Tops Don't Have to Be Masc: Sexual Roles, Personality and Real Appeal

Many gay patients come to me with a similar question: "Doctor, I'm a top, but I don't look masculine at all. My voice isn't deep and I'm a bit camp. Can I have hormone injections to look more butch?" I understand that feeling well, because on dating apps and in the gay scene itself there's a strong stereotype that "tops must be masc, muscular and deep-voiced". But before we talk about hormones, let's separate a few things clearly.

Sexual roles aren't personality, and they aren't identity

Top, bottom and versatile describe roles or preferences in sexual activity. They don't say how masculine someone is, and they don't say anything about gender identity.

• Some tops are gentle, camp, softly spoken and into fashion, and they're still great tops.
• Some bottoms are big, muscular and deep-voiced, and that's completely normal.
• Many people change roles depending on their partner and stage of life.

This fits the principle that gender expression is separate from orientation and roles (see gender identity and the axes of gender). Trying to squeeze yourself into a stereotype usually leaves you more stressed and less confident than before.

Sexual role

• Top
• Bottom
• Versatile

Expression

• Masculine
• Feminine
• Neutral or mixed

Build and voice

• Small or large frame
• Deep or high voice

A gentle top is still a good top, and many people switch roles with partners and life stages.

Why is the "tops must be masc" image so much pressure?

This image comes from old ideas that map traditional male–female roles onto relationships between two men, and it's reinforced by porn and by app profiles that say "masc only". As a result, people who don't fit the stereotype feel inferior, which is completely unnecessary stress.

The truth is that everyone likes different things. Plenty of people prefer a top who is gentle, communicates well and pays attention to his partner over one with big muscles or a deep voice.

Can I use testosterone to look more masculine?

This is where I need to be straight with you. If your testosterone level is normal, injecting or applying testosterone to "look masc" is not a treatment, and it is not recommended by the Endocrine Society (2018) or AUA (2018) guidelines. They advise testosterone replacement therapy (TRT) only for people who have symptoms together with blood tests confirming a genuinely low level.

Harms seen when it's used without a deficiency:

• The body stops making its own hormone, the testicles shrink and sperm count falls, which can make it hard to have children.
• Thickened blood (high haematocrit), raising the risk of clots.
• Acne, hair thinning from DHT, and mood swings.
• When you stop, there can be a hormone crash, with fatigue, low mood and reduced sex drive.

The TRAVERSE trial (2023), which eased concerns about heart risk, studied middle-aged men with genuinely low testosterone given treatment doses. It does not mean that use in men with normal levels, or high doses, is safe. Using steroids or PEDs to build muscle fast is riskier still (read steroids and PEDs).

Normal hormones, but want to look masculine

• Not a treatment; not advised
• Smaller testes, lower sperm count, infertility
• Thick blood, clot risk
• Acne, hair thinning, mood swings

Symptoms + truly low blood level

• TRT is an appropriate treatment
• Blood tests confirm before starting
• Regular follow-up by a doctor

vs

Per Endocrine Society (2018) and AUA (2018) guidance.

Real appeal can be built without changing who you are

What makes someone attractive as a partner isn't just outward masculinity. From talking with many patients, the things people mention most often are:

• Self-confidence, without pretending to be someone else
• Communicating about sex, asking for consent and caring about your partner's feelings
• Good health, clean body odour, and looking after your skin and teeth
• Humour and gentleness

Read more perspectives in what makes a man attractive.

Want a better physique? Build it gradually

If you want muscles or a body shape you like, you can get there without hormones.

1. Do weight or resistance training 3–4 days a week, increasing the load gradually.
2. Eat enough protein, about 1.2–1.6 g per kg of body weight per day for people who train regularly (if you have kidney disease, check with a doctor first).
3. Sleep 7–9 hours, which helps both muscle and hormones.
4. Cut down on alcohol and avoid recreational drugs.
5. Set goals in months, not weeks.

Details are in how much TRT helps muscle, and building muscle the right way and supporting testosterone through lifestyle.

When to talk with a doctor

• You feel unconfident about yourself or your sexual role to the point that it affects your relationships.
• You have problems with erections, ejaculating too quickly, or sex drive.
• You are using hormones or steroids you bought yourself and want to stop or have your safety checked.
• You want your hormones tested for peace of mind.

At Dr. Kris Clinic, I am a family physician who cares for sexual health and a clinical sexologist. We can talk about your body, hormones and confidence without judgement, at the clinic in Surat Thani or online, with English-speaking consultations available.