Masculinizing Hormone Therapy

Masculinizing Hormone Therapy

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Physical Effects

Most physical changes associated with masculinizing hormone therapy occur over the course of approximately two years. However, the amount of change and the exact timeline of effects can be highly variable. Factors that influence the amount and timeline of changes include inheritance (genetic influences passed down from biological parents), age, health status, lifestyle, and dosage (amount, frequency, route of administration). 

It is important to note that increasing dosage does not necessarily speed up the process or result in more changes. In fact, high levels of testosterone are converted into estrogen by the body. Your healthcare provider can help select the right treatment for you. It is important to attend follow up appointments with this provider in order to monitor effects. 

TABLE 1: Effects and Expected Time Course of Masculinizing Hormones (Print Friendly Version)

 

Expected
Onset

Maximum
Effect

Reversible?

Comments

Skin Oiliness/Acne

1-6 mo

1-2 yrs

Yes

  • Acne may cause permanent scars
  • Medication can help manage symptoms

Increased Sex Drive

1-3 mo

 

Yes

  • Varies person to person
  • May involve other changes in sexuality (e.g., changes in the types of people you find attractive)

Emotional Changes

 

 

Yes

  • Highly variable person to person
  • May experience more narrow range of emotions
  • May become irritable, frustrated, or angry more easily
  • Switching to weekly injections (versus biweekly) may help

Monthly Period Stop

2-6 mo

 

Yes, although prolonged use may decrease fertility

  • Pregnancy may still be possible without regular periods

Clitoral Growth

3-6 mo

1-2 yrs

Not likely

  • Typical size is 1-3 cm

Thinning/Drying of Vaginal Lining

3-6 mo

1-2 yrs

Possible

  • May make penetration uncomfortable or more difficult
  • Lubrication products can help

Body Fat Redistribution

3-6 mo

2-5 yrs

Yes

  • More abdominal fat
  • Less fat in hips, thighs, buttocks

Facial/Body Hair Growth

3-6 mo

3-5 yrs

Not likely

  • Gradual growth of mustache/beard
  • Thicker/coarser hair on abdomen, chest, back, arms, and legs
  • Dependent on inheritance

Deepened Voice

3-12 mo

1-2 yrs

No

  • May not impact all aspects of speech
  • Working with speech/language pathologist may help

Increased Muscle Mass/Strength

6-12 mo

2-5 yrs

Yes

  • Depends on amount of exercise

Male Patten Baldness

 

 

Not likely

  • Highly dependent of age and inheritance
  • Medications may help
Skin Oiliness/Acne
  • Expected Onset: 1-6 mo
  • Maximum Effect: 1-2 yrs
  • Reversible?: Yes
  • Comments:
    • Acne may cause permanent scars
    • Medication can help manage symptoms
Increased Sex Drive
  • Expected Onset: 1-3 mo
  • Reversible?: Yes
  • Comments:
    • Varies person to person
    • May involve other changes in sexuality (e.g., changes in the types of people you find attractive) 
Emotional Changes
  • Reversible?: Yes
  • Comments:
    • Highly variable person to person
    • May experience more narrow range of emotions 
    • May become irritable, frustrated, or angry more easily
    • Switching to weekly injections (versus biweekly) may help ​​
Monthly Period Stops
  • Expected Onset: 2-6 mo
  • Reversible?: Yes, although prolonged use may decrease fertility
  • Comments:
    • Prengnacy may still be possible without regular periods
Clitoral Growth
  • Expected Onset: 3-6 mo
  • Maximum Effect: 1-2 yrs
  • Reversible?: Not Likely
  • Comments:
    • Typical size 1-3 cm
Thinning/Drying of Vaginal Lining
  • Expected Onset: 3-6 mo
  • Maximum Effect: 1-2 yrs
  • Reversible?: Possible
  • Comments:
    • May make penetration uncomfortable or more difficult 
    • Lubrication products can help
Body Fat Redistribution
  • Expected Onset: 3-6 mo
  • Maximum Effect: 2-5 yrs
  • Reversible?: Yes
  • Comments:
    • More abdominal fat 
    • Less fat in hips, thighs, buttocks 
Facial/Body Hair Growth
  • Expected Onset: 3-6 mo
  • Maximum Effect: 3-5 yrs
  • Reversible?: Not likely
  • Comments:
    • Gradual growth of mustache/beard 
    • Thicker/coarser hair on abdomen, chest, back, arms, and legs 
    • Dependent on inheritance 
Deepened Voice
  • Expected Onset: 3-12 mo
  • Maximum Effect: 1-2 yrs
  • Reversible?: No
  • Comments:
    • May not impact all aspects of speech 
    • Working with speech/language pathologist may help 
Increased Muscle Mass/Strength
  • Expected Onset: 6-12 mo
  • Maximum Effect: 2-5 yrs
  • Reversible?: Yes
  • Comments:
    • Depends on amount of exercise
Male Pattern Baldness
  • Reversible?: Not likely
  • Comments:
    • Highly dependent of age and inheritance
    • Medications may help

