Overview
Masculinizing hormone therapy typically is used by transgender men and nonbinary people to produce physical changes in the body that are caused by male hormones during puberty. Those changes are called secondary sex characteristics. This hormone therapy helps better align the body with a person’s gender identity. Masculinizing hormone therapy also is called gender-affirming hormone therapy. Masculinizing hormone therapy involves taking the male hormone testosterone. It stops menstrual cycles and decreases the ovaries’ ability to make estrogen. Masculinizing hormone therapy can be done alone or along with masculinizing surgery. Not everybody chooses to have masculinizing hormone therapy. It can affect fertility and sexual function, and it might lead to health problems. Talk with your health care provider about the risks and benefits for you.
Why it’s done
Masculinizing hormone therapy is used to change the body’s hormone levels. Those hormone changes trigger physical changes that help better align the body with a person’s gender identity. In some cases, people seeking masculinizing hormone therapy experience discomfort or distress because their gender identity differs from their sex assigned at birth or from their sex-related physical characteristics. This condition is called gender dysphoria. Masculinizing hormone therapy can:
- Improve psychological and social well-being
- Ease psychological and emotional distress related to gender
- Improve satisfaction with sex
- Improve quality of life
Your health care provider might advise against masculinizing hormone therapy if you:
- Are pregnant
- Have a hormone-sensitive cancer, such as breast cancer
- Have problems with blood clots, such as when a blood clot forms in a deep vein, a condition called deep vein thrombosis, or a there’s a blockage in one of the pulmonary arteries of the lungs, called a pulmonary embolism
- Have significant medical conditions that haven’t been addressed
- Have behavioral health conditions that haven’t been addressed
- Have a condition that limits your ability to give your informed consent
Risks
Research has found that masculinizing hormone therapy can be safe and effective when delivered by a health care provider with expertise in transgender care. Talk to your health care provider about questions or concerns you have regarding the changes that will happen in your body as a result of masculinizing hormone therapy. Complications can include:
- Weight gain
- Acne
- Developing male-pattern baldness
- Sleep apnea
- A rise in cholesterol, which may increase the risk of heart problems
- High blood pressure
- Making too many red blood cells — a condition called polycythemia
- Type 2 diabetes
- Blood clots in a deep vein or in the lungs
- Infertility
- Drying and thinning of the lining of the vagina
- Pelvic pain
- Discomfort in the clitoris
Evidence suggests that people who have masculinizing hormone therapy don’t have an increased risk of breast cancer, endometrial cancer or heart disease when compared to cisgender women — women whose gender identity aligns with societal norms related to their sex assigned at birth. It’s unclear whether masculinizing hormone therapy raises the risk of ovarian and uterine cancer. Further research is needed. To minimize risk, the goal for people taking masculinizing hormone therapy is to keep hormone levels in the range that’s typical for cisgender men.
Fertility
Masculinizing hormone therapy might limit your fertility. If possible, it’s best to make decisions about fertility before starting treatment. The risk of permanent infertility increases with long-term use of hormones. That is particularly true for those who start hormone therapy before puberty begins. Even after stopping hormone therapy, your ovaries and uterus might not recover enough for you to become pregnant without infertility treatment. If you want to have biological children, talk to your health care provider about your choices. They may include:
- Egg freezing. This procedure also is called mature oocyte cryopreservation. Egg freezing has multiple steps that involve triggering ovulation, retrieving the eggs and then freezing them.
- Embryo freezing. This process also is known as embryo cryopreservation. If you want to freeze embryos, you’ll need to have the eggs fertilized before they are frozen.
- Ovarian tissue cryopreservation. With this procedure, ovarian tissue is removed, frozen, and later thawed and reimplanted.
Although testosterone might limit your fertility, you still can become pregnant if you have your uterus and ovaries and you have sex with a person who produces sperm. If you want to avoid pregnancy, use birth control consistently. Talk with your health care provider about the form of birth control that’s best for your situation.
