What are Health Concerns for Transmen?
Gynecological and Breast Health
Sometimes, transmen (or FAAB transgender-identified people) may feel disconnected from female body parts, such as breasts and female genitalia. This can cause physical or emotional discomfort. Additionally, you may find it is difficult to find a medical provider who is sensitive to your needs. Because of these barriers, transmen are less likely to receive the regular medical exams--including gynecological exams and breast exams--which are important to maintain a healthy body and detect cancers, STIs, or other illnesses. At all phases of your transition process, regular medical exams are important.
Some transmen choose to bind their chests to create a more masculine appearance.Be sure to bind properly - if not, sores and other skin irritations can occur. If the binding is too tight it may hurt, cause cuts, irritate the skin, or prevent comfortable breathing. If you are currently considering binding, DO NOT use Ace bandages, saran wrap, or duct tape. Using any of these methods can peel away skin and permanently damage one’s ribs.
In order to bind safely, one makes sure that the binding methods allow for proper breathing. If you bind your chest, make sure that the material used to bind can wick away sweat, such as CoolMax or Powernet fabrics. A popular method to bind amongst transmen is the use of the compression vest, usually used for cisgender men who have gynecomastia (development of breast tissue in cisgender males). The most popular compression vest used amongst transgender men can be purchased from Underworks, an online vendor of undergarments. The website has a section devoted to the needs of transmen (transmen.underworks.com). The most popular models are the 997 and the 983. However, the vests are expensive ($29.99 - $36.99 each, not including shipping and handling). A website that provides used binders is called the Big Brothers Used Binder Program (http://www.thetransitionalmale.com/BBUB.html), where transmen who have had top surgery donate their binders to transmen who otherwise would not be able to afford them.
If you have had a mastectomy (surgical removal of breasts), you should consult with your medical provider about whether or not to continue breast exams, as some breast tissue may still be present.
Unless you have had a hysterectomy (surgical removal of the uterus), regular gynecological exams and Pap smears remain an important piece of your total health care.
Transmen may choose to use testosterone (“T”) to create changes to their bodies, including lowered voice, redistributed body fat, increased muscle and hair growth, and enlarged clitoris.
For some, this choice is made easily, while others will struggle with the idea and may go on and off testosterone at different points in their lives. When considering testosterone, it is important to visit a medical provider for a physical exam and regular updates on blood work and health status. Various personal and family health factors will influence how each person will react to use.
There are two main ways to administer testosterone: injections and gel/cream/patch attached to the skin (there is also a pill form - however, in large concentrations, the testosterone pill damages the liver in the long term). Injections are the most popular method to administer hormone replacement therapy. Injections occur once every week or two weeks. The testosterone comes suspended in either cottonseed or sesame seed oil, and it is injected through a syringe in either the thigh or buttocks. The dose varies per individual - some do better with a larger dose every two weeks, while others do better with a small dose every week. Doses can vary between 50 mg to 300 mg. Be prepared to work with your doctor on calibrating the right amount for you.
Although injections are the most popular choice, they do not provide a steady administration of T into the body. People feel the highest concentration and highest intensity of T upon the first day of injection, and by the day before their next injections, people have reported feeling low or depressed.
The other method is through gel, cream or patch that is attached to the skin. This method is less popular because changes occur more slowly than injections. Also, if using a cream or gel, some transmen have complained of the texture or smell. However, unlike injections, this method allows for a more steady and consistent administration of T into the body.
It is also important to obtain testosterone through a medical provider. Using testosterone that is bought off the “black market” is illegal and unsafe. It may limit your access to clean needles (some states require a prescription to buy and carry needles), and it can be impure (cut with other substances). It is also critical to use the appropriate dosage as determined by a medical provider. Taking more testosterone than prescribed will not speed up the changes desired and may increase the risk of serious side effects.
Side Effects of Hormones
The rate at which changes occur varies amongst transmen due to the dose, as well as genetic factors. The first noticeable change, within the first three months, is often the lowering of the voice. After about a year of therapy transmen often pass well enough as male, and changes can even occur for years afterwards. In terms of facial hair, some transmen grow their first beard within months. For others, it may take years before a full beard is able to develop. The best way to determine how your hair will change from T is to look at the hair of the cisgender males in your family and how their facial hair developed.
Possible health effects of testosterone use include acne, balding, and increased fat around the abdomen. Other side effects include greater risk for high blood pressure, high cholesterol, and liver problems - however, despite the increased risk, these risks are also consistent with normal health risks for cisgender men. Medical research has not yet determined the long-term effects of using testosterone.
Other changes caused by testosterone are an increase in appetite, energy level, increased metabolism, and increased libido. Some have gained weight due to poor eating habits. Others have lost weight, due to an increased metabolism. Also, with increased energy level, a side effect some transmen have faced is a lack of focus and racing thoughts. If you increase your sexual activity due to increased libido, be sure to use safe sex practices. If you start taking testosterone, you should take a lighter workload, to allow time to adjust to the possible side effects of T. Some trans individuals decide to take a quarter, several quarters, or even a year off in order to fully focus on transitioning.
It is still possible to become pregnant while on testosterone, although infertility occurs after continued use. It is possible to get pregnant later in life despite using T for years - however, you will have to stop taking T for several months before attempting to get pregnant. Speak to your medical provider for more information about fertility and contraception options if pregnancy is a concern. Some male-identified transgender people choose to have their eggs frozen before starting testosterone, to have the option of using them later, either by giving birth themselves or by using a surrogate.
For an excellent guide to the use of hormones, as well as advice on locker room tips, passing, and even where to find clothing for shorter men, visit the FTM Resource Guide (ftmguide.org).
If you decide to have surgery as part of transitioning from female to male, surgery options can include liposuction (surgical removal of fat deposits), breast reduction, double mastectomy (surgical removal of breasts), or pectoral implants (“top surgery") and various “bottom surgeries” including metoidioplasty (clitoral hood release), phalloplasty (construction of a penis), scrotoplasty (creation of a scrotum), and hysterectomy (removal of the uterus). Since technology involving bottom surgery is not as advanced as bottom surgery for transwomen (in addition to the cost), many transmen choose not to get bottom surgery.
As with any surgery, there can be minor or major complications during and after these procedures. It is important to follow the guidelines given by your surgeon and medical provider at all times. These surgeries are expensive, and may also require time off from school or work. Not everyone will be a candidate due to other medical conditions. Most surgeons in the US will also require a clearance letter from a psychologist, in compliance with the World Professional Association for Transgender Health (WPATH) Standards of Care.
You can find more detailed information and useful links on Trans Health at Transgender Care for Students