Masculinizing Hormone Therapy
Overview
Masculinizing hormone therapy, sometimes called hormonal gender affirmation or gender-affirming hormone therapy, uses testosterone to create physical changes in the body. These changes often include the development of secondary sex characteristics like a deeper voice, facial hair growth, and increased muscle mass.
Main Features of This Therapy:
- Uses testosterone to support bodily changes.
- Stops menstrual cycles and reduces natural estrogen levels.
- Can help align physical appearance with gender identity.
| Effects | Notes |
|---|---|
| Deeper voice | May happen gradually |
| Facial/body hair | Increases with continued use |
| Muscle mass | Often grows over time |
| Menstrual periods | Usually stop |
People considering this treatment should talk with a healthcare provider about possible benefits, risks, fertility changes, and impact on sexual function. This therapy may be used with or without masculinizing surgeries.
Reasons for Pursuing Masculinizing Hormone Treatment
Healthcare providers offer masculinizing hormone therapy to people whose gender identity does not match the sex assigned at birth. Transgender men, nonbinary, and transmasculine people most often choose this treatment. It brings hormone levels, such as testosterone, closer to typical male ranges while decreasing estrogen and estradiol levels.
Many experience gender dysphoria, which is discomfort or distress linked to having physical traits that do not reflect their gender identity. By beginning masculinizing hormone therapy, these individuals may see changes like more facial and body hair, a deeper voice, and fat shifting to areas more commonly seen in men. This treatment can lead to better mental health, improved social well-being, and higher quality of life.
Common Goals
- Reducing feelings of gender dysphoria.
- Supporting a transition to a gender that matches identity.
- Easing emotional and psychological discomfort.
- Boosting self-confidence and social satisfaction.
People with certain health issues, such as estrogen-sensitive cancers, blood clots, or untreated mental health conditions, may not be good candidates for this therapy. Anyone considering this should talk with a qualified provider first.
Possible Complications
Impact on the Ability to Have Children
Masculinizing hormone therapy can reduce the chances of having biological children. Taking testosterone may lower fertility, and this effect is stronger if the therapy starts before puberty.
Over time, long-term hormone treatment can increase the risk of permanent infertility. In some cases, even after stopping testosterone, the ovaries and uterus might not return to normal function.
This can make it hard—or sometimes not possible—to become pregnant without medical help. If someone wants to have children in the future, they should talk with a healthcare professional before starting hormone treatment. Several ways exist to try to preserve fertility:
| Option | Description |
|---|---|
| Egg Freezing | Medical teams collect eggs and keep them frozen until needed for future pregnancy. |
| Embryo Freezing | Teams fertilize eggs with sperm, then freeze embryos for later use. |
| Ovarian Tissue Preservation | Providers remove part of an ovary, freeze it, and may use it in the future. |
Each option has different steps and may not be suitable for everyone. A provider who understands reproductive health and transgender care can discuss these options. Even with testosterone therapy, people with a uterus and ovaries can still get pregnant if they have sexual activity with a partner who can produce sperm.
Birth control remains necessary to prevent pregnancy. Doctors can help find the right form of birth control. Masculinizing hormone therapy does not prevent pregnancy. People who want to avoid pregnancy need to use birth control during sexual activity.
Related Concerns
- Menstrual Changes: Amenorrhea (absence of periods) is common when taking testosterone, but stopping periods does not mean infertility.
- Vaginal Atrophy: The vaginal lining may dry and thin, which can cause discomfort.
- Pelvic Pain or Sexual Dysfunction: Some notice pelvic discomfort or changes in sexual function.
- Risk of Permanent Infertility: The longer the duration of hormone therapy, especially before puberty, the higher the risk.
Other Considerations
- Bone Health: Hormone changes can affect bone density over time.
- Reproductive Health Monitoring: Regular health checks, such as blood pressure and cholesterol, are important.
- Blood Changes: Red blood cell count (polycythemia), hemoglobin, and hematocrit can increase.
- Possible Health Risks:
- High blood pressure
- Sleep apnea
- Weight gain
- Type 2 diabetes
- Blood clots (deep vein thrombosis or pulmonary embolism)
- Changes in skin (acne, male-pattern baldness)
- Cardiovascular disease
People starting or taking masculinizing hormone therapy should have regular medical checkups.