How you prepare
Before you start masculinizing hormone therapy, your health care provider assesses your health. This helps address any medical conditions that might affect your treatment. The evaluation may include:
- A review of your personal and family medical history
- A physical exam
- Lab tests
- A review of your vaccinations
- Screening tests for some conditions and diseases
- Identification and management, if needed, of tobacco use, drug use, alcohol use disorder, HIV or other sexually transmitted infections
- Discussion about birth control, fertility and sexual function
You also might have a behavioral health evaluation by a provider with expertise in transgender health. The evaluation may assess:
- Gender identity
- Gender dysphoria
- Mental health concerns
- Sexual health concerns
- The impact of gender identity at work, at school, at home and in social settings
- Risky behaviors, such as substance use or use of unapproved hormone therapy or supplements
- Support from family, friends and caregivers
- Your goals and expectations of treatment
- Care planning and follow-up care
People younger than age 18, along with a parent or guardian, should see a medical care provider and a behavioral health provider with expertise in pediatric transgender health to discuss the risks and benefits of hormone therapy and gender transitioning in that age group.
What you can expect
You should start masculinizing hormone therapy only after you’ve had a discussion of the risks and benefits as well as treatment alternatives with a health care provider who has expertise in transgender care. Make sure you understand what will happen and get answers to any questions you may have before you begin hormone therapy. Masculinizing hormone therapy typically begins by taking testosterone. A low dose of testosterone is prescribed, and then the dose is slowly increased over time. Testosterone usually is given through a shot, also called an injection, or through a gel or patch applied to the skin. Other forms of testosterone that may be appropriate for some people include testosterone pellets placed under the skin, a prolonged action injection and an oral capsule taken twice a day. The testosterone that’s used for masculinizing hormone therapy is identical to the hormone that the testicles and ovaries make naturally. Don’t use synthetic androgens, such as oral methyl testosterone or anabolic steroids. They can harm your liver and cannot be accurately monitored. After you begin masculinizing hormone therapy, you’ll notice the following changes in your body over time:
- Menstruation stops. This will occur within 2 to 6 months of starting treatment.
- Voice deepens. This will begin 3 to 12 months after you start treatment. You’ll see the full effect within 1 to 2 years.
- Facial and body hair grows. This will begin 3 to 6 months after treatment starts. The full effect will happen within 3 to 5 years.
- Body fat is redistributed. This will begin within 3 to 6 months. You’ll see the full effect within 2 to 5 years.
- Clitoris become larger, and the vaginal lining thins and become drier. This will begin 3 to 12 months after treatment starts. The full effect will happen in about 1 to 2 years.
- Muscle mass and strength increases. This will begin within 6 to 12 months. You’ll see the full effect within 2 to 5 years.
If menstrual bleeding doesn’t stop after you’ve taken testosterone for several months, your health care provider might recommend that you take medicine to stop it. Some of the physical changes caused by masculinizing hormone therapy can be reversed if you stop taking testosterone. Others, such as a deeper voice, a larger clitoris, scalp hair loss, and increased body and facial hair, cannot be reversed.
Results
While on masculinizing hormone therapy, you meet regularly with your health care provider to:
- Keep track of your physical changes.
- Monitor your hormone levels. Over time, your dose of testosterone may need to change to ensure you are taking the lowest dose necessary to get the physical effects that you want.
- Have lab tests to check for changes in your cholesterol, blood sugar, blood count, liver enzymes and electrolytes that could be caused by hormone therapy.
- Monitor your behavioral health.
You also need routine preventive care. Depending on your situation, this may include:
- Breast cancer screening. This should be done according to breast cancer screening recommendations for cisgender women your age.
- Cervical cancer screening. This should be done according to cervical cancer screening recommendations for cisgender women your age. Be aware that masculinizing hormone therapy can cause your cervical tissues to thin. That can look like a condition called cervical dysplasia in which unusual cells are found on the surface of the cervix. If you have questions or concerns about this, talk to your health care provider.
- Monitoring bone health. You should have bone density assessment according to the recommendations for cisgender men your age. You may need to take calcium and vitamin D supplements for bone health.
