Pediatric feminizing hormone therapy
What are the physical effects of pediatric feminizing hormone therapy?
Physical effects of feminizing hormone can involve testosterone blocking medication alone, estrogen medication alone, or testosterone blocking medication along with estrogen.
Most physical changes associated with feminizing 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).
TABLE 1: Effects and expected time course of feminizing hormones (print friendly version)
Expectedonset
Maximumeffect
Reversible?
Comments
Decreased sex drive
1-3 mo
1-2 yrs
Yes
Fewer spontaneous and morning erections
Emotional changes
1-3 mo
Yes
Highly variable person to person
May experience broader range of emotions
Fertility
Varies
Likely, although prolonged use may decrease fertility
Less semen and ejaculatory fluid is produced
Sperm may no longer reach maturity
Ongoing birth control still recommended
Decreased muscle mass/strength
3-6 mo
1-2 yrs
Yes
Depends on amount of exercise
Breast growth
3-6 mo
2-3 yrs
No, although atrophy of breast tissue may occur
Size varies person to person and depends on inheritance
Typically, A to B cup
Decreased testicular volume
3-6 mo
2-3 yrs
Maybe
Testes shrink to approximately half of initial size
Body fat redistribution
3-6 mo
2-5 yrs
Yes
Less abdominal fat
More fat in hips, thighs, buttocks
Skin softening
3-6 mo
Yes
Skin also becomes less oily
Face/body hair changes
6-12 mo
No
Hair follicles will continue to produce hair
Hair may growth more slowly and be thinner/less noticeable
Male pattern baldness may stop or slow down but hair already lost will likely not grow back
Decreased Sex Drive
Expected onset: 1-3 mo
Madimum effect: 1-2 yrs
Reversible?: Yes
Comments:
Fewer spontaneous and morning erections
Can make penetrative sex more difficult as the insertive partner
Emotional changes
Expected onset: 1-3 mo
Reversible?: Yes
Comments:
Highly variable person to person
May experience broader range of emotions
Fertility
Expected onset: Varies
Reversible?: Likely, although prolonged use may decrease fertility
Comments:
Less semen and ejaculatory fluid is produced
Sperm may no longer reach maturity
Ongoing birth control still recommended
Decreased muscle mass/strength
Expected onset: 3-6 mo
Maximum effect: 1-2 yrs
Reversible?: Yes
Comments:
Depends on amount of exercise
Breast growth
Expected onset: 3-6 mo
Maximum effect: 2-3 yrs
Reversible?: No, although atrophy of breast tissue may occur
Comments:
Size varies person to person and depends on inheritance
Typically, A to B cup
Decreased testicular volume
Expected onset: 3-6 mo
Maximum effect: 2-3 yrs
Reversible?: Maybe
Comments:
Testes shrink to approximately half of the initial size
Body fat redistribution
Expected onset: 3-6 mo
Maximum effect: 2-5 yrs
Reversible?: Yes
Comments:
Less abdominal fat
More fat in hips, thighs, buttocks
Skin softening
Expected onset: 3-6 mo
Reversible?: Yes
Comments:
Skin also becomes less oily
Face/body hair changes
Expected onset: 6-12 mo
Reversible?: No
Comments:
Hair follicles will continue to produce hair
Hair may growth more slowly and be thinner/less noticeable
Male pattern baldness may stop or slow down but hair already lost will likely not grow back
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 associate with masculinizing hormones
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
May not cause symptoms
Increased risk likely with additional risk factors present
Cardiovascular disease (heart disease)
Healthy eating, exercise, and not smoking tobacco can decrease risk
Possible increased risk
Hypertension (high blood pressure)
Risk increases 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
Medications can help manage symptoms
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
Healthy eating, exercise and maintaining a healthy weight can decrease risk
No increase risk
Breast cancer
Risk may still be present
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
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
Healthy eating, exercise and maintaining a healthy weight can decrease risk
No increase risk
Breast cancer
Risk may still be present
Children's Health Resources
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