Sexplain It Live: I'm Trans and Struggle With Anger. Is Testosterone a Bad Idea?

Zachary Zane and Dr. Lin-Fan Wang of FOLX help a man worried about 'roid rage.'

unhappy man on sofa
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I'm Zachary Zane, a sex writer and ethical manwhore (a fancy way of saying I sleep with a lot of people, and I'm very, very open about it). Over the years, I've had my fair share of sexual experiences, dating and sleeping with hundreds of people of all genders and orientations. In doing so, I've learned a thing or two about navigating issues in the bedroom (and a bunch of other places, TBH). I'm here to answer your most pressing sex questions with thorough, actionable advice that isn't just "communicate with your partner," because you know that already. Ask me anything—literally, anything—and I will gladly Sexplain It. To submit a question for a future column, fill out this form.

This is an edited and condensed transcription from last week's "Sexplain It Live," which was recorded on Men's Health's Instagram. I was joined by Lin-Fan Wang, M.D., MPH, the Chief Medical Officer of FOLX Health, to answer a bunch of your sex and relationship questions.

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I'm a trans man and am thinking about starting testosterone, and I'm really worried about the side effects. Especially since I already lose my temper quickly and am moody. What can you tell me?

LFW: I often get patients who ask me that question, whether they've had mood problems or not. What I tell them is that when testosterone is prescribed in very safe doses and under medical supervision. So we will monitor how testosterone impacts your mood. We do know that if a testosterone dose is too high for an individual, that’s when anger issues come up.

ZZ: Roid rage.

LFW: Exactly, and that's what people are most fearful about. So, for some patients, I really think it's safer to try a lower dose first, see how they do with it, and then gradually go up. But then I have some patients who are like, “I do have these anger issues, but I've been through counseling and therapy, I have techniques for how to manage it, and a good support system." For those patients, I might say, "Well, let's just try our regular starting dose then."

ZZ: Someone just commented, "Put them on an anti-depressant." Could you put them on a mood stabilizer or something like that?

LFW: You can definitely start medications for depression or a mood stabilizer for someone who's taking testosterone. But I want to make sure that we talk about them separately. Someone who is starting hormones does so for one very specific reason; they may also be dealing with either depression or anxiety, and that's a separate issue that we might want to talk about. So there are not related. I wouldn't want to start someone on a mood stabilizer just because I'm starting them on testosterone.

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Men's Health

I've been dating this guy for three months now, and he just told me he's HIV-positive. He says he's undetectable, and I'm on PrEP, so even though we didn't use condoms, I know there's like a zero percent chance that I got HIV. I'm not worried about that. I'm just more upset that he kept this from me. I feel lied to and want to break up with him. But I also don't want to HIV-shame. I also really do like him, so I don't want to actually break up with him. I don't know what to do.

LFW: I love this question. I thought it was so sweet. A few things that I loved about it is that this person just seems so thoughtful and likes this guy. I love the piece where they said I don't want to HIV-shame him because that's definitely not what we want to do. For me, I just had a lot of questions. I don't want to give relationship advice; I feel like that's a person-to-person discussion.

ZZ: I mean, that's my entire job.

LFW: [Laughs] Yeah, yeah! But there's so much shame and stigma about having HIV. [After receiving a positive HIV diagnosis,] a lot of my patients will say, “I don't know how to talk to someone else about living with HIV. I don't know how to talk to my sex partners. How do I have sex safely?” I think it requires a conversation between the two of them, but it could be that this guy was just scared to tell you. But now that he really likes and trusts you, he feels safe telling you.

ZZ: Okay, so I want to first congratulate the reader who understands that if you're undetectable, you cannot transmit the virus, even without a condom. Actually, can you explain more of what having an undetectable HIV status means for people who don't know?

LFW: Basically, HIV medications prevent the virus from spreading in your body. It controls it. Then you essentially have no virus that is in your bloodstream. This can happen as quickly as one to two months after being on HIV medication. The medications that we have now are very safe, and they're very effective. There've been many studies that have shown that if you are undetectable—which means that we can only see 200 copies of the virus in your blood or less—that means you have no chance of transmitting the virus to someone else. So this is what we mean by undetectable equals transmissible.

ZZ: Exactly. And so I think you can talk to him without HIV shaming him, saying, "I'm really upset you lied to me. I don't care about your status; I'm on PrEP. I just wish you told me." Of course, he was very nervous about telling you. He really likes you. And I understand where his fear is coming from. Now I don't know if he lied outright to you or if you didn't talk about your statuses before having sex, but he did lie to [or omit this from] you. That said, I think it's valid to forgive him, keep dating him, and say, "You need to be open about things going forward. This is important to me." I also think it's valid to be like, "I'm really hurt. You lied to me, and I don't trust you. And because I don't trust you, I, I can't date you." So both are valid, but I think you absolutely can communicate with him in a way where you're not HIV-shaming, but rather are upset that you were lied to, especially since you've been dating for three months.

Watch the full conversation here:

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