Nov. 04, 2022 Hormone regimes for transgender women (male to women, MTF) 1. Anti-androgen
- Spironolactone 100 – 200 mg/day (up to 400 mg)
- Cyproterone acetatea 50–100mg/day
- GnRH agonists 3.75 mg subcutaneous monthly
2. Oral estrogen
- Oral conjugated estrogens 2.5–7.5mg/day
- Oral 17-beta estradiol 2–6mg/day
3. Parenteral estrogen
- Estradiol valerate 5–20mg i.m./2 weeks or cypionate 2–10mg i.m./week
4. Transdermal estrogen
- Estradiol patch 0.1–0.4mg/2X week
i.m., Intramuscular; MTF, male to female. aNot available in the USA. Monitoring for transgender women (MTF) on hormone therapy:
- Monitor for feminizing and adverse effects every 3 months for first year and then every 6– 12 months.
- Monitor serum testosterone and estradiol at follow-up visits with a practical target in the female range (testosterone 30 – 100 ng/dl; E2 <200 pg/ml).
- Monitor prolactin and triglycerides before start- ing hormones and at follow-up visits.
- Monitor potassium levels if the patient is taking spironolactone.
- BMD screening before starting hormones for patients at risk for osteoporosis. Otherwise, start screening at age 60 or earlier if sex hormone levels are consistently low.
- MTF patients should be screened for breast and prostate cancer appropriately.
REFERENCES AND RECOMMENDED READING (from Gardner & Safer, 2013) 1.Gates GJ. How many people are lesbian, gay, bisexual, and transgender? The Williams Institute; 2011. 2. Sanchez NF, Sanchez JP, Danoff A. Healthcare utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City. Am J Public Health 2009; 99:713 – 719. 3. Leinung MC, Urizar MF, Patel N, Sood SC. Endocrine treatment of transsexual * persons: extensive personal experience. Endocr Pract 2013; 19:644 – 650. 4. Gorin-Lazard A, Baumstarck K, Boyer L, et al. Is hormonal therapy associated *with better quality of life in transsexuals? A cross-sectional study. J Sex Med 2012; 9:531–541. 5. Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. J Am Med Assoc 2011; 306:971 – 977. 6. Safer JD, Tangpricha V. Out of the shadows: it is time to mainstream treatment for transgender patients. Endocrine Pract 2008; 14:248 – 250. 7. Reiner WG, Gearhart JP. Discordant sexual identity in some genetic males with cloacal exstrophy assigned to female sex at birth. N Engl J Med 2004; 350:333 – 341. 8. Meyer-Bahlburg HFL. Gender identity outcome in female-raised 46,XY per- sons with penile agenesis, cloacal exstrophy of the bladder, or penile ablation. Arch Sex Behav 2005; 34:423 – 438. 9. Zhou J-N, Hofman MA, Gooren LJG, Swaab DF. A sex difference in the human brain and its relation to transsexuality. Nature 1995; 378:68 – 70. 10. Kruijver FP, Zhou JN, Pool CW, et al. Male-to-female transsexuals have female neuron numbers in a limbic nucleus. J Clin Endocrinol Metab 2000; 85:2034 – 204z 11. Berglund H, Lindstro ̈ m P, Dhejne-Helmy C, Savic I. Male-to-female transsex- uals show sex-atypical hypothalamus activation when smelling odorous steroids. Cerebr Cortex 2008; 18:1900 – 1908. 12. Rametti G, Carrillo B, Go ́mez-Gil E, et al. White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study. J Psychiatr Res 2011; 45:199 – 204. 13. RamettiG,CarrilloB,Go ́mez-GilE,etal.Themicrostructureofwhitematterin male to female transsexuals before cross-sex hormonal treatment. A DTI study. J Psychiatr Res 2011; 45:949–954. 14. GreenR,NewmanL,StollerR.Treatmentofboyhood‘transsexualism’.Arch Gen Psychiatry 1972; 26:213–217. 15. Liao L-M, Audi L, Magritte E, et al. Determinant factors of gender identity: a commentary. J Pediatr Urol 2012; 8:597–601. 16. World Professional Association for Transgender Health. Standards of care for the health of transsexual, transgender, and gender nonconforming people. 7th ed.; 2011. http://www.wpath.org/documents/Standards%20of%20Care% 20V7%20-%202011%20WPATH.pdf (Accessed on 24 December 2012) 17. