Part 1 of this guide was originally posted on Reddit. There, I mentioned there isn’t really a detailed guide to FtM healthcare like there is for MtFs.

In Part 2 of this guide (of basically everything I can think of, regarding FtM non-surgical medical transition), I am going to talk about FtM-relevant side effects to watch out for, and some of the possible solutions.

Part 1:

Reddit version: https://www.reddit.com/r/4tran4/s/6k0O8bLMZP

Substack version (cleaner language and better formatting): https://theteatable.substack.com/p/part-1-a-consolidated-guide-to-ftm

Part 2:

Tranistan version: This post itself

Reddit version: https://www.reddit.com/r/4tran4/s/cGgPTA22Qm

Substack version (cleaner language and better formatting): https://theteatable.substack.com/p/part-2-a-consolidated-guide-to-ftm

Part 3: (I will insert the link here when it is done)

Part 4: (I will insert the link here when it is done)

Feel free to repost and share this anywhere, in fact that would be super helpful for getting the word out.

Some of this is based on studies but a lot is also based on personal experience, so if I missed anything out, please say so in the comments. It was very helpful for me to hear what some people shared of their experiences and issues and concerns after they read Part 1.

Disclaimer

This guide is not meant as medical advice, it is for informational and educational purposes. Whenever possible, medical decisions should be made in consultation with a qualified, trans-competent healthcare professional. If you have access to informed care, I encourage discussing the information in this guide with your doctor.

This guide was created for two reasons:

First, to provide trans men with potentially relevant information that they may choose to bring into medical discussions — to better understand their bodies and advocate for their concerns.

Second, to offer harm-reductive information for those who do not have access to quality healthcare, or who do not currently have access to doctors at all.

While this guide cannot replace professional medical advice, I hope to present the information thoughtfully and responsibly so that readers can make more informed decisions.

You are responsible for your own medical decisions. Please use this information carefully and at your own discretion.

Units used in this guide

Useful while you read the guide as not everyone uses the same units. I will use ng/dL for testosterone in this guide and pg/mL for estrogen in this guide.

nmol/L to ng/dL conversion: take your nmol/L value and multiply by 28.84 to get ng/dL

pmol/L to pg/mL conversion: take your pmol/L value and multiply by 0.267 to get pg/mL

High hematocrit (Erythrocytosis)

What are the symptoms / findings (you may not get all):

• Headaches

• Flushing

• Dizziness

• High hematocrit on blood tests

Please remember that headaches, flushing and dizziness are very non-specific symptoms that could have many other possible causes too besides your hematocrit levels.

And for many people, high hematocrit can be asymptomatic (meaning you have no symptoms you experience) and it is only caught on a blood test.

Do also note that there are of course other possible causes of a high hematocrit, besides it being a potential side effect of taking testosterone. If, for example, you have a very high hematocrit while your T levels are at a moderate 500ng/dL, the high hematocrit may not entirely be due to the testosterone you take.

Why this matters:

In the long term, sustaining a significantly high hematocrit increases blood viscosity (meaning your blood gets thicker). Thicker blood is associated with risks for blood clots, heart attacks and strokes.

Guidelines recommend intervention when hematocrit is >54%.

Why does it happen:

This can be due to testosterone-induced secondary polycythemia. Do note that this is only something a minority of FtMs face, and most of that minority will have just a mildly elevated hematocrit which usually does not even require treatment (see the next section on ‘Solutions’). You can skip this Why section and go straight to Solutions, if you are not interested in theory and just want practical advice.

Hematocrit refers to the % of your blood volume that is made of red blood cells. Two other closely related blood test markers are Red Blood Count (number of red blood cells per volume of your blood) and Hemoglobin (the total amount of oxygen-carrying protein in your blood).

In testosterone-induced secondary polycythemia, all three markers are typically high, but hematocrit is typically the one you want to look out for.

In simple terms, testosterone signals the bone marrow to make more red blood cells. This is why, even for cis men, the normal range of hematocrit is a bit higher than that of cis women.

