Masculinizing hormone therapy: Difference between revisions
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[[Masculinizing hormone therapy]], also called masculinizing hormone replacement therapy, androgen hormone therapy, transgender hormone therapy of the masculinizing type, transmasculine hormone therapy, or female-to-male (FTM) hormone therapy, is a form of [[hormone therapy]] or hormone replacement therapy (HRT). Masculinizing hormone therapy means taking certain kinds of medicine to make a person physically look, sound, and even smell masculine, so that one is generally seen as a [[man]] by most people. | [[Masculinizing hormone therapy]], also called masculinizing hormone replacement therapy, androgen hormone therapy, transgender hormone therapy of the masculinizing type, transmasculine hormone therapy, or female-to-male (FTM) hormone therapy, is a form of [[hormone therapy]] or hormone replacement therapy (HRT). Masculinizing hormone therapy means taking certain kinds of medicine to make a person physically look, sound, and even smell masculine, so that one is generally seen as a [[man]] by most people. | ||
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Some other kinds of people who do not necessarily consider themselves trans-masculine may go on masculinizing hormone therapy, such as some [[intersex]] people, and people who were [[sexes#assigned male at birth|assigned male at birth]] who have had their [[orchiectomy|testicles removed]] (which can be due to illness, injury, or gender dysphoria). Members of these two groups may or may not consider themselves transgender. For this reason, this article usually uses the language "masculinizing HRT" rather than terms that could exclude these groups. | Some other kinds of people who do not necessarily consider themselves trans-masculine may go on masculinizing hormone therapy, such as some [[intersex]] people, and people who were [[sexes#assigned male at birth|assigned male at birth]] who have had their [[orchiectomy|testicles removed]] (which can be due to illness, injury, or gender dysphoria). Members of these two groups may or may not consider themselves transgender. For this reason, this article usually uses the language "masculinizing HRT" rather than terms that could exclude these groups. | ||
The World Professional Association for Transgender Health (WPATH), which sets the standards for transgender care in all countries, says that HRT is "a medically necessary intervention for many transsexual, transgender, and gender-nonconforming individuals with gender dysphoria [...] Some people seek maximum feminization/masculinization, while others experience relief with an androgynous presentation resulting from hormonal minimization of existing secondary sex characteristics".<ref name="soc 33-34">World Professional Association for Transgender Health. ''The Standards of Care,'' version 7. 2012. Page 33-34. https://wpath.org/publications/soc</ref> | The World Professional Association for Transgender Health (WPATH), which sets the standards for transgender care in all countries, says that HRT is "a medically necessary intervention for many transsexual, transgender, and gender-nonconforming individuals with gender dysphoria [...] Some people seek maximum feminization/masculinization, while others experience relief with an androgynous presentation resulting from hormonal minimization of existing secondary sex characteristics".<ref name="soc 33-34">World Professional Association for Transgender Health. ''The Standards of Care,'' version 7. 2012. Page 33-34. https://wpath.org/publications/soc [https://web.archive.org/web/20230306101047/https://www.wpath.org/publications/soc Archived] on 17 July 2023</ref> | ||
==Effects of masculinizing hormone therapy== | ==Effects of masculinizing hormone therapy== | ||
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===Voice deepening=== | ===Voice deepening=== | ||