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, et al. Endo- crine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009; 94:3132 – 3154. 18. Gooren LJ. Care of transsexual persons. N Engl J Med 2011; 364:2559– 2560. 19. BhasinS,SaferJ,TangprichaV.Thehormonefoundation’spatientguideto the endocrine treatment of transsexual persons. J Clin Endocrinol Metab 2009; 94:. 20. Bockting WO, Miner MH, Swinburne Romine RE, et al. Stigma, mental health, * and resilience in an online sample of the US transgender population. Am J Public Health 2013; 103:943 – 951. 21. Olshan JS, Spack NP, Eimicke T, et al. Evaluation of the efficacy of sub-cutaneous administration of testosterone in female to male transexuals and hypogonadal males. Endocr Rev 2013; 34:(03_MeetingAbstracts): MON- 594. 22. Nagarajan V, Chamsi-Pasha M, Tang WHW. The role of aldosterone receptor antagonists in the management of heart failure: an update. Cleve Clin J Med 2012; 79:631 – 639. 23. Asscheman H, Giltay EJ, Megens JAJ, et al. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol 2011; 164:635 – 642. 24. Wierckx K, Mueller S, Weyers S, et al. Long-term evaluation of cross-sex * hormone treatment in transsexual persons. J Sex Med 2012; 9:2641–2651. 25. Wallien MSC, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 2008; 47:1413 – 1423. 26. Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJG. The treatment of adolescent transsexuals: changing insights. J Sex Med 2008; 5:1892–1897. 27. De Vries ALC, Steensma TD, Doreleijers TAH, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 2011; 8:2276 – 2283. 28. Safer JD, Pearce EN. A simple curriculum content change increased medical & student comfort with transgender medicine. Endocrine Pract 2013; 33:39–44. Planned Parenthood of Southwest and Central Florida offers gender-affirming hormone therapy, either testosterone or estrogen, for transgender patients. We see hormone therapy as an important service that speaks to the core of our mission. This service can be found at any of our health centers. Our transgender hormone services include:
- Transgender Female (MTF) hormone therapy including estrogen and spironolactone
- Transgender Male (FTM) hormone therapy including testosterone
We may be able to start or continue hormone therapy and provide referrals for gender-qualified therapy and resources if needed. If you are on hormone therapy, you can utilize the health center for ongoing care and monitoring. In order to receive gender-affirming hormone therapy you need to be over 18 and capable of providing consent. If you are 17, you will need your parent/guardian to accompany you for your appointment. If you are 16 or younger, additional paperwork is required. Please be aware that there are special consents for these services. Contact us at 941-567-3800 for specific details and to make your appointment. What to expect on your first visit:
- In order to decrease the amount of time spent in the waiting room, please call to make an appointment first and request transgender services.
- When you check in, let our staff know you are there for transgender care. Please provide your name and pronoun (he or she or they) at the time of check in. This way, when you are called back to meet with the clinician, your correct name and pronoun will be used.
- When you are called back to meet with the clinician, please be honest about your medical history, sexuality and sexual practices. All services are confidential (except in cases of abuse), so being open with the clinician will ensure that you are receiving the best health care.
- As a transgender patient seeking services, you may consult with one of our clinicians and receive a physical assessment and lab testing as appropriate for monitoring hormones and your transition.
