Of course. Here is a summary of the potential adverse effects of testosterone use for transgender men and other AFAB (assigned female at birth) individuals, based on the shared experiences and knowledge from the community.
It's important to remember that many effects of testosterone are the desired, gender-affirming outcomes of treatment. What is considered an "adverse effect" often depends on the individual's goals. The information below focuses on the potential negative health impacts and unwanted changes.
1. Cardiovascular and Metabolic Health Changes
A primary health consideration is that testosterone therapy alters your risk profile for certain conditions to align with that of cisgender men. This means that while your risk for things like heart disease or stroke may increase from a pre-testosterone, female-typical baseline, it generally rises to a level that is normal for men. As one user explains, "I believe the risks of stroke/heart problems/etc usually puts you at the same risk as a cis man" – furrowedbr0w source [citation:93a8d2dd-a8a0-4e7c-9dde-a26448168bdb]. With proper medical supervision, these risks are managed as part of routine healthcare.
2. Reproductive System Changes (e.g., Vaginal Atrophy)
Testosterone can cause changes to the reproductive system, with vaginal atrophy being a specific and common concern. This can lead to dryness, thinning of tissues, and discomfort. This effect is manageable, often with a topical estrogen cream that works locally without affecting the masculinizing effects of testosterone throughout the rest of the body. One user shared their proactive approach: "I already have to use Estrogen Cream down there because of those same symptoms... I just started getting my urethra/vaginal issues mostly under control" – A_Valdorian source [citation:1ede2c1e-af1d-4683-bf0a-cb8dc9749f84].
3. Risks of Improper Use or Dosing
Taking testosterone incorrectly—such as using the wrong dose, taking it orally (in forms meant for injection), or without a prescription—carries significant risks. These include potential liver damage and an increased strain on the heart. A critically important risk of taking too high a dose is that the body can convert the excess testosterone back into estrogen. As warned by one user, "Testosterone can cause heart problems, liver problems, and at a high enough dose, it can actually be converted back into estrogen, which would be counter productive to your transition" – BlueFinch__ source [citation:b446ae95-9794-4c4b-ac8d-96a53511f4bd]. This highlights why working with a knowledgeable doctor is essential.
4. Common Physical Side Effects
Some physical changes are very common and may be considered undesirable by some. These include male-pattern baldness, increased acne, and body hair growth in new places. While someone seeking masculinization may welcome these changes, they can be managed as side effects if needed. For example, one long-term user stated, "I've been on testosterone for ten years. I am in great physical health. The only negative side effect I've had is balding" – tortguy source [citation:9b4f51ab-979d-49bf-af32-faddc52b37b6].
Conclusion
The journey with testosterone is deeply personal. While there are potential adverse effects—primarily relating to cardiovascular health, reproductive system changes, and the consequences of improper use—these are well-documented and can be effectively monitored and managed with the guidance of a qualified healthcare provider. The key is open communication with your doctor to ensure your treatment plan maximizes the affirming benefits while minimizing health risks, allowing you to pursue a path that feels right for you.