Periods on Testosterone
For a lot of people, periods stopping is the change they are waiting for most. For most, it happens within the first few months. For some it takes longer, and for a fair number there is occasional bleeding for a while afterwards, which can feel like a setback when it is usually nothing of the kind.
This page covers when periods usually stop, why bleeding comes back, what the options are if it does not settle, and two things that people on testosterone are often told wrongly: that testosterone is contraception, and that they no longer need cervical screening. Neither is true.
It is general information, not medical advice. Unexpected bleeding has several possible causes, most of them harmless, and some worth checking, so it is always worth mentioning to your prescriber rather than guessing.
On this page
When periods usually stop
Most people's periods get lighter and further apart and then stop within the first few months on testosterone, commonly somewhere between two and six months. Some take closer to a year. How fast it happens depends partly on your testosterone level and how steady it is, and partly on your body.
Low or swinging levels are the most common reason periods carry on, which is why your prescriber will usually check a blood test before anything else. People on fortnightly injections sometimes find they bleed or cramp towards the end of each cycle, at the trough.
Breakthrough bleeding
Spotting or a light bleed after periods have stopped is common, particularly in the first couple of years. Typical triggers are a missed or late dose, a change of form or interval, an illness, a big change in weight, or simply the body adjusting.
Most of the time it settles on its own. It is still worth telling your prescriber, because they may check your levels, and because bleeding that is heavy, keeps coming back, comes with pain, or starts after a long stretch of nothing should be looked at properly. The lining of the womb, the uterus, can occasionally need checking with a scan, and that is a routine thing to arrange rather than a cause for alarm.
Bleeding can be distressing in a way that has nothing to do with the medical side. Many people find it helps to know in advance that it can happen and is usually temporary.
If you start spotting again
Note the dates, how heavy it was and when your last dose was, and take that to your prescriber. A short record like that tells them far more than "it came back" and often points straight at the cause.
If periods do not stop
If your levels are where they should be and bleeding carries on, there are several options your prescriber can discuss. Adjusting the form or interval of testosterone to smooth out the troughs is often the first. Beyond that, the common additions are progestogen-only medicines: a tablet such as norethisterone, the contraceptive implant, the injection, or a hormonal coil (an IUD such as Mirena). Several of these also work as contraception.
These do not interfere with testosterone's masculinizing effects in any meaningful way, which is a common worry. A hormonal coil involves a pelvic procedure, which some people find difficult, and it is fair to ask about pain relief and to bring someone with you.
For people who want no further periods at all and are sure they do not want to carry a pregnancy, hysterectomy is sometimes part of their longer-term plans, and it is one of the operations I help people plan in Bangkok. It is a big decision on its own timescale, not a fix for bleeding in the first year.
Testosterone is not contraception
This is the single most important thing on this page. Periods stopping does not mean you cannot get pregnant. Ovulation can still happen on testosterone, sometimes without any bleeding to warn you, and there are people who have become pregnant while on it.
Testosterone can harm a developing pregnancy, so if you have sex that could lead to pregnancy you need separate contraception. Condoms, the copper coil and progestogen-only methods (implant, injection, hormonal coil, progestogen-only pill) are the options usually discussed. Methods containing estrogen, such as the combined pill, are generally avoided alongside testosterone.
If you think you might be pregnant, take a test and contact your prescriber or doctor promptly. Fertility covers pregnancy and fertility on testosterone in more detail.
Cervical screening and vaginal changes
If you have a cervix, you still need cervical screening at the usual intervals for where you live, whatever your hormones and however your records list your gender. In the UK, for example, people registered as male with their GP may not be invited automatically, so it is worth asking your practice to make sure you are on the list.
Testosterone thins and dries the vaginal tissue over time, called atrophy. It can make screening and penetrative sex uncomfortable, and it occasionally causes spotting or discomfort on its own. Things that help include asking for a smaller speculum, telling the person taking the sample that you are on testosterone (it can affect how the sample looks under the microscope), and asking your prescriber whether a local vaginal estrogen cream is suitable. Used locally, it works on the tissue and has little effect elsewhere in the body.
When you book screening
Say you are on testosterone at the booking stage, not on the day. You can ask for a longer appointment, a smaller speculum and a clinician you are comfortable with, and many clinics now offer this routinely.
Frequently asked questions
How long does it take for periods to stop on testosterone?
Commonly two to six months, sometimes up to a year, and occasional bleeding after that is common. See when periods usually stop.
Why has my period come back on testosterone?
Usually a missed or late dose, a trough between injections, a change of form or just adjustment. Tell your prescriber, especially if it is heavy or painful. See breakthrough bleeding.
Can I get pregnant on testosterone?
Yes. Testosterone is not contraception, even if your periods have stopped, and it can harm a pregnancy. See testosterone is not contraception.
Do I still need a smear test?
Yes, if you have a cervix. Ask to be kept on the screening list and mention testosterone when you book. See cervical screening and vaginal changes.