So why do a minority of FtMs still have hematocrit which is high relative to that of cis men? We may not fully understand that yet, but the following are plausible mechanisms in some of these FtMs. Cis men produce testosterone steadily throughout the day, but people taking testosterone via certain methods will often get higher peaks, which can push the body to make more red blood cells than average. Another possibility pertains to FtMs early in transition, especially if they had already gone through natal female puberty— switching from a female hormonal profile to a male hormonal profile might cause temporary overshoots in one’s system (I am simplifying a lot). The body has to recalibrate. Hence, one of the temporary overshoots that might happen is a higher hematocrit, but eventually the body will reach a state of equilibrium.

Solutions:

Blood donation may be recommended as a hematocrit-lowering solution in some cases, especially if hematocrit is >54%. This can take the form of just the regular voluntary blood donations you likely already know of.

Also recommended for investigating high hematocrit would be rechecking hydration (especially if the hematocrit is just slightly high), and addressing potential contributors to high hematocrit (e.g., sleep apnea/smoking).

• Reducing testosterone dosage (instead of donating blood) may be the route taken by some. This may be the preferred solution of FtMs who, for example, have T levels on their blood tests of >1000 ng/dL and they are not looking for that. Reducing T dosage (and thus reducing the levels of T in your body) should bring hematocrit down, as hematocrit is positively correlated to testosterone levels.

For slightly elevated hematocrit

If you have only slightly elevated hematocrit, usually this is not considered significant enough for any action to be needed. A slightly elevated hematocrit can be the result of the person just being dehydrated when taking the blood test too.

However, with a slightly elevated hematocrit, doctors may be cautious to increase your testosterone dosage further if that is what you are looking to do. As hematocrit rise is correlated to testosterone rise. In such a situation, your hematocrit levels and possible solutions may still be up for discussion.

What if donating blood is difficult for you:

Some people may have other medical conditions that present challenges for donating blood. For example, low iron or POTS.

In which case, consider the cause of these challenges to donate blood. For example, feeling too faint when donating blood could be due to low iron. Low iron can be fixed with iron supplementation— you should also check the cause of your low iron. It could be that you simply don’t get enough iron in your diet, or it could be due to a medical condition that impedes your body’s ability to absorb iron (and you may need to treat that root cause, lest it has other health impacts if left untreated). One example of such a condition would be Crohn’s.

If you remain ineligible to donate blood for whatever reasons, and you suffer from high hematocrit while on T as mentioned, you can consider asking about low volume therapeutic phlebotomy. Therapeutic phlebotomy removes blood under closer medical version, including low volume versions that take out a smaller volume of your blood compared to a standard blood donation. As previously mentioned, you can possibly combine this solution with lowering your T dosage if you are comfortable with that (For more on T levels and T dosage, see Part 1 of this guide).

—

Vaginal Atrophy

What are the symptoms (you may not get all):

• Burning, irritation or itching in the area

• Stabs of pain from the area randomly (this can have other potential causes too of course)

• Dryness and sensitivity of the area

• Painful when urinating

• If PIV is done: increased pain, spotting from tearing

Some of these symptoms may be confused with that of UTIs

Why does it happen:

The vaginal and urethral tissues depend on estrogen.

Atrophy can happen a. Even with testosterone in the male range, b. Is more common if your E on a blood test is very low (however, some may still have ‘ok’ overall E levels while having localised atrophy from low vaginal tissue estrogen), c. Occurs more commonly after years on T (but is not guaranteed to happen).

Solutions:

Consider low-dose topical vaginal estrogen cream e.g. Premarin.

Note that this will not estrogenise the rest of your body (mostly). Most effects of the topical are localized to the region you apply it to. Furthermore, the vaginal estrogen cream for this use case should be low-dose to begin with. You can also track your overall estrogen levels throughout your body using a blood test, if you are able to obtain that and you want to play it safe. For more on estrogen, see Part 1 of this Guide.

Some methods of vaginal estrogen, especially ring or tablet, involve putting the medicine into the vagina. Some creams come with such advice as well. But it is not necessary in many cases to do this. For those who cannot tolerate penetration, spreading the cream in the general area near/around the vaginal entrance can be enough to work for some.

