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For men (identified female at birth)
testosterone therapy treatment, within a relatively
short period of time (usually twelve months or
less), can cause visible, reversible and
irreversible male secondary sexual development.
Depending on your
age,
genetics
and general
health as well as the
dosage and
method of testosterone delivery,
there is often some variability in the following
effects.
Body Hair
[This effect is
permanent] Body hair will increase
in both extent and coarseness with full development
taking place over a number of years depending on
genetic factors.
The rate and extent of body hair development
will be determined by the genetic heritage which
will greatly influence the amount of hair that
grows, the colour, its texture and location on the
body. Older biological male relatives are the best
indicator of body hair pattern the individual is
most likely to develop (Gooren, 1999).
Body Odours (skin and urine)
Odours tend to become less "sweet" or "musky"
and more "tangy" or "metallic."
Body Shape
Over time, the female pattern of carrying body
fat on the hips, buttocks and upper thighs moves to
that of the male pattern where body fat usually
accumulates around the mid-torso.
People who stop taking their testosterone
medication for whatever reasons, often find this
pattern reverts reasonably rapidly the female
pattern again.
Bones
These do not change dramatically. If the
individual is still growing (at the time of
starting testosterone therapy), sometimes the
hormone can affect bone development like other
young men of a similar age. Overall, the bones of
the skull, hands, feet, chest and hips do not
alter.
There are anecdotal reports from people who
began testosterone during their late teens or early
twenties of an increase in shoe size or other
unexpected growth spurts. Changes for older
individuals are likely due to ligament tissues
around the joints and bones and a growth in muscle
bulk, than any changes to bones themselves.
Testosterone treatment protects the bones from
the deleterious effects of estrogen deficiency.
Studies show increased cortical thickness and
density of the bone suggesting an anabolic effect
of the testosterone on the bones (Turner et al.,
2004; Synder et al., 2000).
The main concern for all aging men and women, is
the risk of osteoporosis. Osteoporosis is a gradual
thinning of bone-mass, which can lead to fragile
bones in older age. Bones are assisted by a calcium
rich diet, regular exercise and not smoking.
Breasts
These do not significantly alter due to hormone
therapy alone (Gooren, 1999). A slight reduction in
size has been reported and this can occur due to an
initial loss of breast fat as body fat moves to the
male pattern of storing fat in the body.
Emotions
Some people report mood swings either when they
begin hormone treatment or during treatment.
Two of the most common emotions are
uncharacteristic feelings of aggression when
starting testosterone and an increase in libido
(sexual urge or desire). Either can indicate an
adjustment of the dose is necessary, by the
treating doctor. Blood tests comparing an
individual's testosterone levels with the average
male testosterone range will show if this is the
case.
Many men report an increased feeling of well
being and a 'calming-down' of their emotions. This
is thought to be due to increased satisfaction with
their physical appearance as physical changes
become evident to others.
Beginning testosterone therapy is an exciting
time, holding a mixture of emotions, positive and
negative as men interact with workmates, family and
friends in their wider social community. It's also
a strange new time; aches, pains, muscle tinges,
changes, low energy, high energy, moodiness, funny
feelings and all. (Know any teenagers?)
Facial Hair
[This effect is
permanent] The development of facial
hair largely depends on individual biological
family traits, ethnic origin and genetic makeup. It
also depends on the maintenance dose of
testosterone. Hair development follows that
observed in pubertal boys - the upper lip, the
cheeks and the chin and so on (Gooren, 1999).
Men of Asian descent usually experience much
less facial hair growth than Caucasian men who
usually develop less facial hair than men of
Italian or Greek genetic heritage.
Fertility
[This effect is
permanent] The ovaries will stop
working, eventually resulting in permanent
sterility. Cessation of menstruation usually occurs
within three months of testosterone treatment. If
menstruation has not ceased within five months of
testosterone therapy it is important for the
individual to consult with a gynaecologist.
Many individuals report brief "hot flashes" (in
the first few months of treatment) similar to
menopause symptoms. After these changes, ovaries no
longer produce effective quantities of oestrogen
(female) hormones. Fertility changes will differ
from person to person, so any fertility concerns
should be addressed prior to treatment.
Genitals
[This effect is
permanent] Amongst the first
noticeable changes is clitoral enlargement, to
varying degrees in all men. There are reports of
between 3 and 8 cm when erect and sensitivity
increases. For some men, the size becomes
sufficient for penetration with a female partner
(Gooren, 1999). If receptive intercourse is part of
an individual's sexual behaviour, vaginal
intercourse can become difficult and painful as the
vaginal tissues usually become drier, less flexible
and more fragile. If an unexpected blood loss
occurs from the vagina at any time, the individual
should immediately report this to the treating
doctor for investigation.
Libido (Sex drive)
Some individuals report an increase in libido
when starting testosterone treatment. Other people
report a decrease and others notice no change.
Male Pattern Baldness
[This effect is
permanent] If older male biological
relatives are bald, there is a high likelihood this
will affect the individual after several years of
treatment. Male pattern baldness regularly occurs
in men treated with testosterone. Baldness can
usually be predicted from the degree and pattern in
uncles on the biological mother's side of the
family.
Metabolism Increases
Most men report an increase in their metabolic
rate and appetite. While studies report a reduction
of subcutaneous fat they also report an increase of
abdominal fat storage (Gooren, 1999). About 10% of
individuals gain excess weight after beginning
testosterone therapy (Elbers., et al, 1997). Many
men gain weight due to the increased muscle mass
and calorie intake. Unless a conscious balance is
maintained between exercise and food intake, weight
gain is inevitable.
