Many trans people experience relief from the negative symptoms of gender dysphoria through gender affirming strategies like transitioning. Some find social strategies like adopting new pronouns and a new name alleviates their symptoms, while for others, it’s not enough. Physical gender affirming strategies might include surgeries but often begins first with hormone therapy.
Hormone therapy is the first step in affirming one’s gender physically.
The Role of Hormones
Hormones play a crucial role in the function of the human body; specifically, they aid in the development and maintenance of the sex characteristics known to separate males from females. For a brief explanation of hormones, please read our previous article, Feminizing Hormone Therapy. Having a basic understanding of the role of hormones is crucial to understanding the therapy options available.
Puberty and Secondary Sex Characteristics
Trans men are born with primary female sex characteristics which begin to evolve, eventually maturing during puberty. During infancy and pre-pubescent childhood, female primary sex characteristics develop; these include the development of ovaries, fallopian tubes, uterus, cervix, vagina, and the clitoris.
For trans men, puberty, unless halted through the administration of puberty blockers, generally begins between 8-13 years of age. Puberty, the catalyst for the development of secondary sex characteristics, occurs over a period of a year and a half and might take as long as six years.
As in male-bodied persons, profound changes also occur for female-bodied children during puberty. The breasts begin to grow, pubic hair and underarm hair begins to grow. A growth spurt is common with the head, hands, and feet being the first things to grow. Acne begins. Puberty also coincides with the beginning of menstruation.
Where cis-gender children feel aligned with their sex and gender, transgender children have primary sex characteristics which are misaligned from their gender. For example, trans males have a strong desire to identify as male. As such, impending puberty is especially stressful for transgender children.
While some children might be prescribed puberty blockers, preventing the development of unwanted secondary sex characteristics becomes a primary motivation for trans children, particularly when they reach puberty. In one article a trans individual reported that “The parts of our bodies that are the most dysphoric need the most tenderness and love.” Thus, to cope with the dysphoria, transgender children become creative in their efforts to hide their secondary sex characteristics.
Those feeling dysphoric about their female parts because they identify as male, may compress their breasts through binding and taping. They might also wear undergarments that have room for a prosthetic penis or stuffing material to visually mimic the gender with which they identify. These creative strategies are most necessary before hormone therapy and potential gender-affirming surgeries.
Hormone therapy is specific for feminizing or masculinizing. In masculinizing hormone therapy, the existing female sex characteristics are minimized in order to enhance masculine characteristics. Where testosterone is blocked before feminizing, estrogen (the primary female hormone) does not require blocking before the administration of testosterone. The combination of prescribed hormones (including dosages) is highly individual and should be determined under the guidance of a physician only.
Unless otherwise noted, the following information is from Trans Care BC:
Common combinations of masculinizing hormone therapy include various forms of testosterone which vary in cost, administration type, and related advantages and disadvantages.
More commonly known as testosterone cypionate or testosterone enanthate, injectable testosterone is administered once per week or once every other week. Injectable testosterone is readily accessible costing roughly 10 CAN per month. As testosterone is known to impact mood, significant swings in mood are possible.
Androderm is a testosterone patch worn daily on the back, upper arm, thigh or stomach. The release of testosterone is constant when compared to other forms of administration; this is thought to even out swings in mood. Disadvantages include the cost which is 130CAN per month in addition to some who are allergic to the adhesive.
Known sometimes by one of its brand names, Androgel, this testosterone gel or cream is applied to the skin, once per day. Like Androderm, Androgel is also fairly expensive at 130CAN per month. As a topical gel or cream, skin to skin contact with another person threatens exposure to another person. Being that it’s released at a constant rate though, one’s mood is more likely to be constant, avoiding the high and lows associated with other types of administration.
Perhaps one of the least effective and least safe methods of administration is oral testosterone, or testosterone undecanoate, which is a pill taken daily. Monthly menstrual cycle bleeding does not always stop with this form of testosterone. Additionally, it’s costly at 130CAN per month. Although, it’s released into the body at a somewhat constant rate, it is felt to be less safe.
