The main effects of HRT of the FTM type are as follows: ; Reversible changes: * Increased libido * Redistribution of body fat * Cessation of ovulation and menstruation * Increased musculature * Increased sweat and changes in body odor * Prominence of veins and coarser skin * Acne (especially in the first few years of therapy) * Alterations in blood lipids (cholesterol and triglycerides) * Increased red blood cell count ; Irreversible changes: * Deepening of the voice * Growth of facial and body hair * Male-pattern baldness (in some individuals) * Enlargement of the clitoris * Growth spurt and closure of growth plates if given before the end of puberty * Breast atrophy – possible shrinking and/or softening of breasts Many transgender men are unable to pass as cisgender men without<unk> s. The most commonly cited reason for this is that their voice may reveal them. Physical changes Skin changes * Increased activity of oil and sweat glands. * Change in body odorless sweet and musky, more metallic and acrid. * If severe odor is a problem, an antibacterial soap like chlorhexidine may be used in the armpits when showering. After 1–2 weeks of daily use, a noticeable decrease in odor should occur. * Acne: generally worse the first few years of testosterone therapy (mimicking a second puberty). Can be treated with standard acne therapy. Initial treatment is with increased cleansing (at least twice daily) with an anti-acne or oil reducing scrub. If this doesn't work, additional therapy may be prescribed by a physician. * Some physicians see acne as a contraindication to increasing testosterone dose. Hair changes * The action of testosterone on hair follicles is mainly due to the more potent androgen, dihydrotestosterone, DHT. * With androgen therapy, genetics primarily determines how much hair will develop (and where) as well as whether male pattern baldness will develop. * Testosterone is converted (within the cells of the hair follicle's dermal papilla) by 5α-reductase to DHT. There are two forms of this enzyme: type 1 and 2. However, type 2 is the form that is most important to the development of male pattern hair loss. Males with congenital 5α-reductase type 2 deficiency (but functional 5α-reductase type 1) never develop male-pattern hair loss. Facial changes Facial changes develop gradually over time, and sexual dimorphism (physical difference between the sexes) tends to increase with age. Within a population of similar body size and ethnicity: * Brow: Males tend to develop heavier bony brows than females, thus HRT results in a more prominent brow. * Cheeks: Female cheeks tend to be fuller and more rounded. Under the influence of estrogen, fat is deposited beneath the skin and overall facial and body contours become softer. This is reversed by androgens, resulting in a male-type fat distribution after<unk>  therapy. * Nose: The tips of the nasal bones tend to grow more in males than females, creating a larger (longer or wider) nose. Thus, androgens result in the development of the nose. * Jaw: The jaw in males tends to grow wider and more deeply sculptured than in females, thus the jaw widens under androgens. * Larynx: At puberty, the bones and cartilage of the voicebox tend to enlarge less in females than males. In most males, the larynx becomes visible as a bony "Adam's apple," which is developed in transgender men under<unk>  therapy. * Lips: Females, tend to have thicker, fleshier lips than males of the same size due to estrogen. Thus, after being administered androgens, transgender men may have a fat redistribution that results in smaller lips. Gynecological changes * Menses should cease within 5 months of testosterone therapy (often sooner). If bleeding continues past 5 months, transgender men are strongly encouraged to see a gynecologist. * Clitoromegaly occurs, and frequently reaches its apex within 2–3 years of therapy. Sizes generally range from 3–8 cm with 4–5 cm being about average. This is genetically determined, but some physicians advocate topical clitoral testosterone as an adjunct to growth before metoidioplasty. However, this testosterone is absorbed and should be calculated into one's total regimen. * After long-term androgen therapy, ovaries may develop polycystic ovary syndrome (PCOS) morphology. (In both PCOS and transgender men there is an up-regulation of testosterone receptors in the ovaries.) * Untreated PCOS is associated with a possibly increased risk of endometrial cancer as well as decreased fertility. * It is unknown whether the risk of ovarian cancer is increased, decreased or unchanged in transgender men compared to women. It is unlikely to be determined in the near future because ovarian cancer is a relatively rare disease and the population of transgender men is too small to do the appropriate study. However, it has been recommended by some physicians that