Elliot Page TRT: What It Would Cost a Non-Celebrity

What Elliot Page Has Said About Testosterone Therapy

Elliot Page has not released a detailed pharmaceutical prescription list, so any clinical specifics require clear labeling as inference. What is documented is substantial.

In his 2021 memoir "Pageboy," Page describes beginning testosterone therapy after coming out as transgender in December 2020. He writes about the physical and psychological shifts that followed, including voice deepening, body composition changes, and what he characterizes as relief from longstanding dysphoria. In a 2023 interview with Time magazine, Page stated: "Testosterone changed my life. I feel like myself for the first time."

What the Public Record Shows

Page's publicly described timeline (coming out late 2020, memoir published 2023 detailing early transition) aligns with a testosterone initiation date of approximately early-to-mid 2021. His described physical changes, including a lower voice audible in post-2021 interviews and visible body composition shifts, are consistent with 2 to 4 years of masculinizing testosterone therapy.

What Remains Inference

The specific formulation, dose, and prescribing physician are not public. Injectable testosterone cypionate is the most commonly prescribed formulation in the United States for gender-affirming care, used by roughly 60 to 70% of transmasculine patients in clinical surveys. Testosterone gel (AndroGel, Testim) and subcutaneous pellets are alternatives. This article uses injectable cypionate as the reference formulation for cost modeling because it is the most statistically likely choice and the lowest-cost option.

The Clinical Evidence Behind Gender-Affirming TRT

Testosterone therapy for transmasculine individuals is one of the better-studied areas in gender-affirming medicine, with data from prospective cohorts spanning more than a decade.

Mental Health Outcomes

A 2020 prospective study published in JAMA Surgery (N=68 transmasculine participants) found that gender-affirming hormone therapy produced a 52% reduction in depression symptoms and a 48% reduction in anxiety at 12 months compared to baseline. 1

The American Psychological Association's position statement notes that gender-affirming care, including hormone therapy, is "medically necessary for many transgender and gender diverse individuals." 2

A broader systematic review in The Lancet Psychiatry (2020, covering 27 studies, N=3,754) found that gender-affirming hormone therapy was associated with significant improvements in psychological functioning across the majority of included studies, with low rates of regret averaging 1% across study populations. 3

Physical Changes and Timeline

The Endocrine Society's 2017 Clinical Practice Guideline on gender-affirming endocrinology, updated with WPATH Standards of Care Version 8 in 2022, describes the expected masculinizing effects of testosterone as follows: 4

• Voice deepening: onset 3 to 6 months, maximum change 1 to 2 years
• Clitoral enlargement: onset 1 to 3 months
• Body fat redistribution: onset 3 to 6 months
• Facial and body hair growth: onset 6 to 12 months, maximum 4 to 5 years
• Scalp hair loss (androgenic alopecia, in genetically predisposed individuals): onset variable

Safety Monitoring Protocol

The Endocrine Society guideline recommends total testosterone levels be maintained in the normal male range (400 to 700 ng/dL) during gender-affirming therapy. 4 Hematocrit must be monitored because testosterone stimulates erythropoiesis; a hematocrit above 50% warrants dose reduction or phlebotomy. A 2019 study in Annals of Internal Medicine (N=477 transmasculine patients followed for 8 years) found hematocrit elevations in 9.7% of participants, none of which led to serious thromboembolic events when actively managed. 5

What Testosterone Therapy Actually Costs

This is the part celebrity coverage consistently omits. Page's medical care is almost certainly paid through private insurance or out of pocket at rates most patients never see. Here is what a non-celebrity actually pays.

Injectable Testosterone Cypionate (The Most Affordable Route)

Generic testosterone cypionate 200 mg/mL (10 mL vial) costs $30 to $80 at most U.S. Pharmacies without insurance. That single vial contains roughly a 10-to-20-week supply at typical gender-affirming doses (50 mg weekly to 100 mg biweekly). Monthly drug cost: approximately $10 to $25.

