Pediatric Feminizing Hormone Therapy

Dallas

214-456-5959
Fax: 214-456-5963

Park Cities

469-488-7000
Fax: 469-488-7001

Plano

469-303-2400
Fax: 469-303-2407

Request an Appointment with codes: Endocrinology

Refer a Patient with Pediatric Feminizing Hormone Therapy

Accepted Insurance Plans

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)

	Expected Onset	Maximum Effect	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
	Gallstones	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
Possible Increased 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

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

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.

Resources

Information adapted from:

World Professional Association for Transgender Health (WPATH) Standards of Care Version 7
Endocrine Society - Clinical Practice Guideline for Endocrine Treatment of Transsexual Persons.