Transitioning with PCOS

There isn’t any evidence that additional testosterone from HRT causes any negative effects with PCOS if that’s something you’re worried about. Some studies have found a correlation between higher T and more symptoms, but none of those studies are looking at people intentionally raising their T levels to normal male range. One study even found that trans men with PCOS going on testosterone didn’t show any signs of the metabolic disturbances caused by PCOS: https://pubmed.ncbi.nlm.nih.gov/29624102/

It may mean you need a different dose than is typical depending on how your body responds to it, but that’s not unusual. A good GP or endocrinologist will be able to monitor your levels and adjust your dose accordingly.

Generally pcos means that you eventually need to be on hormone treatment anyway, so the treatment might as well be masculine since your hormones already need to be changed. It's different for everyone ofc but my endocronoligist says that my terrible hormones were like a blessing in disguise because it was hard to make it worse with the treatment lmao

I have PCOS and am on a normal dose of T. I had the same worries as you about messing with my hormones since it took years for them to stabilise!! But haven’t had any problems so far so I’m glad I didn’t delay starting any longer.

My endocrinologist also had no issues starting me on Testosterone. He wants me to get regular blood tests but that’s the same for all his patients.

I already had a bit of body hair and a bit of a moustache pre-T so timeline wise that is the only thing that seems to have happened quicker than normal (I’m on T 4 months now and already have to shave). I haven’t had any other outwardly noticeable changes except my voice dropping a little.

tl;Dr, it is quite possible that T will be an option for you, with adequate medical supervision.

Personally, no (I am FtM binary with fairly standard plumbing) but I have a friend who has PCOS and takes T, so it's definitely an option for some people. You would want to make sure you were working with a trans-friendly gynecologist, and you might also want to be seeing an endocrinologist to make sure you didn't run into issues not related to reproductive health. My understanding is that taking T tends to suppress production of estrogen and progesterone, so starting T might actually calm everything down for you, but it's also the kind of thing where your specific needs may be unrelated to anyone else's experience.

Also, I talked to a gynecological surgeon who works with a lot of transmasc people about the long-term effects of T on my ovaries, and she said that it was really no big deal, and it would probably reduce my risk of ovarian cancer. (Apparently anything that stops ovulation reduces the risk of ovarian cancer). It may be a different situation with PCOS, and I didn't ask about fertility, but it sounded like the ovaries don't care about T. She said there are some genital tissues that can respond poorly to being deprived of estrogen in the long run, but in a "this is uncomfortable" way, not a "this is bad for your overall health" way, and that can be treated with topical estrogen (which doesn't affect overall hormone levels).

However, there are reasons why microdosing T might not be what you want, even if you really don't want a huge amount of masculinization. My endocrinologist told me that everyone needs a minimal level of either estrogen or testosterone to maintain bone density, and transmasc people will do fine with either as the dominant hormone, but if the dose of T is too low, it will suppress estrogen production without replacing its benefits for bone health. That creates approximately the osteoporosis risk of a postmenopausal cis woman. I know microdosing is considered appropriate by some doctors, but I personally trust my endocrinologist on this one. He has a lot of trans patients, but he also deals with endocrine conditions specifically related to bone density, among other things, so I think he is qualified to know what is necessary for bone health, and to make a good call on whether it's worth adjusting HRT for that reason. He is the most chill about gender-affirming care of any doctor I have ever had, so I don't think he's just saying it because he doesn't understand trans care. The range that's appropriate for bone density also goes pretty low, and it's possible to target that zone (at least, with injections it is; I don't know how other delivery systems are customized).

And you might not actually need to keep the lowest possible level to achieve your goals. I think people tend to overestimate the speed and suddenness of masculinization on T. It's like cis-male puberty, in that it takes time, and you pass through intermediate stages. (I have never heard of anyone going to bed one night with peach fuzz and waking up with a full beard, for example). It was at least a year before I personally got to the point where I could no longer easily present female, and a lot longer before it became actually impossible to hide the fact that I take T. And a lot of my friends have been taking T at a higher dose than I do for many years without getting the level of results I have. So if your goal is to have increased masculinization without going all the way to looking like a cis guy, taking a standard dose for just a year or two and then stopping might be your best bet, rather than microdosing for an extended period and risking bone issues later on. My understanding is that loss of bone density can sometimes be reversed, but it's difficult, and there is generally a lot of pain and inconvenience involved in diagnosis and treatment. It can be monitored with bone scans, and probably would be with microdosing T, but still, I personally would think really hard about whether the advantages of microdosing outweighed the risks. If you really hate a standard dose, microdosing might be worth it, but it's not the kind of thing you would know in advance. You may find you actually like the high end of the range best.

A doctor is the person to tell you what your options are, of course, so take all that with a grain of salt. But if it were me, I would look into T before committing to therapy to get your existing equipment to do it's job, since I think the two types of hormone therapy would be mutually exclusive. (If you are taking T, you want to be outside the recommended hormone levels for cis women, so taking treatments meant for cis women would be undesirable).