Getting Ready for Testosterone Therapy
Before starting masculinizing hormone therapy, a healthcare provider reviews your full health history. This checkup covers both your past and current health and helps identify any issues that might affect your treatment plan. A typical preparation may include:
- Medical History: The provider reviews both personal and family health records.
- Physical Check: A physical exam documents your current health.
- Lab Work: Blood tests and other labs identify any hidden problems.
- Vaccination Status: The provider checks your vaccines to ensure you’re up to date.
- Screenings: Tests for conditions like HIV or other infections are included.
Providers often ask about lifestyle factors like smoking, drug or alcohol use, and sexual health. You might also discuss birth control, fertility, or how therapy could affect sexual function. Behavioral health experts with training in transgender health may participate.
They ask about gender identity, mental health, and sources of support. The team discusses goals, expectations, and care planning to help you get the right care. For teens under 18, specialists with experience in pediatric transgender health guide both the youth and their parent or guardian about benefits and risks.
Changes You Might Notice
Masculinizing hormone therapy uses testosterone to develop more masculine characteristics. People can take testosterone through injections (intramuscular or subcutaneous), patches, gels, or oral capsules. These treatments increase testosterone levels in the body and cause several changes over time.
Timeline of Physical Changes
| Change | When Changes Start | When Changes Are Most Noticeable |
|---|---|---|
| Menstrual cycles stop | 2–6 months | Up to 1 year |
| Voice gets deeper | 3–12 months | 1–2 years |
| More facial/body hair | 3–6 months | 3–5 years |
| Body fat shifts | 3–6 months | 2–5 years |
| Increase in muscle mass and strength | 6–12 months | 2–5 years |
| Clitoris gets larger, vaginal lining thins | 3–12 months | 1–2 years |
People may take testosterone in these forms:
- Injectable testosterone (enanthate, cypionate, undecanoate)
- Transdermal testosterone (patches, gels)
- Oral capsules
- Pellets under the skin (parenteral testosterone)
Medical professionals usually start with low doses of testosterone and raise the dosage slowly over time. Regular checks of hormone levels help ensure safety and the best results.
Expected Results
- Most people find that their menstruation stops within the first few months. If periods continue, other treatments might be suggested.
- Facial and body hair growth increases, although it can take years to reach the full effect.
- Voice deepening is gradual and becomes noticeable after a few months.
- Muscle mass and strength increase, because testosterone helps build muscle.
- Fat distribution changes, with fat moving away from the hips and thighs and toward the abdomen.
- The clitoris becomes larger, and the vaginal lining may become thinner and drier.
- Some individuals notice an increased sex drive.
Important Points
- Some changes, like a deeper voice or more facial hair, are usually permanent even if testosterone is stopped.
- Others, such as muscle growth or some fat changes, may slowly reverse if treatment ends.
- Certain forms of testosterone (like anabolic steroids) should not be used because they are harmful and hard to monitor.
- People who start therapy should see a provider with experience in transgender care for the safest results.
Note: Everyone’s experience is different, but the chart above gives a general idea of when certain changes might happen.
Outcomes
Healthcare providers regularly check in with individuals on masculinizing hormone therapy to observe changes in their bodies and adjust hormone levels as needed. Lab work tracks important health indicators such as cholesterol, blood sugar, potassium, blood count, and liver function. This careful follow-up helps identify any medical concerns early.
Preventive healthcare is a key part of care. Providers continue to recommend routine cancer screenings. For example, breast cancer checks and cervical exams follow the same recommendations used for cisgender women of the same age. Because testosterone treatment can make cervical tissues thinner, test results might sometimes look unusual, leading to further conversations or follow-up tests.
Bone health is another focus. Providers monitor bone density, similar to what is suggested for cisgender men. They may add supplements like calcium or vitamin D if needed, based on individual assessments. A summary table of important care elements:
| Area | Care Needed |
|---|---|
| Physical Changes | Regular check-ups, dose adjustment |
| Lab Tests | Monitor cholesterol, liver, sugar, etc. |
| Cancer Screening | Breast, cervical as recommended |
| Bone Health | Density checks, supplements as needed |
| Emotional Well-being | Ongoing behavioral health monitoring |
Providers include attention to quality of life and sexual health in these visits, addressing any emotional or physical concerns.