Inheritance (genetic influences passed down from biological parents), age, health status, lifestyle, and dosage (amount, frequency, route of administration) also impact the likelihood of experiencing negative side effects associated with masculinizing hormone therapy. Your healthcare provider will collect information regarding your history, as well as your biological family’s history, in order to provide more specific feedback regarding your risks prior to starting hormone therapy. Regular follow-up appointments are critical to monitoring your health and risk over time. 

TABLE 2: Risks Associated with Masculinizing Hormones

Increased Risk Likely

Polycythemia (increase in red blood cell volume)

  • Donating blood can reduce risk

Weight gain

  • Health eating and regular exercise can reduce risk

Acne

  • Medications can help manage symptoms

Male pattern balding

  • Medications may help

Sleep apnea (sleep disorder where breathing stops and starts)

  • Maintaining health weight can reduce risk
  • Treatments are available to help manage symptoms

Increased Risk Possible

Elevated liver enzymes

  • Orally-administered testosterone may increase this risk (vs. injectable forms)
  • Monitored via periodic blood test

Hyperlipidemia (high cholesterol/triglycerides)

  • Health eating and regular exercise can decrease risk
  • Medications can help manage symptoms

Increased Risk Possible with Additional Risk Factors Present

Destabilization of mental health difficulties (particularly those involving manic or psychotic symptoms)

  • Risk appears to be linked to higher doses and/or higher blood levels of testosterone

Cardiovascular disease (heart disease)

  • Healthy eating, exercise, and not smoking tobacco can decrease risk

Hypertension (high blood pressure)

  • Hypertension increases the risk of heart attack or stroke
  • Healthy eating, exercise, and not smoking tobacco can decrease risk
  • Medications can help manage symptoms

Type 2 diabetes

  • Healthy eating, exercise, and maintaining a healthy weight can decrease risk

No Increased Risk

Loss of bone density
Breast cancer
Cervical cancer
Ovarian cancer
Uterine cancer

  • Risk may still be present
  • Hysterectomy and HPV vaccine may reduce this risk
  • Regular pap tests screen for cervical cancer
  • See a doctor if you experience changes in discharge/bleeding, pelvic/back pain, and/or bathroom habits
Increased Risk Likely
  • Polycythemia (increase in red blood cell volume) 
    • Donating blood can reduce risk
  • Weight gain
    • Healthy eating and regular exercise can reduce risk
  • Acne
    • Medications can help manage symptoms
  • Male pattern balding
    • Medications may help
  • Sleep apnea (sleep disorder where breathing stops and starts)
    • Maintaining healthy weight can reduce risk 
    • Treatments are available to help manage symptoms 
Increased Risk Possible
  • Elevated liver enzymes
    • Orally-administered testosterone may increase this risk (vs. injectable forms) 
    • Monitored via periodic blood test 
  • Hyperlipidemia (high cholesterol/triglycerides)
    • Healthy eating and regular exercise can decrease risk 
    • Medications can help manage symptoms
Increased Risk Possible with Additional Risk Factors Present
  • Destabilization of mental health difficulties (particularly those involving manic or psychotic symptoms)
    • Risk appears to be linked to higher doses and/or higher blood levels of testosterone
  • Cardiovascular disease (heart disease)
    • Healthy eating, exercise, and not smoking tobacco can decrease risk
  • Hypertension (high blood pressure)
    • Hypertension increases the risk of heart attack or stroke 
    • Healthy eating, exercise, and not smoking tobacco can decrease risk 
    • Medications can help manage symptoms 
  • Type 2 diabetes
    • Healthy eating, exercise, and maintaining a healthy weight can decrease risk
No Increased Risk
  • Loss of bone density breast cancer cervical cancer ovarian cancer uterine cancer 
    • Risk may still be present 
    • Hysterectomy and HPV vaccine may reduce this risk 
    • Regular pap tests screen for cervical cancer 
    • See a doctor if you experience changes in discharge/bleeding, pelvic/back pain, and/or bathroom habits 

Information adapted from the World Professional Association for Transgender Health (WPATH) Standards of Care Version 7 and the Endocrine Society Clinical Practice Guideline for Endocrine Treatment of Transsexual Persons.

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