Most commonly used hormones for trans people: masculinising hormones and interactions
Interaction table between masculinising hormones (testosterone in different formulations) and psychoactive substances, with risk levels and recommendations.
How do masculinising hormones interact with psychoactive substances?
This table shows the risk level of combining the hormones most commonly used in masculinisation processes with psychoactive substances. Risk may vary depending on dose, route of administration, your health status, and other medicines you take. Always consult healthcare professionals.
About testosterone
Testosterone promotes masculine characteristics and may affect mood, blood pressure, cholesterol, and metabolism.
Using it without medical supervision may increase health risks.
Risk level
- Low: no clinically relevant interaction
- Caution: mild risk, use carefully
- Moderate: important risk
- High: avoid the combination or consult your healthcare team
- Insufficient evidence
Hormones most commonly used in masculinisation
| Substance | Testosterone enanthate (injectable) — 250 mg/mL ampoules, every 1-2 weeks | Testosterone cypionate (injectable) — 200 mg/mL ampoules, every 1-2 weeks | Testosterone undecanoate (injectable) — Nebido® 1000 mg/4 mL, every 10-14 weeks | Testosterone gel (topical) — Androgel® and generics, daily use | Why does it happen? Main mechanism |
|---|---|---|---|---|---|
| Alcohol | Caution: May increase liver damage and blood pressure. Heavy use reduces treatment benefits. | Caution: May increase liver damage and blood pressure. Heavy use reduces treatment benefits. | Caution: May increase liver damage and blood pressure. Heavy use reduces treatment benefits. | Caution: May increase liver damage and blood pressure. Heavy use reduces treatment benefits. | Alcohol increases liver strain and may worsen changes in blood pressure and lipid profile. |
| Cannabis | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | No significant interactions have been reported. |
| Cocaine | High: Increases blood pressure, arrhythmia risk, and cardiovascular event risk. | High: Increases blood pressure, arrhythmia risk, and cardiovascular event risk. | High: Increases blood pressure, arrhythmia risk, and cardiovascular event risk. | High: Increases blood pressure, arrhythmia risk, and cardiovascular event risk. | Intense vasoconstriction and sympathetic stimulation add to androgen-related effects on lipids and blood pressure. |
| MDMA / Ecstasy | Moderate: Risk of hyperthermia, dehydration, hyponatraemia, and cardiovascular overload. | Moderate: Risk of hyperthermia, dehydration, hyponatraemia, and cardiovascular overload. | Moderate: Risk of hyperthermia, dehydration, hyponatraemia, and cardiovascular overload. | Moderate: Risk of hyperthermia, dehydration, hyponatraemia, and cardiovascular overload. | MDMA affects temperature regulation and fluid balance. Androgens may affect lipids and blood pressure. |
| Methamphetamine | High: Increases the risk of hypertension, arrhythmias, aggression, and cardiovascular events. | High: Increases the risk of hypertension, arrhythmias, aggression, and cardiovascular events. | High: Increases the risk of hypertension, arrhythmias, aggression, and cardiovascular events. | High: Increases the risk of hypertension, arrhythmias, aggression, and cardiovascular events. | Strong stimulant effects increase blood pressure and sympathetic activity, adding to androgenic effects. |
| Ketamine | Caution: May increase blood pressure and affect liver function with repeated use. | Caution: May increase blood pressure and affect liver function with repeated use. | Caution: May increase blood pressure and affect liver function with repeated use. | Caution: May increase blood pressure and affect liver function with repeated use. | It may raise blood pressure and, with chronic use, affect the liver and urinary system. |
| GHB / GBL | Moderate: CNS depression, hypotension, and dehydration risk. | Moderate: CNS depression, hypotension, and dehydration risk. | Moderate: CNS depression, hypotension, and dehydration risk. | Moderate: CNS depression, hypotension, and dehydration risk. | CNS depressants may cause deep drowsiness, hypotension, and loss of consciousness. |
| Poppers (inhaled nitrites) | High: Intense vasodilation and sudden drop in blood pressure. | High: Intense vasodilation and sudden drop in blood pressure. | High: Intense vasodilation and sudden drop in blood pressure. | High: Intense vasodilation and sudden drop in blood pressure. | Nitrites cause marked vasodilation; combined with other vasodilators they may cause severe hypotension or syncope. |
| Opioids | Moderate: Increases respiratory depression, sedation, and overdose risk. | Moderate: Increases respiratory depression, sedation, and overdose risk. | Moderate: Increases respiratory depression, sedation, and overdose risk. | Moderate: Increases respiratory depression, sedation, and overdose risk. | CNS and respiratory depression may be intensified by concurrent use. |
| LSD | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | No significant interactions have been reported. |
| Inhalants | Moderate: Increase the risk of liver damage, cardiotoxicity, and neurological toxicity. | Moderate: Increase the risk of liver damage, cardiotoxicity, and neurological toxicity. | Moderate: Increase the risk of liver damage, cardiotoxicity, and neurological toxicity. | Moderate: Increase the risk of liver damage, cardiotoxicity, and neurological toxicity. | Inhalants may be toxic to the liver, heart, and nervous system, adding to androgen-related lipid effects. |
General recommendations
- Stay hydrated and avoid heavy substance use.
- Get regular medical follow-up: blood pressure, lipid profile, liver function, and haematocrit.
- Do not combine hormones with substances if you have heart, liver, or kidney disease.
- Always tell your healthcare professional about every substance you use.
- If you have chest pain, swelling in your legs, or blurred vision, seek medical care immediately.
Important
- This table does not include every hormone or every substance.
- Interactions may vary depending on dose, route of administration, and your health status.
- Do not stop your hormone treatment without professional guidance.
- Harm reduction and self-care save lives.
This information is educational and does not replace medical advice. Every body is unique and risks may change.