Individuals have reported metabolic-related
changes such as an increase in energy, less sleep
demands, slightly higher body temperature, and
generally feeling more alert.
Muscles
[This effect is
permanent] The effects of
testosterone are both androgenic (responsible for
the development of male sexual characteristics) and
anabolic (helps to build and repair muscle
tissue).
Anabolic effects mean that muscles will develop
according to male family traits and enhanced by
exercise. Muscle mass, especially around the
shoulders, neck and chest can increase slightly
with little effort.
Ovaries
Ovarian changes occur which are
indistinguishable from polycystic ovaries (Gooren,
1999).
Skin Changes
As oil and sweat glands become more active,
changes occur in the skin of the face and body.
Acne results in up to 40% of individuals evidenced
mainly on the back (Gooren, 1999; Giltay &
Gooren, 2000) which is similar to the case of
hypogonadal men who start androgen treatment past
the age of normal puberty (Gooren, 1999; Van
Kesteren et al., 1997). These changes increase the
body's ability to sweat.
The layer of fat just under the skin,
characteristic of the female body, diminishes
slowly over many months.
Voice
[This effect is
permanent] As vocal cords thicken,
the voice is deepened gradually within the early
months of therapy (occurs after six to twelve
weeks) (Gooren, 1999). This effect is related to
biological family traits and genetic makeup. Many
individuals report this continuing over the
following years.
SUMMARY
Reversible effects
- male-pattern fat distribution throughout the
body;
- acne (especially in the first few years of
therapy);
- increased upper body strength and over-all
muscle density;
- alterations in blood lipids (cholesterol and
triglycerides);
- prominence of veins and coarser skin
(depending on genetic traits);
- fertility cycle (reversible for some
individuals); and
- oestrogen production (reversible for few
individuals).
(HBIGDA, SOC6, 2001)
Irreversible Effects (Permanent)
- deepening of the voice;
- body hair development;
- increased facial hair, after the same
pattern observed in pubertal boys;
- male pattern baldness (if it runs in the
family);
- fertility cycle (irreversible over
time);
- cessation of menstrual activity within three
months for over 90% of individuals;
- mild breast atrophy (due to loss of
fat);
- oestrogen production ceases over time;
- clitoral enlargement to varying degrees;
and
- muscle development and conditioning
(especially upper body).
(Asscheman and Gooren, 1992; HBIGDA, SOC6, 2001;
Kirk, S., 1994; Meyer & Reiter, 1979; Meyer et
al., 1986)
Note on Mitigating Factors
The effects of testosterone hormone treatment
are moderated due to many factors such as age at
commencement of treatment, general health, dosage
and frequency of treatment, use of recreational
drugs, substance abuse, smoking, alcohol
consumption and the use of antipsychotic
medication.
References
- Asscheman H
and Gooren, L J G (1992) Hormone treatment in
transsexuals, Journal of Psychology &
Human Sexuality, 5 pp. 39-54. Available from
http://www.transgendercare.com/medical/hormonal/hormone-tx_assch_gooren.htm
[Accessed June 19, 2006].
- Elbers J M H,
Asscheman H, Seidell J C, Megens J A J and
Gooren L JG (1997) Long-Term Testosterone
Administration Increases Visceral Fat in Female
to Male Transsexuals, The Journal of Clinical
Endocrinology & Metabolism, 82(7)
2044-2047. Available from http://jcem.endojournals.org/cgi/content/abstract/82/7/2044
[Accessed 14 June 2005].
- Gooren L G J
(1999) Hormonal Sex Reassignment. IJT
3(3), Available from http://www.symposion.com/ijt/ijt990301.htm
[Accessed June 15, 2005].
- Harry
Benjamin International Gender Dysphoria
Association. (n.d./2001) The standards of care:
The hormonal and surgical sex reassignment of
gender dysphoric persons. [online]
Minneapolis, USA. Available from
http://www.hbigda.org/
[Accessed 1 March 2003].
- Kirk S M D
(1994) Hormones for the female to male
Transgender Individual, Massachusetts, USA,
IFGE Publications.
- Meyer J K,
and Reiter D J (1979) Sex reassignment
follow-up. Archives of General
Psychiatry, 36, pp.1010-1015.
- Meyer W J
3rd, Finkelstein J W, Stuart C A, Webb A, Smith
E R, Payer A F, and Walker P A (1986). Physical
and hormonal evaluation of transsexual patients
during hormonal therapy. Archives of Sexual
Behavior, 15(2), pp.121-138.
- Snyder PJ.,
Peachey H., Berlin JA., Hannoush P., Haddad G.,
Dlewati A., Santanna J., Loh L., Lenrow DA.,
Holmes JH., Kapoor SC., Atkinson LE., and Strom
BL. (2000). Effects of testosterone replacement
in hypogonadal men. J Clin Endocrinol
Metab. 85(8):2670-7.
- Turner, A,
Chen, Tai C, Barber, T W, Malabanan, A O,
Holick, M F, and Tangpricha, V (2004)
Testosterone increases bone mineral density in
female-to-male transsexuals: a case series of 15
subjects. Clinical Endocrinology. 61(5),
pp.560-566.
- van Kesteren
P, Lips P, Gooren L J G, Asscheman H, Megens J
(1998) Long-term follow-up of bone mineral
density and bone metabolism in transsexuals
treated with cross-sex hormones. Clinical
Endocrinology. 48(3),
pp.347-354.
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Masculinising Effects of Testosterone
