Masculinizing hormone therapy is used to induce the physical changes in your body caused by male hormones during puberty (secondary sex characteristics) to promote the matching of your gender identity and body (gender congruence). If masculinizing hormone therapy is started before the changes of female puberty begins, female secondary sex characteristics, such as the development of breasts, can be avoided. Masculinizing hormone therapy is also referred to as cross-sex hormone therapy.
During masculinizing hormone therapy, you'll be given the male hormone testosterone, which suppresses your menstrual cycles and decreases the production of estrogen from your ovaries. Changes caused by these medications can be temporary or permanent. Masculinizing hormone therapy can be done alone on in combination with masculinizing surgery.
Masculinizing hormone therapy isn't for all transgender men, however. Masculinizing hormone therapy can affect your fertility and sexual function and cause other health problems. Your doctor can help you weigh the risks and benefits.
Masculinizing hormone therapy is used to alter your hormone levels to match your gender identity.
Typically, people who seek masculinizing hormone therapy experience distress due to a difference between experienced or expressed gender and sex assigned at birth (gender dysphoria). To avoid excess risk, the goal is to maintain hormone levels in the normal range for the target gender.
Masculinizing hormone therapy can:
Although use of hormones is currently not approved by the Food and Drug Administration for treatment of gender dysphoria, research suggests that it can be safe and effective.
If used in an adolescent, hormone therapy typically begins at age 16. Ideally, treatment starts before the development of secondary sex characteristics so that teens can go through puberty as their identified gender. Hormone therapy is not typically used in children.
Masculinizing hormone therapy isn't for everyone, however. Your doctor might discourage masculinizing hormone therapy if you:
Talk to your doctor about the changes in your body and any concerns you might have. Complications of masculinizing hormone therapy include:
Evidence suggests no increased risk of breast or cervical cancer.
The evidence that masculinizing hormone therapy increases the risk of ovarian and uterine cancer is inconclusive. Further research is needed.
Because masculinizing hormone therapy might reduce your fertility, you'll need to make decisions about your fertility before starting treatment. The risk of permanent infertility increases with long-term use of hormones, especially when hormone therapy is initiated before puberty. Even after discontinuation of hormone therapy, ovarian and uterine function might not recover well enough to ensure that you can become pregnant.
If you want to have biological children, talk to your doctor about egg freezing (mature oocyte cryopreservation) or embryo freezing (embryo cryopreservation). Keep in mind that egg freezing has multiple steps — ovulation induction, egg retrieval and freezing. If you want to freeze embryos, you'll need to go through the additional step of having your eggs fertilized before they are frozen.
At the same time, while testosterone might limit your fertility, you're still at risk of pregnancy if you have your uterus and ovaries. If you want to avoid becoming pregnant, use a barrier form of contraception or an intrauterine device.
Before starting masculinizing hormone therapy, your doctor will evaluate your health to rule out or address any medical conditions that might affect or contraindicate treatment. The evaluation might include:
You might also need a mental health evaluation by a provider with expertise in transgender health. The evaluation might assess:
Adolescents younger than age 18, accompanied by their custodial parents or guardians, also should see doctors and mental health providers with expertise in pediatric transgender health to discuss the risks of hormone therapy, as well as the effects and possible complications of gender transition.
Typically, you'll begin masculinizing hormone therapy by taking testosterone. Testosterone is given either by injection or by a patch or gel applied to the skin. Oral testosterone or synthetic male sex hormone (androgen) medication shouldn't be used because of potential adverse effects on your liver and lipids.
If you have persistent menstrual flow, your doctor might recommend taking progesterone to control it.
Masculinizing hormone therapy will begin producing changes in your body within weeks to months. Your timeline might look as follows:
After masculinizing hormone therapy, you'll meet regularly with your doctor. He or she will:
After masculinizing hormone therapy, you will also need routine preventive care if you have not had certain surgical interventions, including:
When undergoing cervical cancer screening, be sure to share that you're on testosterone therapy and make sure that the gender designation on your sample is disregarded. This kind of therapy can cause your cervical tissues to thin (cervical atrophy), which might mimic a condition in which abnormal cells are found on the surface of the cervix (cervical dysplasia).