What I personally do is put on disposable latex gloves (or nitrile gloves if you have a latex allergy) and spread the cream in that general area if I get symptoms, and the symptoms resolve in weeks.

Note for those taking an aromatase inhibitor:

If you are already taking aromatase inhibitor, and the dosage is making your overall E levels on blood tests very low, this could be the root cause of the vaginal atrophy. In which case, instead of using topical estrogen cream to address the atrophy, a doctor might recommend reducing your dosage of aromatase inhibitor instead (while still keeping your E in the male range of course).

—

Male Pattern Balding (MPB)

What are the symptoms (you may not get all):

• Receding hairline

• Thinning at temples

• Crown thinning

• Increased hair shedding

Why does it happen:

Testosterone converts to DHT in the body. DHT then binds to any genetically-susceptible scalp follicles, shortening the growth phase of the hair and shrinking the follicles. Note that this for scalp follicles specifically.

With follicles that have just begun shrinking, these are ‘miniaturized/suppressed’. Medication can help to regrow these.

In advanced male pattern baldness however, some susceptible follicles can become permanently inactive. This is a gradual process. However, these ‘dead’ follicles cannot be regrown with medication, and a hair transplant is needed.

Note that DHT actually has the opposite effect on facial / body hair, promoting its growth instead.

The risk of MPB depends on:

• Family history

• DHT sensitivity (some people have no DHT-sensitive scalp follicles and pass on at age 80 with a full head of hair)

• Age

Solutions:

Consider a topical DHT blocker e.g. topical finasteride spray (it is far less recommended to use finasteride pills or other systemic DHT blockers).

You can also consider topical minoxidil (Note: topical minoxidil is highly toxic to cats and dogs). Minoxidil does not block DHT, instead it thickens hair strands and prolongs the growing phase of the hair. While minoxidil is less effective for fighting MPB compared to finasteride, topical minoxidil is typically easier to obtain and comes with lower risks of side effects.

There is also oral minoxidil, which is possible for FtMs to take for MPB but it also increases facial / body hair. I will talk about it in great detailing (including the risks) in Part 3 of this Guide.

Finasteride and minoxidil are often used at the same time to treat MPB.

If you reduce your T dosage, this would logically reduce your DHT, thus that would slow/halt the rate (or reduce your risk) of male pattern balding. However, if your genetics are very prone to male pattern balding, just reducing your T dosage is unlikely to stop all MPB (you presumably don’t want to take so little T that you end up not even being in the male range, for example).

If your MPB is already quite severe, you can consider starting the medications anyway to prevent further losses. However, you might need to consider a hair transplant to reverse the losses, and subsequently take topical finasteride and minoxidil to maintain your results from the transplant. While you take time to schedule the transplant (and save up financially for it), as mentioned, it may still be good to consider topical fin and min in the meantime to prevent further losses.

More on Topical Finasteride:

(This is an optional section if you want to know more)

In studies, the spray is typically described to be of a 0.2% - 0.25% concentration, applied once or twice a day, with 3-5 sprays total each time, to the parts of the scalp where one is balding, applied to dry hair and with caution to avoid showering for a few hours after each application. This also happens to be the way that I am currently using my prescribed version of it.

Finasteride (in whatever form it is taken in) can have subtle gradual effects. It can take months before you notice finasteride making a difference, and finasteride making a difference requires complying with the daily schedule. In some people, finasteride prevents further hair loss from MPB. In other (luckier) people, finasteride can appear to reverse some of the existing MPB partially. Why can’t it do more? The reasons are as mentioned in the previous section ‘Why does it (MPB) happen?’.

Hence, if you are very concerned about preventing MPB, you can consider monitoring your hair / hairline and asking about finasteride in the very-early stages of balding.

What about the hair transplant option, if my MPB is too severe for the spray itself to obtain the results I want?

As previously mentioned, finasteride cannot always return a full head of hair, especially in those with more severe cases of MPB which had already started years ago.

