Pediatric masculinizing hormone therapy
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)
Expectedonset
Maximumeffect
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/scne
Expected onset: 1-6 mo
Maximum effect: 1-2 yrs
Reversible?: Yes
Comments:
Acne may cause permanent scars
Medication can help manage symptoms
Increased dex 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 eedistribution
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)
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