Expected Effects of Masculinizing Hormone Therapy
Hormone therapy is specific for either feminizing or masculinizing. In feminizing hormone therapy, the existing male sex characteristics are minimized with the goal of enhancing female sex characteristics. Existing male sex characteristics are blocked using testosterone blockers with female sex characteristics enhanced or developed through estrogen and possibly progesterone. The combination of prescribed hormones—including dosages—is highly individual and should be determined under the guidance of a physician only.
The clitoris begins to grow within 3-6 months, reaching its full size (1-3 centimetres) in 1-2 years. However, upon ceasing hormone therapy, the change in size will remain.
Increased Facial and Body Hair
While not always true, for most people the increase in both the thickness and amount of hair is likely permanent even upon cessation of hormone therapy. Over a course of 3-6 months of treatment, hair will increase and become coarser, and the maximum change realized after 3-5 years. It is expected a beard and mustache will develop along with thicker hair on the abdomen, arms, chest, back and legs.
Male Pattern Baldness
Beginning in less than12 months, those taking testosterone will begin to lose hair at the temples and crown of the head. For some, complete hair loss is possible. While medications are available to help minimize baldness, most changes are permanent even in the absence of hormone therapy.
A permanent deeper voice takes 1-2 years and begins to deepen within 3-6 months of starting hormones. While the Adam’s Apple is often thought to correlate to a deeper voice, it will not enlarge through hormone therapy.
Increased Sex Drive
Hormone therapy involving testosterone is known to increase one’s libido. Libido ramps up in 1-3 months and will drop off again following cessation of hormone therapy.
Cessation of Monthly Bleeding
Though monthly bleeding may stop in 2-6 months, the risk of pregnancy is still possible. As noted above, the effective cessation of monthly bleeding can depend on the type of testosterone.
Oily Skin and Acne
Trans men taking testosterone may see an effect like that seen in cis-male teenagers who have reached puberty. Common is oilier skin, acne generally occurs within 1-6 months, with the maximum impact seen in 1-2 years. Thankfully, medications are available to combat acne.
More Strength and Muscle Mass
Strength and muscle mass increasing in 6-12 months, with the maximum effect seen in 2-5 years.
Redistribution of Body Fat
In 3-6 months, body fat begins to redistribute by leaving the butt, hips and thighs, and increasing in the abdomen. The maximum effect is seen in 2-5 years.
As mentioned previously, changes in mood are common with testosterone. The mood swings common with injectable testosterone are thought to correlate to the testosterone levels in the body. While some changes in mood are common, those which cause concern should be discussed with a physician immediately.
Potential Risks of Hormone Therapies
There are a variety of risks posed to those pursuing hormone therapy. The risks are broken into likely increased risks, possible increased risks, possible increase risk in the presence of other risk factors, and no increased risk or inconclusive research. This is not an exhaustive list, and there are likely additional risks to consider.
Those taking Masculinizing Hormone Therapy are likely to have an increased risk for:
- A blood disorder known as polycythemia
- Weight gain
- Balding (formerly known as androgenic alopecia)
- Sleep Apnea
There is the possibility of the following risks:
- Elevated liver enzymes
- Hyperlipidemia (essentially meaning, higher level of lipids including fats, cholesterol and triglycerides circulating in the blood)
For those with certain existing risk factors, there is the possibility of increased risk for:
- Destabilization of psychiatric disorders
- Cardiovascular disease
- High blood pressure (hypertension)
- Type 2 Diabetes
The following risks appear to have no increase, or there is generally inconclusive research regarding them:
- Loss of bone density
- Breast cancer
- Cervical cancer
- Ovarian cancer
- Uterine cancer
The Bottom Line
Masculinizing hormone therapy is meant to create gender congruence by aligning one’s gender identity with their body. As the risks of hormone therapy should be cautiously weighed, there are certainly benefits too. The greatest advantage is the diminishing of gender dysphoria symptoms, which leads to a decrease in psychological and emotional distress. Additionally, the ability to function both socially and psychologically is thought to improve. The most important part of hormone treatments is the increase in one’s overall well-being, self-esteem, and ultimately their quality of life. Both advantages and potential risks should be discussed at length with a reputable physician.