A hair transplant would involve taking hair follicles from the back of your head and planting them into the (usually frontal) areas where you have balded. Given that you have enough hair follicles at the back of your head, and most people do, this can give you a hairline like you never balded in the first place.

If you don’t take any fin or min as maintenance post-transplant, it is possible to start balding ‘behind’ the transplant. E.g. imagine someone whose hairline was receding, then he transplanted follicles from the back of his head to the front to lower his hairline. These transplanted follicles do fine, but without any maintanence meds, the follicles higher on his head start getting affected by MPB.

For finasteride for FtMs, why should it be a topical spray instead of a pill?

(This is also an optional section if you want to know more)

The pill version is systemic (meaning it affects all of your body). Systemic DHT blockers can have a negative impact on your transition, especially in the earlier years of your transition. Conversely, the effects of the topical spray are mostly concentrated to the sites you apply it to (in this case, the scalp), with only a small amount getting to the rest of your body (assuming you don’t wear haircaps soaked in the liquid of the spray 24/7 or something like that).

In natal male puberty in cis boys, DHT is responsible for facial / body hair and growth of the phallus. However, once all of male puberty is completed and thus all of those changes are complete, most men can take systemic DHT blockers like finasteride pills relatively safely (there is a vocal minority of adult cis male finasteride pill users who say they get depression and erectile dysfunction from it, that is its own whole other can of worms).

In FtMs who are hormonally transitioning (at whatever age), the effects of DHT are largely similar. Facial / body hair growth and growth of the clitoris. But this means that if an FtM takes a systemic DHT blocker while early in transition, that’s kind of like a 13 year old cis teen boy taking it and ending up impeding his puberty.

Can an FtM take finasteride pills relatively safety when later into hormonal transition?

Theoretically yes. E.g. let’s say a given person, after 10 years of T, has gotten a level of DHT-linked changes that he is satisfied with.

This is very understudied so I have not seen any studies on this. Even anecdotal data on this is scarce. But following the logic I have gathered so far, if your body is pretty much done with the effects from DHT in terms of facial / body hair and bottom growth, then similar to post-pubertal cis men, blocking DHT systematically may not be an issue.

If you would like to know about how finasteride spray works differently from the pill version, you can check out this quick literature review on the serum (blood) levels of DHT in people who used sprays: https://www.ishrs-htforum.org/content/htfi/28/3/112.full.pdf

(For this specific paragraph, please take it with a huge grain of salt) It has been anecdotally mentioned by some FtMs that taking finasteride pills impeded their transition progress in terms of bodyfat distribution (in other words, that the skin and fat took a significantly longer time to masculinize), and even some say they started to get periods again after taking it. However, I can find no studies on this, and I cannot think of a possible mechanism by which this might happen. At the same time, I mention these anecdotes to avoid dismissing them outright, as there really is very little data in any direction in studies about FtMs on such issues. I haven’t found anyone attesting to this while using sprays.

Note of caution:

All medications come with risks, not just finasteride but also all other medications mentioned before and after within this guide. As with most things, it is about weighting the benefits vs the risks.

In the case of finasteride, there is emerging though inconclusive research on its long term use increasing the risks of non-alcoholic fatty liver diseases (NAFLD), insulin resistance (IR) and type 2 diabetes (T2DM). ‘Emerging but inconclusive’ means this is very new research and we cannot say for sure. ‘Increases the risks’ is a matter of extent, it is not a guarantee you will get those medical issues.

In some such studies, they study older patients who take oral finasteride to treat benign prostatic hyperplasia. This is therefore a different patient group from those who take a different dosage and/or different method of administration.

Practically speaking, this is likely only really a concern for those who have pre-existing liver conditions. But if you have pre-existing liver conditions, you probably already know that taking most medications is a headache since most medications have to be processed by the liver.

Note also that lifestyle factors can play a significant beneficial role in lowering your risk of getting medical conditions like NAFLD or T2DM. In simpler words, eating healthily and getting regular moderate exercise can be quite helpful, for making it less likely that you get a fatty liver or type 2 diabetes.

