Shep* has been microdosing testosterone (also known as T) for four weeks.
The 24-year-old applies 1.25mg of testogel – testosterone gel – every morning to their shoulders, a quarter of the regular starting dose of testosterone recommended to transmasculine people. They wait three to five minutes for the gel to absorb and then they start their day.
Even though it’s been a short while since Shep started experimenting with this treatment to explore their gender identity, the changes have been palpable.
"My voice dropped a minor third after only two weeks, which was very fast, and my sense of taste changed a few days after that," they say. "I have much less of a sweet tooth. Sweet things I used to love now taste too sweet to me. I think I've had some small muscle changes and now, a month in, I think I'm having some thickening of body hair."
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Shep is agender, a term which can be literally translated as 'without gender'. They do not identify as a man or a woman but they were assigned female at birth (AFAB).
While they have no desire to transition in order to present as a man (binary masculine), they would like to appear a little more masculine and so they use a small amount of testosterone to alter their gender presentation.
Some transmasculine people may desire more body and facial hair, a lighter period or no period at all, or perhaps increased muscle mass or an enlarged clitoris, which are some of the effects brought about by using the hormone.
Shep’s approach is known as microdosing because it allows someone outside of the gender binary to alter their physical appearance at a rate and to a degree they are comfortable with. By microdosing testosterone, they can induce a more subtle rate of hormonal changes which happen more gradually than if they were taking a higher dose.
"I'm really interested in a lower voice, a certain amount of fat redistribution and muscle changes but I don't feel binary masculine and it doesn't feel right for me to fully present as such," Shep explains.
"I don’t want the entire fat and muscle redistribution, full facial hair, and I'm hoping that microdosing might allow me to keep more in a 'middle' area with those things," they add.
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Microdosing allows someone outside of the gender binary to alter their physical appearance at a rate and to a degree they are comfortable with.
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To understand microdosing, we need to understand our hormonal make-up. Our bodies naturally produce three hormones – oestrogen, testosterone and progesterone – with levels varying depending on your birth sex.
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Cisgender women – people who are born as women and identify as women – produce a higher rate of oestrogen, as well as progesterone, which helps prepare the body for conception and pregnancy, and regulates the monthly menstrual cycle.
Non-binary people like Shep, who was assigned female at birth, produce enough oestrogen naturally. So when they take a small amount of testosterone without first suppressing their endogenous (naturally produced) oestrogen, they will experience a masculinising effect without presenting as entirely male.
"We all have naturally different levels of hormones, even if we are cisgender," one anonymous gender clinician who worked for a private practice offering microdosing to non-binary patients tells Refinery29.
Accessing hormone treatment like that which Shep has embarked upon through private practices is legal. However the clinician declined to supply their name because they do not want to appear to endorse procuring hormones over the internet from sources which may not be reputable, which is illegal but, sadly, something that those who do not want to or cannot pay to see a private doctor resort to.
"Many of our non-binary patients wonder what that will feel like if they take a small dose of a hormone. They want to know what their body will look like and know that if they don’t like it, they can stop it," the clinician adds. This is a crucial point: by taking a smaller dose it’s possible to slow down or stop the process if the person taking testosterone doesn’t like the changes it brings.
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It’s not just non-binary and transmasculine people who turn to microdosing. Mairead*, a trans woman, uses testosterone to revive her sex drive.
She uses a low dose of testosterone cream on her genitals as a way to retain functionality. Otherwise, she says, having sex becomes really painful.
"I receive a really strong on/off oestrogen injection that lasts more than three months and it completely kills my sex drive," says the 39-year-old Brightonian.
"The tissue in my genitals was starting to atrophy so even if I tried, having sex becomes really painful. This isn't a price I was willing to pay just for being trans."
As well as easing the sense of discomfort that a person may have because of a mismatch between their biological sex and their gender identity (gender dysphoria), microdosing is less costly than cross-sex hormone therapy because less of the medication is consumed over time.