Most individuals on testosterone will experience a gradual deepening of the voice,<ref name="soc 36">World Professional Association for Transgender Health. ''The Standards of Care,'' version 7. 2012. Page 36. https://wpath.org/publications/soc</ref> caused by growth of the larynx (voice box). In most cases, this begins after 3 to 12 months, and finished after 1 to 2 years.<ref name="soc 37" /> | Most individuals on testosterone will experience a gradual deepening of the voice,<ref name="soc 36">World Professional Association for Transgender Health. ''The Standards of Care,'' version 7. 2012. Page 36. https://wpath.org/publications/soc [https://web.archive.org/web/20230306101047/https://www.wpath.org/publications/soc Archived] on 17 July 2023</ref> caused by growth of the larynx (voice box). In most cases, this begins after 3 to 12 months, and finished after 1 to 2 years.<ref name="soc 37" /> The changes are permanent, meaning a trans-masculine person's voice will stay as low as it got even if they stop taking HRT. Many individuals who do not want the full effect of voice deepening will take testosterone until their voice deepens to their desired resonance and then stop. | ||
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====Acne==== | ====Acne==== | ||
The WPATH says that masculinizing HRT causes a likely increased risk of [[acne]].<ref name="soc 40">World Professional Association for Transgender Health. ''The Standards of Care,'' version 7. 2012. Page 40. https://wpath.org/publications/soc</ref> Acne is generally worse during only the first two years of testosterone therapy, as with 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. | The WPATH says that masculinizing HRT causes a likely increased risk of [[acne]].<ref name="soc 40">World Professional Association for Transgender Health. ''The Standards of Care,'' version 7. 2012. Page 40. https://wpath.org/publications/soc [https://web.archive.org/web/20230306101047/https://www.wpath.org/publications/soc Archived] on 17 July 2023</ref> Acne is generally worse during only the first two years of testosterone therapy, as with 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. | ||
Increased skin oiliness and acne happens only when the person is first starting HRT, similar to how cisgender men have oiliness and acne during puberty. Trans-masculine people usually see oiliness and acne start in 1 to 6 months of starting HRT. Then the oiliness and acne usually goes away after 1 to 2 years of HRT.<ref name="soc 37">World Professional Association for Transgender Health. ''The Standards of Care,'' version 7. 2012. Page 37. https://wpath.org/publications/soc</ref> | Increased skin oiliness and acne happens only when the person is first starting HRT, similar to how cisgender men have oiliness and acne during puberty. Trans-masculine people usually see oiliness and acne start in 1 to 6 months of starting HRT. Then the oiliness and acne usually goes away after 1 to 2 years of HRT.<ref name="soc 37">World Professional Association for Transgender Health. ''The Standards of Care,'' version 7. 2012. Page 37. https://wpath.org/publications/soc [https://web.archive.org/web/20230306101047/https://www.wpath.org/publications/soc Archived] on 17 July 2023</ref> | ||
===Hair changes=== | ===Hair changes=== | ||
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If a transgender man is planning on having a hysterectomy/oophorectomy, future reproduction may still be preserved by: | If a transgender man is planning on having a hysterectomy/oophorectomy, future reproduction may still be preserved by: | ||
* Oocyte banking. Hormonal 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. | * Oocyte banking. Hormonal 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 banking. Oocyte 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. | * Embryo banking. Oocyte 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. | * 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. | ||
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====Question of relationship with PCOS==== | ====Question of relationship with PCOS==== | ||
[[Polycystic ovary syndrome]] (PCOS), also called polycystic ovarian syndrome, is a set of symptoms with no known cause,<ref name=Fauser2011>Page 836 (Section:''Polycystic ovary syndrome'') in: {{cite journal | vauthors = Fauser BC, Diedrich K, Bouchard P, Domínguez F, Matzuk M, Franks S, Hamamah S, Simón C, Devroey P, Ezcurra D, Howles CM | title = Contemporary genetic technologies and female reproduction | journal = Hum. Reprod. Update | volume = 17 | issue = 6 | pages = 829–47 | year = 2011 | pmid = 21896560 | doi = 10.1093/humupd/dmr033 | pmc=3191938}}</ref><ref name=FertSter_molecular>{{cite journal | vauthors = Legro RS, Strauss JF | title = Molecular progress in infertility: polycystic ovary syndrome | journal = Fertil. Steril. | volume = 78 | issue = 3 | pages = 569–76 | year = 2002 | pmid = 12215335 | doi = 10.1016/S0015-0282(02)03275-2 }}</ref> and no known cure as of 2020.