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Pediatric Masculinizing Hormone Therapy

Dallas

214-456-5959
Fax: 214-456-5963
Suite F4400

Plano

469-303-2400
Fax: 469-303-2407
Suite P4400

Park Cities

469-488-7000
Fax: 469-488-7001
Suite 106

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Request an Appointment with codes: Endocrinology

Refer a Patient with Pediatric Masculinizing Hormone Therapy

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What are the Physical Effects of Pediatric Masculinizing Hormone Therapy?

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

  • Less abdominal fat
  • More 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)

Monthly Period Stop

  • Expected Onset: 2-6 mo
  • Reversible?: Yes, although prolonged use may decrease fertility
  • Comments:
    • Pregnancy 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 is 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 Patten 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 feminizing 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
Increased Risk Possible
Increased Risk Likely with Additional Risk Factors Present
No Increase Risk
Polycythemia (increase in red blood cell volume)
Weight gain
Acne
Male pattern balding
Sleep apnea (sleep disorder where breathing stops starts)
Elevated liver enzymes
Hyperlipidemia (high cholesterol/triglycerides)
Destabilization of mental health difficulties (particularly those involving manic or psychotic symptoms)
Cardiovascular disease (heart disease)
Hypertension (high blood pressure)
Type 2 diabetes

Loss of bone density

Breast cancer

Cervical cancer

Ovarian cancer

Uterine cancer

  • Donating blood can reduce risk
  • Healthy eating and regular exercise can reduce risk
  • Medications can help manage symptoms
  • Medications may help
  • Maintaining healthy weight can reduce risk
  • Treatments are available to help manage symptoms
  • Orally-administered testosterone may increase this risk (vs. injectable forms)
  • Monitored via periodic blood test
  • Healthy eating and regular exercise can decrease risk
  • Medications can help manage symptoms
  • Risk appears to be linked to higher doses and/or higher blood levels of testosterone
  • Healthy eating, exercise, and not smoking tobacco can decrease risk
  • Hypertension increases the risk of heart attack or stroke
  • Healthy eating, exercise, and not smoking tobacco can decrease risk
  • Medications can help manage symptoms
  • Healthy eating, exercise, and maintaining a healthy weight can decrease risk
  • 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

  • Venous thromboembolic disease (blood clots)
    • A blood clot that travels to the lungs can create a life-threatening pulmonary embolism
    • Surgery/hospitalization, high cholesterol, hypertension, diabetes, cigarette smoking can increase risk
  • Hypertriglyceridemia (elevation of triglycerides in blood)
    • Can increase risk of cardiovascular disease
    • Very high levels can increase risk of acute pancreatitis
  • Weight Gain
    • Regular exercise can reduce risk
  • Elevated liver enzymes
    • Monitored via periodic blood test
  • Gallstones
    • May not cause symptoms

Increased Risk Likely with Additional Risk Factors

  • Cardiovascular disease (heart disease)
    • Healthy eating, exercise, and not smoking tobacco can decrease risk

Possible Increased Risk

  • Hypertension (high blood pressure)
    • Risk increase with estrogen but can decrease with the testosterone blocker spironolactone
    • Hypertension increases risk of heart attack or stroke
    • Healthy eating, exercise and not smoking tobacco can decrease risk
  • Hyperprolactinemia (elevated prolactin in blood) or prolactinoma (noncancerous pituitary gland tumor)
    • Risk appears limited to the first year of treatment

Increased Risk Possible with Additional Risk Factors Present

  • Type 2 diabetes
    • Healthy eating, exercise and maintaining a healthy weight can decrease risk

No Increase Risk

  • Breast cancer
    • Risk may still be present

Pediatric Masculinizing Hormone Therapy Doctors and Providers