Although Mairead is administered oestrogen by an NHS gender clinician, she also buys six sachets of testosterone for £40 from her weed dealer. It is not illegal to buy or possess testosterone for personal use, provided it is not brought into the country via the postal system.
However, supplying or selling testosterone, which is defined as a class C drug, is punishable by an unlimited fine or up to 14 years in jail.
Microdosing and the self-administration of hormones is growing in popularity for people across the gender binary as the wait to see an NHS clinician grows to up to four years for gender-diverse people, resulting in a deficit of specialists who can supply and oversee hormone use.
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Sourcing and administering hormones bought on the black market also means the quality of the drug cannot be guaranteed, with some counterfeit samples tracked down in 2020 by the BBC's Victoria Derbyshire programme.
Like all medical interventions, taking additional amounts of a hormone, no matter how small, carries a risk. Experts warn that without proper care, those microdosing testosterone place themselves at increased risk of a heart attack, headaches and migraines, anger and irritability, and even blood clotting.
Mairead fears that sharing her decision to microdose and how she procures it may mean she is prosecuted. Added to this, Mairead fears that disclosing microdosing could "risk a GP taking my oestrogen script away".
"Losing my sex drive felt like I'd lost an important part of me and knowing I couldn't bring it up in front of an NHS doctor meant I was on my own," she says. "In the UK, gender care is 100% binary – you either want to transition to be a man or a woman – and engaging with the gender services feels confrontational."
"I knew I had to choose between withholding parts of the truth about my gender identity or being totally open and risk not getting the oestrogen I need as a trans woman," she adds.
Mairead’s concerns are shared by Shep, who buys their testosterone from abroad via the dark web.
In the absence of medical advice, they have relied on Reddit subreddits to check how to administer the hormone.
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As well as easing the sense of discomfort that a person may have because of a mismatch between their biological sex and their gender identity (gender dysphoria), microdosing is less costly than cross-sex hormone therapy because less of the medication is consumed over time.
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"Only my partner and some friends know I'm doing it, I've also had to not mention it in some trans groups I'm in because they don't allow talk of DIY, which has made it feel somewhat isolating," Shep says.
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But for Shep, self-medicating in private feels like a smaller risk compared to potentially cutting off any treatment through the NHS they may need later down the line.
While the NHS Gender Identity Clinic says it cannot endorse microdosing hormones without a clinician’s supervision, its guidelines state that it "does not penalise people for it" nor "do we discriminate against patients who have chosen to access private gender care".
"I'm currently not 'out' to the NHS," says Shep. "I'm hoping I’ll be able to get a breast reduction on the NHS in the next few years on the grounds of size and back pain rather than anything gender-related."
"I'm worried that if I'm out to them as trans, it might impact my care and they'll say instead I'll have to be referred to a gender clinic," they add. "That could take years longer and might well result in nothing, because non-binary care isn't fantastic."
Watching their trans wife struggle to receive healthcare during the pandemic affirmed Shep’s decision to go it alone.
"My wife is trans and under the care of an NHS gender clinic but she hasn't been able to contact them at all over the pandemic, and has been without her anti-androgens (testosterone blockers) because her doctor refuses to change her prescription without word from the gender clinic," Shep explains.
"It would be fantastic to see the NHS be more confident and generous with giving bridging prescriptions for people who are stuck on these lengthy waiting lists, and more knowledge about trans and non-binary people in general," Shep concludes.
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They and Mairead agree that the benefits of microdosing outweigh the risks.
Mairead says: "I can't encourage anyone to break the law but I do encourage every non-binary and trans person to take charge of their healthcare, don't stop until you get exactly what you want from it. The feeling of being in control of your own body is life-changing."
*Names have been changed to protect identities.
If you are a young person and you don’t identify with the gender you were given at birth, Mermaids can help. Give them a call on 0808 801 0400.
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