With a GoodRx coupon, the same vial at Walgreens or CVS runs as low as $28 in most states. 6

Add disposable syringes (roughly $0.20 each) and alcohol swabs, and total monthly consumable cost sits under $35 for self-administered intramuscular injections.

Testosterone Gel (AndroGel, Authorized Generic)

Testosterone gel 1.62% (60 pump actuations, 75 g) retails at approximately $400 to $500 per month without insurance. The authorized generic drops that to $80 to $150. Daily topical application is preferred by patients who want to avoid injections, but skin transfer to partners or children is a documented risk requiring consistent hand-washing and covering. 7

Testosterone Pellets (Subcutaneous Implants)

Pellet insertion costs $300 to $600 per procedure, with procedures typically every 3 to 6 months. Annual cost ranges from $600 to $2,400 before lab fees. No FDA-approved testosterone pellet product exists for gender-affirming indications specifically; clinicians use compounded pellets off-label.

Lab Monitoring Costs

The Endocrine Society protocol calls for total testosterone, hematocrit, and lipids at 3 months post-initiation, then every 6 to 12 months once stable. 4 Without insurance:

• Testosterone total (serum): $25, $75 at direct-pay lab services (Quest Diagnostics, LabCorp)
• Comprehensive metabolic panel: $30, $60
• Lipid panel: $25, $45
• Complete blood count (hematocrit): included in CBC, approximately $20, $40

Annual lab cost for a stable patient: $200 to $400 out of pocket.

Provider Fees

A gender-affirming endocrinologist or primary care physician charges $150 to $350 per new-patient visit. Annual follow-up visits typically run $100 to $200 each. Telehealth platforms offering gender-affirming TRT (Folx Health, Plume, QueerDoc, and others) charge subscription models ranging from $49 to $99 per month, often including provider visits and prescription management.

Insurance Coverage for Gender-Affirming Testosterone

Coverage varies significantly by state and plan type.

ACA Marketplace Plans

Since 2016, the U.S. Department of Health and Human Services has interpreted Section 1557 of the Affordable Care Act to prohibit categorical exclusions of gender-affirming care in ACA-compliant plans. A 2022 HHS rule re-affirmed this interpretation. 8 In practice, many plans now cover testosterone as a prescription drug benefit, subject to standard formulary tiers and deductibles.

Medicaid

As of 2024, 25 states plus the District of Columbia explicitly cover gender-affirming hormone therapy under Medicaid. 9 In those states, testosterone cypionate for transmasculine patients is typically a Tier 1 generic with a $0 to $4 copay.

States With Restrictions

Twelve states had enacted restrictions on gender-affirming care for adults or minors as of early 2025, affecting both coverage and provider availability. Patients in those states may need to access care via telehealth from providers licensed in more permissive states, or travel. The ACLU tracks current state-level legislation at aclu.org/gender-affirming-care.

Building a Realistic Annual Budget

The table below models three patient scenarios: a fully uninsured patient using generic injectables, a patient on an ACA marketplace plan, and a patient using a gender-affirming telehealth subscription.

| Cost Category | Uninsured + Generic Injectable | ACA Marketplace Plan | Telehealth Subscription | |---|---|---|---| | Testosterone drug (annual) | $120, $300 | $0, $100 (post-deductible) | Included or $50, $150 | | Syringes/supplies | $50, $80 | $0, $30 | $50, $80 | | Lab monitoring | $200, $400 | $0, $100 | $100, $200 | | Provider visits | $300, $700 | $50, $200 | Included | | Annual total | $670, $1,480 | $50, $430 | $588, $1,830 |

For a non-celebrity patient on a modest income, the uninsured injectable route is the most affordable standalone path. The telehealth subscription model may cost more annually than self-pay injectable care at a direct-pay clinic, but it offers coordinated care, prescription refills, and lab ordering through a single platform.