—

Acne

What are the symptoms (you may not get all):

• Oily skin

• Small white bumps (closed comedones)

• Blackheads

• Red inflamed pimples

• Deep painful cysts under the skin

• Acne on the face (especially forehead, jawline or chin)

• Acne on the back, shoulders or chest

Why does it happen:

Testosterone increases the activity of sebaceous glands, which produce oil (sebum) in the skin. This means pores clog more easily, certain bacteria that normally live on the skin can grow more, and inflammation occurs around clogged follicles, ultimately resulting in acne. This process is similar to what happens in cis male puberty.

Acne most commonly appears during the first 1–2 years of testosterone therapy, though its severity can vary widely between individuals. Genetics play a role as well— if your male relatives had significant acne during puberty, you may be more likely to get it too.

Acne risk during testosterone therapy can correlate to your hormonal profile (see Part 1 of this Guide for more details). However, getting acne does not necessarily mean your testosterone levels are too high, your skin could just be especially sensitive to androgens.

Other factors that can worsen acne include:

• higher testosterone levels

• increased sweating

• friction (helmets, binders, backpack straps etc.)

• hair products touching the skin

• certain skincare products clogging pores

Solutions:

Mild acne

• Gentle facial cleanser

• Benzoyl peroxide spot treatments on specific acne spots

• Non-comedogenic moisturizer

Even if you have oily acne-prone skin, moisturizer is important. Only applying ‘stripping’ products to your skin without moisturizing can damage the skin barrier and increase irritation/inflammation, which can worsen acne and tolerability.

Mild-moderate acne

• Gentle facial cleanser

• Benzoyl peroxide shower washes and/or spot treatments

• Chemical exfoliants (e.g. azelaic acid, Stridex which is salicylic acid, etc)

• Non-comedogenic moisturizer

Moderate acne

• Topical retinoids (e.g. adapalene or tretinoin)

• Prescription topical antibiotics

Severe acne (especially deep cystic acne)

• Oral antibiotics (short-term, e.g. doxycycline)

• Accutane, aka Isotretinoin (also short-term)

There are also post-acne treatments which are for addressing darkened spots left behind by acne (PIE and PIH), these are separate from what is described above.

Most FtMs do not need to reduce their testosterone dosage to treat acne. However, if testosterone levels are on the higher side (e.g. >1000 ng/dL), you can consider reducing the dosage if you’d like to do that to improve acne.

Note that skincare routines should also be adapted to climate and environment. For example, humid climates may require lighter moisturizers, while cold or dry climates may require thicker creams. A too-thick moisturizer in a hot humid climate can be too clogging and cause more acne, while a too-thin moisturizer can be basically ineffective in a cold and dry climate.

Lifestyle solutions / considerations:

These can help more than you might think.

• Change pillowcases and bedsheets regularly, e.g. change pillowcases every 2-3 days

• Wash hats or items that touch the face frequently

• Avoid letting hair products sit on the forehead

• Wash sweat from the face after exercise

• Hydrate frequently and drink enough water

Diet may also play a role for some people. Diets very high in high-glycaemic foods or dairyhave been associated with worsening acne in some people, though this is ymmv.

Acne patterns sometimes seen:

Hormonal acne:

More likely to appear on the lower face, including:

• jawline

• chin

• neck

These areas contain sebaceous glands that are particularly responsive to androgens.

Pomade / fringe acne:

This is only applicable if you let your fringe down, or if you use pomades/waxes/creams in your hair. This type of acne is concentrated on the forehead or hairline.

(You can get forehead acne anyway even with no fringe and with no hair products, but in which case, that would be from a different cause than what is described in this section)

Pomade / fringe acne can happen when:

• pomades, waxes or creams transfer from the hair onto the skin

• sweat mixes with hair products

• hair rests against the forehead for long periods

Possible solutions include:

• switching to lighter hair products e.g. water-based pomades

• avoiding heavy pomades touching the skin, e.g. be careful how you apply the pomade and how much

• washing hair more frequently when using styling products

• keeping hair off the forehead when possible

For water-based pomades, I find that Grafen Sea Water pomade works ok for me. Shear Revival Northern Lights is another recommended pomade-type product for acne-prone skin. There is also the Vanicream hair styling gel. Unfortunately, you sometimes have to make some cosmetic compromises, vs other non-water-based pomades / hair products that might look better and feel better in your hair (at least for some people) but break you out more.

