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Pediatric feminizing hormone therapy
What are the physical effects of pediatric feminizing hormone therapy?
Physical effects of feminizing hormone can involve testosterone blocking medication alone, estrogen medication alone, or testosterone blocking medication along with estrogen.
Most physical changes associated with feminizing 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).
TABLE 1: Effects and expected time course of feminizing hormones (print friendly version)
|
|
Expected |
Maximum |
Reversible? |
Comments |
|
Decreased sex drive |
1-3 mo |
1-2 yrs |
Yes |
|
|
Emotional changes |
1-3 mo |
|
Yes |
|
|
Fertility |
Varies |
|
Likely, although prolonged use may decrease fertility |
|
|
Decreased muscle mass/strength |
3-6 mo |
1-2 yrs |
Yes |
|
|
Breast growth |
3-6 mo |
2-3 yrs |
No, although atrophy of breast tissue may occur |
|
|
Decreased testicular volume |
3-6 mo |
2-3 yrs |
Maybe |
|
|
Body fat redistribution |
3-6 mo |
2-5 yrs |
Yes |
|
|
Skin softening |
3-6 mo |
|
Yes |
|
|
Face/body hair changes |
6-12 mo |
|
No |
|
Decreased Sex Drive
- Expected onset: 1-3 mo
- Madimum effect: 1-2 yrs
- Reversible?: Yes
- Comments:
- Fewer spontaneous and morning erections
- Can make penetrative sex more difficult as the insertive partner
Emotional changes
- Expected onset: 1-3 mo
- Reversible?: Yes
- Comments:
- Highly variable person to person
- May experience broader range of emotions
Fertility
- Expected onset: Varies
- Reversible?: Likely, although prolonged use may decrease fertility
- Comments:
- Less semen and ejaculatory fluid is produced
- Sperm may no longer reach maturity
- Ongoing birth control still recommended
Decreased muscle mass/strength
- Expected onset: 3-6 mo
- Maximum effect: 1-2 yrs
- Reversible?: Yes
- Comments:
- Depends on amount of exercise
Breast growth
- Expected onset: 3-6 mo
- Maximum effect: 2-3 yrs
- Reversible?: No, although atrophy of breast tissue may occur
- Comments:
- Size varies person to person and depends on inheritance
- Typically, A to B cup
Decreased testicular volume
- Expected onset: 3-6 mo
- Maximum effect: 2-3 yrs
- Reversible?: Maybe
- Comments:
- Testes shrink to approximately half of the initial size
Body fat redistribution
- Expected onset: 3-6 mo
- Maximum effect: 2-5 yrs
- Reversible?: Yes
- Comments:
- Less abdominal fat
- More fat in hips, thighs, buttocks
Skin softening
- Expected onset: 3-6 mo
- Reversible?: Yes
- Comments:
- Skin also becomes less oily
Face/body hair changes
- Expected onset: 6-12 mo
- Reversible?: No
- Comments:
- Hair follicles will continue to produce hair
- Hair may growth more slowly and be thinner/less noticeable
- Male pattern baldness may stop or slow down but hair already lost will likely not grow back
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 associate with masculinizing hormones
|
Increased risk likely |
Venous thromboembolic disease (blood clots) |
|
|
Hypertriglyceridemia (elevation of triglycerides in blood) |
|
|
|
Weight gain |
|
|
|
Elevated liver enzymes |
|
|
|
||
|
Increased risk likely with additional risk factors present |
Cardiovascular disease (heart disease) |
|
|
Possible increased risk |
Hypertension (high blood pressure) |
|
|
Hyperprolactinemia (elevated prolactin in blood) or prolactinoma (noncancerous pituitary gland tumor) |
|
|
|
Increased risk possible with additional risk factors present |
|
|
|
No increase risk |
Breast cancer |
|
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
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