Masculinizing Hormones

Masculinizing hormones are medications (e.g. testosterone) used to develop physical characteristics that are in line with one’s gender identity or gender expression.
This page sets out the advantages and disadvantages of common  testosterones as well as the expected effects and potential risks associated with masculinizing hormones. The list of therapies is not exhaustive. Talk to your health care provider to determine the best fit for you.
Common therapies

Injectable testosterone (testosterone cypionate or testosterone enanthate)

  • description: a medication you inject once a week or once every two weeks
  • advantages: its lower cost (around $10 a month) and it is widely available
  • disadvantages: may lead to highs and lows in energy and mood in between doses (becoming worse with every two-week injection)

Testosterone patch

  • brand name: Androderm
  • description: a  patch you wear every day on your back, upper arm, thigh or stomach
  • advantages: it is administered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosterone
  • disadvantages: it’s relatively expensive (around $130 a month). Some people have a skin reaction to the adhesive

Testosterone gel (compounded testosterone gel or cream) 

  • brand name: Androgel
  • description: a  gel or cream applied to your skin at the same time each day
  • advantages: it is administered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosterone
  • disadvantages: Androgel is relatively expensive (around $130 a month). When you are in intimate contact with someone, it can be challenging to avoid exposing them to the gel

Oral testosterone (testosterone undecanoate)

  • description: a  pill you take once a day
  • advantages: it is administered at a constant rate, eliminating the highs and lows in energy and mood associated with injectable testosterone
  • disadvantages: not commonly used because it is less effective at stopping monthly bleeding, and felt to be less safe. Costs $130 a month
Effects

Increased sex drive

  • usually starts in 1 to 3 months

Monthly bleeding stops

  • usually happens within 2 – 6 months
  • you may still be able to get pregnant even when your monthly bleeding stops (Note: it is not safe to take testosterone while pregnant)
  • reversible change, if you stop taking testosterone

Bigger  erectile tissue (clitoris)

  • usually starts in 3 to 6 months
  • reaches full size in 1 to 2 years
  • size typically ranges from 1 to 3 cm
  • likely permanent change, even if you stop taking testosterone

More facial & body hair

  • usually starts in 3 to 6 months
  • maximum effect in 3 to 5 years
  • gradual growth of mustache and beard
  • more hair and thicker and coarser hairs on abdomen, arms, chest, back and legs
  • likely permanent change, even if you stop taking testosterone

Male pattern baldness

  • usually starts in less than 12 months
  • hair loss at temples and along the crown of head
  • possibility of becoming completely bald
  • likely permanent change, even if you stop taking testosterone
  • you can take medications to minimize this

Oily skin & acne

  • usually starts in 1 to 6 months
  • maximum effect in 1 to 2 years
  • more acne and may permanently scar
  • you can take medications to minimize this
  • not a permanent change if you stop taking testosterone
  • Increased muscle mass and strength
  • usually starts in 6 to 12 months
  • maximum effect in 2 to 5 years
  • not a permanent change if you stop taking testosterone

Body fat redistribution

  • usually starts in 3 to 6 months
  • maximum effect in 2 to 5 years
  • more abdominal fat
  • less fat around buttocks, hips and thighs
  • not a permanent change if you stop taking testosterone

Deepened voice

  • usually starts in 3 to 12 months
  • maximum effect in 1 to 2 years
  • while your voice may deepen, other aspects of the way you speak may not be perceived as typically male. You can work with a speech language pathologist to achieve this, if desired
  • permanent change

Changes to lining of internal gentitals (vagina)

  • usually starts in 3 to 6 months
  • maximum effect in 1 to 2 years
  • thinning and drying of the lining of the internal genitals (vagina)
  • may make penetration uncomfortable (treatments are available)

Emotional changes

  • overall emotional state may or may not change; this varies from person to person
  • many people experience positive mood changes
  • may experience a narrower range of emotions or feelings
  • may become irritable, frustrated or angry more easily

External video resource

A presentation by Dr. Maddie Deutsch, from the Center of Excellence for Transgender Health.


Risks

With masculinizing hormone therapies, there is:

  • a likely increased risk of polycythemia (blood disorder), weight gain, acne, androgenic alopecia (balding) and sleep apnea
  • a possible increased risk of elevated liver enzymes and hyperlipidemia
  • a possible increased risk (with the presence of additional risk factors) of destabilization of certain psychiatric disorders (bipolar disorder, psychotic disorders), cardiovascular disease, hypertension (high blood pressure) and type 2 diabetes

There is either no increased risk of bone density loss or cancer (breast, cervical, ovarian, uterine), or the research is inconclusive 

If you are injecting testosterone, your emotional changes may be the result of your fluctuating testosterone level. You may want to talk to your doctor about switching to more frequent injections or topical testosterone). Any mood changes that cause you concern should be discussed with your primary care provider.

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SOURCE: Masculinizing Hormones ( )
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