Especially if you are using a heavier pomade— be careful not to apply too much, especially to the roots of your hair.

Even without using hair products, it is possible to get fringe acne from one’s fringe/bangs lying on an already acne-prone forehead, together with friction and sweat and sebum. Compared to leaving my fringe down, I actually get the least acne when I style my hair up to keep it off my face (but using a water-based pomades that doesn’t break me out).

Acne caused by over-exfoliation

For the details of this, see the ‘Note of caution on overexfoliation’ section below.

Note of caution about over-exfoliation:

Products such as salicylic acid (e.g. Stridex) can be helpful but overuse may damage the skin barrier.

Signs of over-exfoliation include:

• tight or burning skin

• increased redness or irritation

• shiny or overly smooth skin

• increased sensitivity to products

• acne worsening rather than improving

Over-exfoliation acne are somewhat likelier to occur as:

• small red pimples appearing in certain more-unusual areas, such as the upper lip, sides of the nose, or around the mouth (+ these pimples are not usually large and deep)

• clusters of small inflamed bumps along the nasolabial folds or chin crease

• irritation and acne appearing mainly in areas where the exfoliating products were frequently applied

If new acne appears in these areas shortly after starting or increasing exfoliating treatments, then over-exfoliation could be a contributing factor.

If this happens, reduce how often you use exfoliating products and allow the skin barrier to recover.

Note that it is also possible for acne in some of these areas (e.g. around the mouth) to be perioral dermatitis instead of over-exfoliation acne. But if, for example, this is happening shortly after you exfoliated the area, over-exfoliation is a possible cause.

Note of caution about retinoids:

Topical retinoids (e.g. adapalene, tretinoin) can initially cause dryness, redness and peeling. It is advised that you moisturize well and try your best to protect your skin barrier considering the harshness of retinoids on the skin.

They also increase photosensitivity, meaning your skin becomes more sensitive to sunlight. Sunscreen and limiting sun exposure are thus recommended.

Starting a retinoid slowly (e.g. every few days at first in frequency, starting from low dose) can improve tolerance.

Note of caution about oral antibiotics (e.g. doxycycline):

Doxycycline is sometimes prescribed for moderate to severe acne. When taking this, you will be advised that you a. should not consume dairy close to the time you take the medication (as calcium can reduce absorption), and b. should not take it together with antacids / iron / magnesium (for similar reasons). You will be advised to take the medication with a full glass of water.

And stay upright (sitting/standing) for the 15-30min after you take it. Avoid lying down nor bending forward, as this can irritate the esophagus (trust me, you can be in pain for like a week).

As with all antibiotics, complete your course of it so that you don’t contribute to the rise of antibiotic-resistant bacterial strains in this world.

Note of caution for Accutane (isotretinoin):

Accutane is one of the most effective treatments for severe acne but is also a very strong medication.

Common side effects include dry lips, dry skin, dry eyes, dry nose (sometimes nosebleeds), dry ear canals. You get the gist. So if you are taking Accutane while on T (and especially if you are on an aromatase inhibitor), note it is plausible for the dryness-related side effects of Accutane to overlap with (and compound on) hormonal dryness symptoms if your E is on the low side of the male range.

Importantly, Accutane can also affect liver enzymes and blood lipids. Hence it is highly recommended to get blood tests tracking your liver enzymes and lipids during treatment.

Some people can take lower-dose Accutane regimens that still effectively treat acne while reducing side effects.

Accutane can cause severe birth defects, miscarriage, and premature birth in fetuses, with no safe exposure level. In some countries, this results in a strict pregnancy prevention requirement implemented as regulation / protocol. This can also cause some doctors to be cautious of prescribing it to some people who they believe may become pregnant unknowingly while taking Accutane (even if not currently pregnant). Personally, I do not engage in any activities that could result in pregnancy and I did not face issues getting it from my doctor.

