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Refer a Patient with Pediatric Masculinizing Hormone Therapy
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)
|
|
Expected |
Maximum |
Reversible? |
Comments |
|
Skin Oiliness/Acne |
1-6 mo |
1-2 yrs |
Yes |
|
|
Increased Sex Drive |
1-3 mo |
|
Yes |
|
|
Emotional Changes |
|
|
Yes |
|
|
Monthly Period Stop |
2-6 mo |
|
Yes, although prolonged use may decrease fertility |
|
|
Clitoral Growth |
3-6 mo |
1-2 yrs |
Not likely |
|
|
Thinning/Drying of Vaginal Lining |
3-6 mo |
1-2 yrs |
Possible |
|
|
Body Fat Redistribution |
3-6 mo |
2-5 yrs |
Yes |
|
|
Facial/Body Hair Growth |
3-6 mo |
3-5 yrs |
Not likely |
|
|
Deepened Voice |
3-12 mo |
1-2 yrs |
No |
|
|
Increased Muscle Mass/Strength |
6-12 mo |
2-5 yrs |
Yes |
|
|
Male Patten Baldness |
|
|
Not likely |
|
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