At Planned Parenthood, we want to make sure you have all the resources you need to live a healthy and strong life. You can find additional resources for transgender care and services through one of our coalition partners, Equality Florida. Call Today
Self-Injection Training
Congratulations on beginning gender-affirming hormone therapy! Planned Parenthood of Southwest and Central Florida (PPSWCF) is dedicated to ensuring you have the support and resources you need during your transition. If you’ve chosen to pursue self-injection training, click the button to view instructions and training videos. View Training Materials
Transgender and Nonbinary Resource Guide
Equality Florida has produced and maintains a Transgender and Nobinary Resource Guide, which provides a statewide directory for safe and transfriendly service providers. The guide is organized by county and includes the following: Crisis hotlines, mental health therapists, primary care physicians, endocrinologists, national legal resources, Florida-specific information on updating legal documents, surgery resources, support centers and social groups, hair & makeup services, vocal coaching, electrolysis providers, and veteran services. Read the Guide
Or call
1-800-230-7526
Overview
Feminizing hormone therapy typically is used by transgender women and nonbinary people to produce physical changes in the body that are caused by female hormones during puberty. Those changes are called secondary sex characteristics. This hormone therapy helps better align the body with a person’s gender identity. Feminizing hormone therapy also is called gender-affirming hormone therapy. Feminizing hormone therapy involves taking medicine to block the action of the hormone testosterone. It also includes taking the hormone estrogen. Estrogen lowers the amount of testosterone the body makes. It also triggers the development of feminine secondary sex characteristics. Feminizing hormone therapy can be done alone or along with feminizing surgery. Not everybody chooses to have feminizing hormone therapy. It can affect fertility and sexual function, and it might lead to health problems. Talk with your health care provider about the risks and benefits for you.
Why it’s done
Feminizing hormone therapy is used to change the body’s hormone levels. Those hormone changes trigger physical changes that help better align the body with a person’s gender identity. In some cases, people seeking feminizing hormone therapy experience discomfort or distress because their gender identity differs from their sex assigned at birth or from their sex-related physical characteristics. This condition is called gender dysphoria. Feminizing hormone therapy can:
- Improve psychological and social well-being.
- Ease psychological and emotional distress related to gender.
- Improve satisfaction with sex.
- Improve quality of life.
Your health care provider might advise against feminizing hormone therapy if you:
- Have a hormone-sensitive cancer, such as prostate cancer.
- Have problems with blood clots, such as when a blood clot forms in a deep vein, a condition called deep vein thrombosis, or a there’s a blockage in one of the pulmonary arteries of the lungs, called a pulmonary embolism.
- Have significant medical conditions that haven’t been addressed.
- Have behavioral health conditions that haven’t been addressed.
- Have a condition that limits your ability to give your informed consent.
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Risks
Research has found that feminizing hormone therapy can be safe and effective when delivered by a health care provider with expertise in transgender care. Talk to your health care provider about questions or concerns you have regarding the changes that will happen in your body as a result of feminizing hormone therapy. Complications can include:
- Blood clots in a deep vein or in the lungs
- Heart problems
- High levels of triglycerides, a type of fat, in the blood
- High levels of potassium in the blood
- High levels of the hormone prolactin in the blood
- Nipple discharge
- Weight gain
- Infertility
- High blood pressure
- Type 2 diabetes
- Stroke
Evidence suggests that people who take feminizing hormone therapy may have an increased risk of breast cancer when compared to cisgender men — men whose gender identity aligns with societal norms related to their sex assigned at birth. But the risk is not greater than that of cisgender women. To minimize risk, the goal for people taking feminizing hormone therapy is to keep hormone levels in the range that’s typical for cisgender women.
Fertility
Feminizing hormone therapy might limit your fertility. If possible, it’s best to make decisions about fertility before starting treatment. The risk of permanent infertility increases with long-term use of hormones. That is particularly true for those who start hormone therapy before puberty begins. Even after stopping hormone therapy, your testicles might not recover enough to ensure conception without infertility treatment. If you want to have biological children, talk to your health care provider about freezing your sperm before you start feminizing hormone therapy. That procedure is called sperm cryopreservation.
How you prepare
Before you start feminizing hormone therapy, your health care provider assesses your health. This helps address any medical conditions that might affect your treatment. The evaluation may include:
- A review of your personal and family medical history.
- A physical exam.
- Lab tests.
- A review of your vaccinations.
- Screening tests for some conditions and diseases.
- Identification and management, if needed, of tobacco use, drug use, alcohol use disorder, HIV or other sexually transmitted infections.
