Masculinizing Hormone Therapy

WHAT IS MASCULINIZING HORMONE THERAPY? Masculinizing hormone therapy, also known as “trans-masculine hormone therapy”, is a type of hormone therapy that is used to alter the secondary sexual characteristics of people from female to male. For this reason, it is also called female-to-male (FTM) hormone therapy. It is a gender-affirming therapy.  It includes medications that will increase testosterone levels in your body to affect masculinizing changes. Testosterone can be given in many different ways. The most common include injections or gels and patches. Each of these has different administrations and specific doses, as well as duration. PURPOSE OF MASCULINIZING HORMONE THERAPY The therapy is used to alter your hormone levels to match your gender identity. Many transgender-aspiring people desire the therapy.  Typically, it seems most transgender people have felt that they were born in the wrong body, especially since birth or at a very young age. Some people in this category resolve that medical intervention is needed to help alleviate those feelings (dysphoria).  Masculinizing hormone therapy is aimed at providing a way out for this group of people. It can:

• Improve the quality of life.
• Improve sexual fulfillment.
• Reduce the severity of gender dysphoria.
• Improve psychological and social usefulness.
• Alleviate psychological and emotional distress.

NON-CANDIDATES FOR MASCULINIZING HORMONE THERAPY Doctors discourage the therapy if you:

• Are aged 15 years and below.
• Had or have hormone-sensitive cancer, such as breast cancer.
• Are a pregnant or breastfeeding mother.
• Have uncontrolled behavioral health conditions.
• Have a thromboembolic disease, such as:
• Pulmonary embolism (blockage of a pulmonary artery in your lungs).
• Deep vein thrombosis (blood clot formation in one or more of the deep veins in your body).
• Experience uncontrolled significant medical conditions.
• Are faced with a condition that limits your ability to provide informed consent.

PREPARATION FOR MASCULINIZING HORMONE THERAPY When preparing for masculinizing hormone therapy:

• Let your doctor know if you are taking any other prescribed or over-the-counter medication because they might affect the masculinizing medication.
• Let your doctor know about your whole medical history.
• A review of your family medical history.
• A review of your immunizations.
• Know (from your doctor) about any other preparation you are expected to make before the testosterone therapy.
• The therapy might reduce your fertility. 

You will need to make decisions about your fertility. The risk of permanent infertility due to long-term use of the hormones proves non-abortive, especially when it is done before puberty age.

• A physical exam, including one to assess your external reproductive organs.
• Your doctor would like to know about your possible tobacco use, drug abuse, alcohol abuse, HIV and other STIs, etc, for proper management; if you have any.
• Engage the counsel of an expert in transgender health, to discuss:
• Gender dysphoria.
• Relationship abuse.
• Social discrimination.
• The risk of hormone therapy.
• The use of non-medical grade silicone injections.
• Unapproved hormone therapy or supplements.
• Lab tests, to measure your:
• Lipids.
• Blood sugar.
• Electrolytes.
• Blood count.
• Liver enzymes.
• A pregnancy test.

THE PROCEDURE

• Taking Testosterone.

These are given either by injection or a gel applied to the skin. Other types of testosterone preparations can be used, such as a patch or pallets placed under the skin.  Your doctor will prescribe a low FTM testosterone dosage, and slowly increase the dosage over a period of time. However, in the US, testosterone can be served as long-lasting injections or as twice-daily pills (testosterone undecanoate). Oral methyl-testosterone or synthetic male sex hormone (androgen) medication is harmful to one’s liver and lipids, and hence shouldn’t be used.

• Taking Progesterone.

Your doctor may recommend this, if you have persistent menstrual flow, to control it. AFTER-EFFECTS OF HORMONE ADMINISTRATION

• Ceasing of your period.

This will take place within 2─6 months of treatment.

• Voice deepening.

This will begin 3─12 months after treatment, with the maximum effect occurring within 1─2 years.

• Body fat redistribution.

This will begin within 3─6 months, with the maximum effect occurring within 2─5 years.

• Increased and coarseness in facial and body hair.

This begins 3─6 months after treatment, with the maximum effect occurring within 3─5 years.

• Enlargement of the clitoris and vaginal atrophy.