<ref name=NIH2013Cure>{{cite web|title=Is there a cure for PCOS?|url=http://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/cure.aspx|website=US Department of Health and Human Services, National Institutes of Health|accessdate=13 March 2015|date=2013-05-23|url-status=live|archiveurl=https://web.archive.org/web/20150405021527/http://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/cure.aspx|archivedate=5 April 2015}}</ref> It correlates with high testosterone levels in people who were assigned female at birth. <ref name=NIH2017Def>{{cite web|title=Polycystic Ovary Syndrome (PCOS): Condition Information |url=https://www.nichd.nih.gov/health/topics/pcos/conditioninfo|publisher=National Institute of Child Health and Human Development |accessdate=19 November 2018|date=January 31, 2017}}</ref><ref>{{cite web|title=Polycystic ovary syndrome (PCOS) fact sheet|url=http://womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html|website=Women's Health|accessdate=11 August 2016|date=December 23, 2014 |url-status=live|archiveurl=https://web.archive.org/web/20160812093306/http://womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html|archivedate=12 August 2016}}</ref> Diagnosis is based on two of the following three findings: no ovulation, high androgen levels, and ovarian cysts. Its symptoms are associated with high testosterone, such as growing extra body hair, menstrual problems, and fertility problems.<ref name="NIH2013Sym">{{cite web|url=http://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/symptoms.aspx|title=What are the symptoms of PCOS?|website=National Institute of Child Health and Human Development (NICHD)|format=05/23/2013|url-status=live|archiveurl=https://web.archive.org/web/20150303190314/http://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/symptoms.aspx|archivedate=3 March 2015|accessdate=13 March 2015}}</ref> Some people informally consider PCOS a [[intersex]] condition, even though PCOS usually develops later in life, rather than at birth, as most intersex conditions do. PCOS itself is not harmful, unless if the androgenic symptoms are found distressing by the person who has them, but it does cause a higher risk of obesity, and therefore of Type II diabetes.<ref name=NIH2017Def/> Treatment for PCOS involves lifestyle changes and medications to reduce those risks. For cisgender women, some treatments for PCOS aim to undo masculinization, but that is not desirable to undo for trans-masculine people. | [[Polycystic ovary syndrome]] (PCOS), also called polycystic ovarian syndrome, is a set of symptoms with no known cause,<ref name=Fauser2011>Page 836 (Section:''Polycystic ovary syndrome'') in: {{cite journal | vauthors = Fauser BC, Diedrich K, Bouchard P, Domínguez F, Matzuk M, Franks S, Hamamah S, Simón C, Devroey P, Ezcurra D, Howles CM | title = Contemporary genetic technologies and female reproduction | journal = Hum. Reprod. Update | volume = 17 | issue = 6 | pages = 829–47 | year = 2011 | pmid = 21896560 | doi = 10.1093/humupd/dmr033 | pmc=3191938}}</ref><ref name=FertSter_molecular>{{cite journal | vauthors = Legro RS, Strauss JF | title = Molecular progress in infertility: polycystic ovary syndrome | journal = Fertil. Steril. | volume = 78 | issue = 3 | pages = 569–76 | year = 2002 | pmid = 12215335 | doi = 10.1016/S0015-0282(02)03275-2 }}</ref> and no known cure as of 2020.<ref name=NIH2013Cure>{{cite web|title=Is there a cure for PCOS?|url=http://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/cure.aspx|website=US Department of Health and Human Services, National Institutes of Health|accessdate=13 March 2015|date=2013-05-23|url-status=live|archiveurl=https://web.archive.org/web/20150405021527/http://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/cure.aspx|archivedate=5 April 2015|archive-url=https://web.archive.org/web/20220605095616/http://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/cure.aspx|archive-date=17 July 2023}}</ref> It correlates with high testosterone levels in people who were assigned female at birth. <ref name=NIH2017Def>{{cite web|title=Polycystic Ovary Syndrome (PCOS): Condition Information |url=https://www.nichd.nih.gov/health/topics/pcos/conditioninfo|publisher=National