- Discussion about sperm freezing and fertility.
You also might have a behavioral health evaluation by a provider with expertise in transgender health. The evaluation may assess:
- Gender identity.
- Gender dysphoria.
- Mental health concerns.
- Sexual health concerns.
- The impact of gender identity at work, at school, at home and in social settings.
- Risky behaviors, such as substance use or use of unapproved silicone injections, hormone therapy or supplements.
- Support from family, friends and caregivers.
- Your goals and expectations of treatment.
- Care planning and follow-up care.
People younger than age 18, along with a parent or guardian, should see a medical care provider and a behavioral health provider with expertise in pediatric transgender health to discuss the risks and benefits of hormone therapy and gender transitioning in that age group.
What you can expect
You should start feminizing hormone therapy only after you’ve had a discussion of the risks and benefits as well as treatment alternatives with a health care provider who has expertise in transgender care. Make sure you understand what will happen and get answers to any questions you may have before you begin hormone therapy. Feminizing hormone therapy typically begins by taking the medicine spironolactone (Aldactone). It blocks male sex hormone receptors — also called androgen receptors. This lowers the amount of testosterone the body makes. About 4 to 8 weeks after you start taking spironolactone, you begin taking estrogen. This also lowers the amount of testosterone the body makes. And it triggers physical changes in the body that are caused by female hormones during puberty. Estrogen can be taken several ways. They include a pill and a shot. There also are several forms of estrogen that are applied to the skin, including a cream, gel, spray and patch. It is best not to take estrogen as a pill if you have a personal or family history of blood clots in a deep vein or in the lungs, a condition called venous thrombosis. Another choice for feminizing hormone therapy is to take gonadotropin-releasing hormone (Gn-RH) analogs. They lower the amount of testosterone your body makes and might allow you to take lower doses of estrogen without the use of spironolactone. The disadvantage is that Gn-RH analogs usually are more expensive. After you begin feminizing hormone therapy, you’ll notice the following changes in your body over time:
- Fewer erections and a decrease in ejaculation. This will begin 1 to 3 months after treatment starts. The full effect will happen within 3 to 6 months.
- Less interest in sex. This also is called decreased libido. It will begin 1 to 3 months after you start treatment. You’ll see the full effect within 1 to 2 years.
- Slower scalp hair loss. This will begin 1 to 3 months after treatment begins. The full effect will happen within 1 to 2 years.
- Breast development. This begins 3 to 6 months after treatment starts. The full effect happens within 2 to 3 years.
- Softer, less oily skin. This will begin 3 to 6 months after treatment starts. That’s also when the full effect will happen.
- Smaller testicles. This also is called testicular atrophy. It begins 3 to 6 months after the start of treatment. You’ll see the full effect within 2 to 3 years.
- Less muscle mass. This will begin 3 to 6 months after treatment starts. You’ll see the full effect within 1 to 2 years.
- More body fat. This will begin 3 to 6 months after treatment starts. The full effect will happen within 2 to 5 years.
- Less facial and body hair growth. This will begin 6 to 12 months after treatment starts. The full effect happens within three years.
Some of the physical changes caused by feminizing hormone therapy can be reversed if you stop taking it. Others, such as breast development, cannot be reversed.
Results
While on feminizing hormone therapy, you meet regularly with your health care provider to:
- Keep track of your physical changes.
- Monitor your hormone levels. Over time, your hormone dose may need to change to ensure you are taking the lowest dose necessary to get the physical effects that you want.
- Have blood tests to check for changes in your cholesterol, blood sugar, blood count, liver enzymes and electrolytes that could be caused by hormone therapy.
- Monitor your behavioral health.
You also need routine preventive care. Depending on your situation, this may include:
- Breast cancer screening. This should be done according to breast cancer screening recommendations for cisgender women your age.
- Prostate cancer screening. This should be done according to prostate cancer screening recommendations for cisgender men your age.
- Monitoring bone health. You should have bone density assessment according to the recommendations for cisgender women your age. You may need to take calcium and vitamin D supplements for bone health.
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