The Role of Telehealth in Access

Telehealth platforms have meaningfully reduced geographic and logistical barriers to gender-affirming TRT since 2020. Plume Health reported serving over 20,000 transgender patients across all 50 states as of 2023, with a median time from intake to first prescription of 5 days. 10

A 2023 study in JAMA Network Open (N=1,200 transgender and nonbinary adults) found that telehealth-delivered gender-affirming hormone care produced equivalent clinical outcomes to in-person care at 12 months, with no statistically significant difference in testosterone level attainment (P<0.05 threshold not crossed for superiority in either direction). 11

Patients in rural states with limited gender-affirming providers benefit most. A 2021 analysis in Transgender Health found that 45% of rural transmasculine patients reported traveling more than 50 miles to access hormone care before telehealth was available; that figure dropped to 18% among patients who initiated care via telehealth platforms. 12

Testosterone Dose Ranges Used in Gender-Affirming Care

Dose selection depends on the patient's goals, baseline hormone levels, and tolerance.

Standard Starting Doses (Endocrine Society Guidelines)

The Endocrine Society recommends initiating testosterone cypionate or enanthate at 25 mg weekly (subcutaneous) or 50 mg weekly (intramuscular) for most transmasculine adults, with dose titration to achieve serum testosterone in the 400 to 700 ng/dL range. 4 Some providers start lower, at 12.5 mg weekly, to allow gradual adjustment.

Dose Stabilization

Most patients reach a stable dose within 6 to 12 months. A 2020 cross-sectional study in Journal of Clinical Endocrinology and Metabolism (N=323) found the median stable dose for transmasculine adults on testosterone cypionate was 80 mg every two weeks, with a range of 40 to 120 mg. 13

Monitoring Targets

The Endocrine Society guideline states: "We recommend maintaining serum testosterone levels in the normal male range (320 to 1,000 ng/dL) and monitoring at 3 months for the first year, then once or twice yearly thereafter." 4 Trough levels (drawn just before the next injection) should be above 300 ng/dL. Peak levels (drawn 24 to 48 hours post-injection) should stay below 1,000 ng/dL.

Patient Assistance Programs and Cost Reduction Strategies

Several concrete options exist for patients who cannot afford standard pricing.

AbbVie (manufacturer of AndroGel) operates a patient assistance program for uninsured patients with income below 400% of the federal poverty level. Eligible patients may receive testosterone gel at no cost. Applications are available at abbvieneedymeds.com.

PFLAG and Lambda Legal maintain resource databases for gender-affirming care funding by state. The Jim Collins Foundation provides grants of $500 to $3,000 for gender-affirming medical procedures, including hormone-related costs, for low-income trans individuals.

For generic injectable testosterone, the Mark Cuban Cost Plus Drug Company (costplusdrugs.com) lists testosterone cypionate 200 mg/mL at under $40 for a 10 mL vial as of 2024, often lower than GoodRx pricing at retail chains. 14

A 2022 study in Health Affairs found that switching from branded testosterone products to generic cypionate or enanthate saved patients an average of $1,840 per year without any measurable difference in clinical outcomes at 12 months. 15

Risks, Contraindications, and Monitoring

Testosterone therapy carries documented risks that require ongoing clinical oversight regardless of how care is accessed.

Polycythemia Risk

Testosterone stimulates red blood cell production. A hematocrit above 54% is a clinical threshold for dose reduction or phlebotomy. The 2019 Annals of Internal Medicine cohort (N=477) found polycythemia was the most common adverse effect, occurring in 9.7% of participants, but was manageable with active monitoring. 5

Cardiovascular Monitoring

Testosterone lowers HDL cholesterol modestly. A 2021 meta-analysis in JAMA Internal Medicine (N=2,671 transmasculine patients, mean follow-up 7.4 years) found no statistically significant increase in major adverse cardiovascular events compared to cisgender female controls, though the authors noted this population is younger and longer follow-up data are needed. 16

Bone Density

Long-term testosterone therapy is associated with preservation of bone mineral density in transmasculine individuals, particularly in those who also had adequate estrogen exposure prior to transition. A DEXA scan is recommended at baseline by WPATH SOC8 for patients at risk of osteopenia. 17