Institute of Child Health and Human Development |accessdate=19 November 2018|date=January 31, 2017|archive-url=https://web.archive.org/web/20230307033416/https://www.nichd.nih.gov/health/topics/pcos/conditioninfo|archive-date=17 July 2023}}</ref><ref>{{cite web|title=Polycystic ovary syndrome (PCOS) fact sheet|url=http://womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html|website=Women's Health|accessdate=11 August 2016|date=December 23, 2014 |url-status=live|archiveurl=https://web.archive.org/web/20160812093306/http://womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html|archivedate=12 August 2016|archive-url=https://web.archive.org/web/20230529134920/https://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html|archive-date=17 July 2023}}</ref> Diagnosis is based on two of the following three findings: no ovulation, high androgen levels, and ovarian cysts. Its symptoms are associated with high testosterone, such as growing extra body hair, menstrual problems, and fertility problems.<ref name="NIH2013Sym">{{cite web|url=http://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/symptoms.aspx|title=What are the symptoms of PCOS?|website=National Institute of Child Health and Human Development (NICHD)|format=05/23/2013|url-status=live|archiveurl=https://web.archive.org/web/20150303190314/http://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/symptoms.aspx|archivedate=3 March 2015|accessdate=13 March 2015|archive-url=https://web.archive.org/web/20220605095615/http://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/symptoms.aspx|archive-date=17 July 2023}}</ref> Some people informally consider PCOS a [[intersex]] condition, even though PCOS usually develops later in life, rather than at birth, as most intersex conditions do. PCOS itself is not harmful, unless if the androgenic symptoms are found distressing by the person who has them, but it does cause a higher risk of obesity, and therefore of Type II diabetes.<ref name=NIH2017Def/> Treatment for PCOS involves lifestyle changes and medications to reduce those risks. For cisgender women, some treatments for PCOS aim to undo masculinization, but that is not desirable to undo for trans-masculine people. | ||
The WPATH says that an increased prevalence of PCOS has been noted among trans-masculine people, ''even in those who have never taken masculinizing hormone therapy'',<ref name="soc 45" /> according to studies from 1993,<ref name="Balen 1993">Balen, A. H., Schachter, M. E., Montgomery, D., Reid, R. W., & Jacobs, H. S. (1993). "Polycystic ovaries are a common finding in untreated female to male transsexuals." ''Clinical Endocrinology'', 38(3), 325-329. doi:10.1111/j.1365-2265.1993.tb01013.x</ref> | The WPATH says that an increased prevalence of PCOS has been noted among trans-masculine people, ''even in those who have never taken masculinizing hormone therapy'',<ref name="soc 45" /> according to studies from 1993,<ref name="Balen 1993">Balen, A. H., Schachter, M. E., Montgomery, D., Reid, R. W., & Jacobs, H. S. (1993). "Polycystic ovaries are a common finding in untreated female to male transsexuals." ''Clinical Endocrinology'', 38(3), 325-329. doi:10.1111/j.1365-2265.1993.tb01013.x</ref> | ||
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A 2006 study found that HRT in trans men correlates with in an increase in brain volume up to male proportions.<ref name="eje-utrecht">{{cite journal|author=Hulshoff, Cohen-Kettenis|date=July 2006|title=Changing your sex changes your brain: influences of testosterone and estrogen on adult human brain structure|url=http://www.eje-online.org/cgi/content/abstract/155/suppl_1/S107|journal=European Journal of Endocrinology|issue=suppl_1|pages=107–114|doi=10.1530/eje.1.02248|issn=0804-4643|volume=155|display-authors=1|last2=Cohen-Kettenis|first2=P. T|last3=Van Haren|first3=N. E M|last4=Peper|first4=J. S|last5=Brans|first5=R. G H|last6=Cahn|first6=W.|last7=Schnack|first7=H. G|last8=Gooren|first8=L. J G|last9=Kahn|first9=R. S|access-date=2007-12-12|archive-url=https://web.archive.org/web/20110411003628/http://www.eje-online.org/cgi/content/abstract/155/suppl_1/S107|archive-date=2011-04-11|url-status=dead|doi-access=free}}</ref> | A 2006 study found that HRT in trans men correlates with in an increase in brain volume up to male proportions.<ref name=&quo | ||