A note on fungal acne:

Fungal acne (Malassezia folliculitis) is a different type of acne that is sometimes confused with regular bacterial acne.

It tends to present as:

• clusters of small, similar-looking red bumps

• bumps that may itch (itching is a key clue, though not universal)

• bumps that appear in large numbers at once

• acne that does not respond to typical acne treatments

These bumps often look more uniform in sizethan typical acne pimples.

Fungal acne is not caused by clogged pores and acne bacteria. Instead, it is caused by an overgrowth of Malassezia yeast, which normally lives on human skin.

Testosterone can indirectly contribute because it increases oil production in the skin, which creates an environment where the yeast can grow more easily. Nonetheless, T is still considerably more likely to contribute to hormonal acne than to fungal acne.

Because fungal acne is caused by yeast rather than bacteria, it requires antifungal treatments rather than typical acne medications.

Possible treatments include:

• ketoconazole shampoo used as a face or body wash

• selenium sulfide shampoo used on affected areas

• prescription antifungal creams

• oral antifungal medication in severe cases

—

Earwax / Dry Ears (various forms of treatment)

What are the symptoms (you may not get all):

• Increased earwax buildup or thick, sticky wax

• Ear canal dryness

• Itching inside ears

• Flaking skin in ear canal

• Mild ear pain from dryness

• Occasionally muffled hearing from wax buildup

Why does it happen:

(The hormonal mechanism by which this could happen is not conclusive, so the details in this section are based on a. emerging more-limited research, b. My personal experience.

Separately, what has been more-established are the genetic factors for earwax, like the ABCC11 gene affecting wet vs dry earwax.)

Hormonal changes might affect glands in the ear canal that produce sweat and sebum (oil). Testosterone might therefore result in thicker wax, while less estrogen may mean less mucosal moisture in the ear canals.

In the long term, it may be the case that the ear canals of FtMs on long-term testosterone therapy are no different than that of cis men (which are on average waxier than that of cis women). But especially when early in hormonal transition, there might be a temporary spike including in earwax while the body adapts to the new hormonal profile, before then stabilizing and settling. It may also be a matter of changing ear cleaning habits, as some FtMs used to inadvisable ear cleaning habits (e.g. Q-tips) might not have seen negative effects from doing that when pre-transition, but now cause ear blockages when doing so.

Solutions:

• Do not stick Q-tips in your ear canal

• Use wax-softening eardrops if earwax buildup occurs

• Ear-irrigating sprays may also help if earwax buildup occurs. Lower-pressure irrigators may be safer than high-pressure ‘jet’ devices. One example of a lower-pressure irrigation mechanism would be the Similisan sea rinse ear cleansing spray. I use such a spray in conjunction with carbamide-peroxide-based wax-softening eardrops. (Naturally, don’t use ear irrigation if you are having an active infection or have perforated ear drums or are in great pain)

• Use hydrating eardrops if canals feel dry or irritated (same warning for use applies here) (and of course I mean OTC hydrating drops marketed as such and not random essential oils)

Unless:

You are already taking aromatase inhibitor, and the dosage is making your E very low and thus causing dry ears. In which case, instead of using ear drops, consider reducing your dosage of aromatase inhibitor instead (while still keeping E in the male range of course).

Note for concurrent use of Accutane:

Accutane (isotretinoin), if you are on it for acne, can also result in dry ears and dry eyes. Accutane reduces sebaceous gland activity aka how much your body produces oil, but it can also cause dryness of some areas.

It is sometimes possible to be on a lower dose of

Accutane (which may mitigate side effects) and have it still be effective. You can of course also try hydrating eardrops and hydrating eyedrops to alleviate the side effects.

—

What’s Next

For Part 3, I will be talking about two more potential FtM-relevant issues and their solutions— not enough bottom growth and not enough facial / body hair. I will also be describing FtM-optional blood tests like for DHT, Cholesterol and Blood Pressure.

In Part 4, I will be creating checklists and diagrams (including of info from Part 1, 2 and 3), so that it is easier for people to understand which steps to take in what order and what to look out for.