transgender men have an oophorectomy within 2–5 years of starting androgen therapy due to the possible increased risk. (Note: Testosterone dose can frequently be decreased after oophorectomy.) * The risk of endometrial cancer is similarly unknown. A large multicenter study along with review of previous studies, noted no increased prevalence of endometrial hyperplasia or malignancy in transgender men undergoing hysterectomy. However while the endometrial linings in these studies were noted to be thin, they remained histologically active. Frequently the first sign of endometrial cancer is bleeding in post-menopausal women. Transgender men who have any bleeding after the cessation of menses with androgen therapy should be evaluated for age appropriate causes of abnormal uterine bleeding as per cisgender female guidelines. * Adults with a uterus/cervix are advised to have a Pap smear per guidelines (Human papillomavirus infection). Use of testosterone is no exception to this rule. * Some transgender men report a decrease in breast size with androgen therapy. However, no morphological changes were found when this was studied and likely it is due to loss of fat in the breasts. * Androgen therapy (and suppression of estrogen production) may cause vaginal atrophy and dryness, which may result in dyspareunia (painful vaginal intercourse). This can be alleviated with topical estrogen cream. * Most transgender men report a significantly increased libido. Some report that this decreases somewhat after several years on testosterone. * While testosterone decreases ovulation, it is not an approved form of contraception; transgender men who engage in sex which places them at risk for pregnancy should be counseled on utilizing concomminant contraception. All contraceptive methods are acceptable for use. Reproductive changes * As the age at which transgender people begin therapy decreases, retention of reproductive potential may become more important to some. * If a transgender man has not undergone hysterectomy and oophorectomy, he may regain fertility on cessation of testosterone. With the ovarian changes of long-term androgen therapy, however, it may require months of cessation of testosterone and possibly assistive reproductive technology to become pregnant. Testosterone must be withheld for the duration of pregnancy. * If a transgender man is planning on having a hysterectomy/oophorectomy, future reproduction may still be preserved by: * Oocyte bankinghormonal stimulation to ‘hyper-ovulate’ with transvaginal oocyte harvest for freezing. Previously using the "slow-freezing" cryopreservation method there were very poor survival rates of banked oocytes. However, the advent of vitrification, a rapid freezing process, has made oocyte cryopreservation a viable option for fertility preservation. It allows the possibility for eggs to later be fertilized and be placed in a surrogate, as opposed to a transgender man having to carry the pregnancy himself. * Embryo bankingoocyte harvest as above with immediate fertilization and banking of the embryo. The sperm donor must be chosen before oophorectomy. Allows the possibility for embryos to later be placed in a surrogate, as opposed to a transgender man having to carry the pregnancy himself. * Ovarian tissue banking Ovarian tissue is frozen after oophorectomy. Even after long-term androgen therapy, ovaries usually retain usable follicles. Eventual use of frozen ovaries will require replantation into the transgender man for stimulation and harvest, but may eventually be possible in a lab as techniques for tissue culture improve. This option does not usually allow for placement into a surrogate as it may require the use of immunosuppressants on the part of the surrogate. Unaffected characteristics A number of skeletal and cartilaginous changes take place after the onset of puberty at various rates and times. Sometime in the late teen years epiphyseal closure (in other words, the ends of bones are fused closed) takes place and the length of bones is fixed for life. Consequently, total height and the length of arms, legs, hands, and feet are not affected by HRT. However, details of bone shape change throughout life, bones becoming heavier and more deeply sculptured under the influence of testosterone. Many of these differences are described in the Desmond Morris book Manwatching. * Pelvis: The pelvis in females tends to be wider than in males and tilted forward; the pelvis in males tends to be more circular and tilted upwards. * Hands: Male hands and feet tend to be larger than female hands and feet in persons of equal height. * Upper Arm:
Masculinizing hormone therapy
Feminizing hormone therapy
Estrogen deprivation therapy
Androgen deprivation therapy
Antihormone therapy
Transgender hormone therapy
Bioidentical hormone replacement therapy
Androgen replacement therapy