Article by Dr Katrina Karkazis, taken from The New York Review of Books

What testosterone does to and for an individual is complex. When people want to know what T does, they usually start with the gender of the person using the T. What does T do for men? For women? This approach tends to assume that people within a given group take T for the same reasons or want the same results. It also assumes that the hormone will have similar effects in bodies within those groups.

Testosterone’s effect for a given individual is inflected by that body’s particularity and history: its age; its current level of, including past exposure to, the hormone; the effects of habituation over time; the quantity, location, and sensitivity of androgen receptors; and the presence of other hormones. All these factors, many of which vary in response to social and environmental stimuli, play a part, as do dose and exposure to that dose over time.

When T is taken at higher doses some physical changes are likely, but T is more like a plated meal than a buffet: no one individual gets to choose precisely what changes it produces. As one friend who had started T said to me, “Let me know if you find a way to get the big muscles and keep the head hair!” It can fail people no matter how much they take, no matter how much they desire some effects but not others. For all the dramatic changes Hansbury experienced when taking T, he concluded that T let him down: he felt he had been more masculine as a “butch dyke.” He described asking people, “What kind of a guy am I?” The answer was not what he had hoped for:

They see a nerd, which I never was before. I was always really cool and popular and hip and whatever. And now I’m 5’ 4”, and I work out, but I’m not real muscular. And I’m pretty small. I’m pale-skinned, and my hair has started to thin, and I’ve got glasses. And of course, I’m also the sensitive guy now. I used to be the butch dyke, and I was seen as very aggressive. And I was more masculine in many ways—outwardly, anyway—before testosterone.

Clinical encounters often involve tempering expectations. As Ronica Mukerjee, a nurse practitioner who specializes in working with transgender individuals, told me, it’s important for those considering T to be aware of the unpredictable changes such as “whether people gain hair or lose hair, whether their body fat redistributes in a phenotypically cis-male pattern, and if their muscle mass significantly increases or not.” This uncertainty can be especially troubling if one’s reason for taking T is to be perceived as more masculine. Like Nelson, Mukerjee understands masculinity as independent of T. “For almost all trans masculine patients,” she told me, “the assertion and understanding of their selves and bodies as masculine happens regardless of testosterone initiation. But the lack of institutional and social acceptance for masculinity, without the addition of testosterone, can be part of the complex reasons that they initiate T.”

What T actually does cannot be easily separated from what one wants it to do. How do you ask a substance to make you more masculine or to give you a masculine trait without imbuing the changes that substance makes with your idea of masculinity? Even some of the earliest T experimenters wondered about what Brown-Séquard called “auto-suggestion without hypnotization.” There is no reason to think that the ideas and ideals of masculinity are immune to the placebo effect. This doesn’t mean that what T does is entirely imaginary or unknowable, but it does mean our knowledge should be far more nuanced than it is. Despite masterful appeals from the pharmaceutical industry, among others, to specific desires, such as increased libido, people approach T with different goals and desires. When people take T for its association with masculinity, it makes sense they would foreground and highlight what they understand as its masculine effects.

Consider, for instance, that we tend not to hear any of the magical stories of dramatic transformation from people who’ve been taking T for twenty years. Are the effects less noteworthy or just less novel? Do people settle into whatever changes took place, over time rendering them less remarkable? Or is it that we only hear from those who are most excited, most vocal? In the case of Hansbury, fifteen years later, does the Xerox machine still thrill?

I put these questions to Hansbury. He compared his experience to a young man’s passing through puberty: the tracking and noting of every feeling, behaviour, and physical change, but also the curiosity and eagerness to see how these changes shaped how he was seen and how people interacted with him. This echoed what Sullivan described when he revisited the topic: “Twenty years ago, as it surged through my pubescent body, [testosterone] deepened my voice, grew hair on my face and chest, strengthened my limbs, made me a man.” But there is a crucial difference, Hansbury noted, between going through puberty and starting T. In the case of puberty, your peers are going through the same process as you are, which gives the experience a structure and context that is absent if the changes are happening only to you at age thirty.

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