Pediatric masculinizing 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 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/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)

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