mL syringes, but are not ideal. It is fine to use 3 mL syringes if you are using testosterone undecanoate due to the high injection volumes.
Subcutaneous vs Intramuscular
There are two methods for a T injection:
- Subcutaneous (subq/SQ/SC) — injection into the layer of fat under the skin
- Intramuscular (IM) — injection deep into the muscle underneath the skin and fat
Both methods result in identical absorption rates and levels of the drug. Whether you prefer subq or IM is mostly personal preference.
Homebrewed injections typically contain benzyl benzoate (a safe solvent also commonly used in prescription-grade medications), which can cause some minor irritation if injected subcutaneously. Usually there will be less post-injection pain if injected intramuscularly.
Needle Sizes
| Injection Type | Gauge (Thickness) | Needle Length |
|---|---|---|
| Subcutaneous (subq) | 25–30G | ½"–⅝" |
| Intramuscular (IM) | 23–25G | 1"–1½" (1" for thinner people, 1½" for larger people) |
Subq needles are thinner than IM needles, which some people find less intimidating.
Video Guide
There are many online videos and guides for how to administer an intramuscular or subcutaneous injection. Here is a decent one:
Guide by Plume: https://support.getplume.co/support/solutions/articles/72000544742-all-about-injections
Very detailed video guides on both IM and subq injections, with the downside that they are split into multiple long videos.
Note that around 0.1 mL of fluid will be lost with each injection due to needle dead space.
Note on Finasteride and Dutasteride Usage
Some transmasculine people choose to take medications like finasteride or dutasteride to prevent male pattern baldness and hair loss.
These medications work by preventing testosterone from naturally converting into another hormone called DHT (dihydrotestosterone). DHT is the main hormone responsible for male pattern hair loss.
DHT also plays an important role in developing body and facial hair growth and bottom growth. If these changes are desired, it may be recommended to not take finasteride or dutasteride until you are satisfied with your level of facial and body hair growth and bottom growth. If finasteride or dutasteride is started too soon, these changes may be limited (though these changes will continue without issue if finasteride or dutasteride is stopped).
Male pattern hair loss is generally very rare in the first year of T, though if you are still concerned, minoxidil (brand name Rogaine) can be used as a topical hair loss prevention medication, and will not inhibit other desired changes.
Blood Testing
It is recommended to do your first blood test within the first 3 months, and then adjust your dosage if necessary. If you change your dosage, try to retest again within 3 months. If your levels look good, blood testing frequency can be reduced to just once a year.
Check out our blood testing page for sources near you.
What to Test
Get your estradiol (E2), total testosterone (T) and complete blood count (CBC) (also referred to as full blood count/FBC) tested every time. Get your blood taken as close as possible to your next scheduled injection/dose (test your blood as far away as possible from a previous dose, right before your next scheduled dose — preferably the day of your shot, or the day before).
Your blood levels of estradiol and testosterone when taken at this time are called trough levels, because they are the levels of E2 and T that are present in your body at the lowest point in your HRT dosing regimen.
What Should My Total T Reading Be?
The Endocrine Society's 2017 clinical guidelines for transsexual HRT recommend that trans men maintain "testosterone levels in the physiologic normal male range", a range which is typically given as 300–1000 ng/dL. Slightly higher or lower testosterone levels above or below this range are not something to worry about unless your estradiol levels are also too high.
What Should My E2 Reading Be?
The typical range for adult males is 10–50 pg/mL, although this varies due to age and individual factors. Try to aim within this range, although slightly higher levels are not something to worry about. Try to keep your estradiol under 70 pg/mL.
What Should My CBC Look Like?
Polycythemia is defined as serum hematocrit (Hct) or hemoglobin (HgB) exceeding normal ranges expected for age and sex, typically Hct > 49% in healthy adult males. So there is no concern if you have Hct levels lower than that. If your levels are elevated, donating blood or reducing testosterone dose can treat polycythemia.
If your red blood cell (RBC) and hematocrit are above reference ranges on your CBC test, you may be at elevated thrombosis (blood clot) risk. You can donate blood or lower your dose to reduce this risk.
Donating blood is also a way to get your CBC checked for free, as CBC is typically checked every time someone donates blood.
Occasional Liver Function Tests (LFT)/liver enzymes, clotting factors test, and lipid profile test (cholesterol, triglycerides) can be useful to monitor certain health risks associated with testosterone therapy. Though these risks would usually only be relevant at excessively high dosages.
Hormone therapy in general is very safe and effective as long as you take reasonable doses.
References
Hembree WC, et al. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. JCEM, 102(11):3869–3903. https://academic.oup.com/jcem/article/102/11/3869/4157558
Coleman E, et al. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(S1). https://www.tandfonline.com/doi/full/10.1080/26895269.2022.2100644
Deutsch MB, ed. (2016). Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. UCSF Transgender Care. https://transcare.ucsf.edu/guidelines
Coleman E, et al. (2022). SOC8 — Chapter 6: Adolescents. WPATH. https://www.tandfonline.com/doi/full/10.1080/26895269.2022.2100644
Hembree WC, et al. (2017). Section 1.4: Prepubertal children. JCEM, 102(11):3869–3903. https://academic.oup.com/jcem/article/102/11/3869/4157558
Hembree WC, et al. (2017). Section 2.1–2.3: Pubertal suppression. JCEM, 102(11):3869–3903. https://academic.oup.com/jcem/article/102/11/3869/4157558
Coleman E, et al. (2022). SOC8 — Statement 6.5: Sex hormone therapy in adolescents. International Journal of Transgender Health, 23(S1). https://www.tandfonline.com/doi/full/10.1080/26895269.2022.2100644
Hembree WC, et al. (2017). Table 8: Protocol for induction of puberty (testosterone). JCEM, 102(11):3869–3903. https://academic.oup.com/jcem/article/102/11/3869/4157558
Hedian HF, et al. (2024). Dosing Guide: Gender Affirming Hormone Therapy for Transgender and Gender Diverse Adolescents. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/-/media/center-for-transgender-health/documents/adolescentdosingguide41224.pdf