This begins 3─12 months after treatment, with the maximum effect occurring within 1─2 years.

• Increased muscle mass and strength.

This begins within 6─12 months after treatment, with the maximum effect occurring within 2─5 years. Other effects of testosterone FTM therapy include:

• Soreness at the injection site.
• Sleep apnea.
• Change to cholesterol profile (for example, lower HDL cholesterol).

RESULTS OF MASCULINIZING HORMONE THERAPY Your doctor will regularly meet with you to monitor the results of the masculinizing hormone therapy and to:

• Monitor and document your physical changes.
• Check your hormone concentrations, while using the lowest dose necessary to achieve desired physical effects.
• Enable him/her to monitor changes in your fasting blood sugar, blood count, lipids, liver enzyme, and electrolytes that might be caused by hormone therapy.
• Check your behavioral health.

FOLLOW-UP TESTS Other follow-up tests depending on your age and medical position include:

• Supplementation.
• Mammogram of your breast.
• Pelvic exam, a pup smear, or HPV test.
• Blood test.

This is done to determine your blood clotting profile, hormone, and STD screening, and to evaluate your vaginal bleeding. MEDICATIONS FOR MASCULINIZING HORMONE THERAPY

S/N	MEDICATIONS	BRAND NAME	DOSAGE
1.	Testosterone.	Androderm. Axiron. Testopel.	2.5─10mg/day
2.	Testosterone enanthate.	Delatestryl.	50─100mg once/week OR 100─250mg every 2─4 weeks.

RISKS ASSOCIATED WITH MASCULINIZING HORMONE THERAPY (FTM) It is important that you talk to your doctor about female-to-male (FTM) therapy complications before embarking on it. The risks associated with masculinizing hormone therapy include:

• Acne.
• Infertility.
• Pelvic pain.
• Weight gain.
• Sleep apnea.
• Type- 2 diabetes.
• Clitoral discomfort.
• Male-pattern baldness.
• Increasing cardiovascular risk.
• Hypertension (high blood pressure).
• Polycythemia (too many blood cells).
• Deep vein thrombosis and/or pulmonary embolism.
• Atrophic vaginitis (the drying and thinning of the vaginal lining).
• Development of an abnormal level of cholesterol and other lipids.

CONCLUSION Masculinizing hormone therapy (female-to-male therapy) is a gender-affirming therapy. Many persons desiring this therapy have felt that they were born in the wrong body, especially since birth or at a very young age, and as such wait a change to alleviate their dysphoria.  FTM (female-to-male) therapy is the goal of providing a way out, to improve their quality of life. It might reduce fertility or eliminate it. You’ll need to make decisions about your fertility before starting the treatment.  The risk of permanent infertility increases with the long-term use of hormones, particularly when hormone therapy is introduced before puberty.

Symptoms

How long can you take estrogen therapy?

Estrogen therapy lasts five years or less, but the duration can be individualized for each female. Only those women who have had their uterus removed can take estrogen.

Does testosterone therapy last for life?

Testosterone therapy is for life. If you stop taking testosterone, your testosterone levels will drop. Some men with low testosterone count decide not to be treated. They may fail other ways to increase their energy level, or they may decide to live with the changes in their sexual desire and body.

Are the effects of hormone therapy permanent?

In some ways, the effects of hormone therapy are not permanent, if you stop taking them. The degree to which they can be reversed depends on how long you have been taking testosterone. However, facial hair growth, clitoral growth, voice deepening, and male-pattern baldness are not reversible.

What does testosterone replacement therapy do?

TRT is a widely used treatment for men with symptomatic hypogonadism. The benefits seen with the therapy, such as increased libido and energy level, beneficial effects on bone density, strength, and muscle, as well as cardio-protective effects, have been well-documented.

What drugs are used for hormone replacement therapy?

Some women choose to treat their menopause symptoms with hormone medicines sometimes called hormone therapy. Estrogen-only medicines:

BRAND NAME	GENETIC NAME	PRODUCT TYPE
EstroGel	Estradiol	Gel
Evarnist	Estradiol	Skin spray (Transdermal)
Femring	Estradiol acetate	Vaginal ring
Femtrace	Estradiol acetate	Pill