Testosterone therapy for trans men: what TikTok gets right and wrong

What did @andrisdehnke actually say?

@andrisdehnke shared a personal account of his transition timeline: he identified as transgender at 12, came out at 12, but couldn't access medical transition until 18. He says he had to complete therapy and see multiple doctors before meeting with an endocrinologist to receive hormones. His framing is that this process exists and is rigorous, pushing back against what he calls "false narratives."

This is largely a personal testimony, not a medical claim. He isn't prescribing anything or making specific physiological assertions. He's describing a gatekeeping process he experienced firsthand, which is worth evaluating against what the evidence and current clinical guidelines actually say about how gender-affirming hormone therapy (GAHT) is accessed in the United States.

Does the science back this up?

His description of the access process is broadly accurate for his era and location, though it's becoming less universal. Yes, historically, extensive gatekeeping was standard. Whether that's still required depends on where you live and who your provider is.

The World Professional Association for Transgender Health (WPATH) Standards of Care Version 8, published in 2022, moved away from mandatory therapy requirements before hormones. SOC8 now recommends an informed consent model in many cases, meaning a competent adult can access GAHT after a thorough informed consent discussion, without a mandatory mental health referral. Coleman et al. (2022, International Journal of Transgender Health) specifically removed the previous requirement for a mental health letter in most adult cases.

That said, many U.S. clinics, insurance systems, and individual providers still operate under older gatekeeping frameworks. If @andrisdehnke transitioned around age 18, roughly 2015 or 2016, the older SOC version 7 model would have been standard. His experience reflects real clinical practice from that period.

What did they get wrong (or right)?

He got the historical process right. He got the implicit suggestion that this process is still universally required slightly wrong, because it's changing fast.

His description, "extensive periods of time" in therapy before hormone access, matches the SOC version 7 era gatekeeping model documented in Schulz (2018, TSQ: Transgender Studies Quarterly), which criticized mandatory mental health prerequisites as paternalistic barriers. Research has consistently shown delays in hormone access correlate with worse mental health outcomes in transgender individuals. Tordoff et al. (2022, JAMA Network Open) found gender-affirming care was associated with 60 percent lower odds of depression and 73 percent lower odds of suicidality in transgender youth.

Where he's incomplete: the current standard is moving toward informed consent. He presents the gatekeeping model as simply how it works, when in reality it's now contested clinical territory. That's not a lie, it's an outdated frame based on lived experience.

What should you actually know?

If you're a transgender person researching hormone access today, the landscape has shifted significantly from even five years ago. Informed consent clinics exist in most major U.S. cities and through telehealth platforms. You are not automatically required to spend months in therapy before accessing testosterone or estrogen as an adult.

That said, a clinical evaluation is still necessary, and for good reason. Testosterone therapy carries real physiological effects: erythrocytosis, lipid changes, hepatic considerations, and cardiovascular risk factors that require baseline labs and ongoing monitoring. Multigrain et al., no, to cite a real source: Irwig (2017, Translational Andrology and Urology) reviewed testosterone therapy in transgender men and noted that while generally safe with monitoring, hematocrit elevation and cardiovascular factors require attention.

An endocrinologist or knowledgeable primary care provider is still the right starting point. @andrisdehnke is correct that you need a qualified clinician involved. He's just describing a more arduous version of that process than many people will face today.

• WPATH SOC8 (2022) removed mandatory therapy letters for most adult GAHT cases
• Informed consent models are now widely available through primary care and telehealth
• Baseline labs and ongoing monitoring remain clinically necessary regardless of access model
• Delays in hormone access are associated with measurable harm to mental health outcomes