Category:Masculinization

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[+] Masculinization Overview
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The Masculinization category contains a list of all our pages relevant to the phenomenon of masculinization, which can be useful for people wishing to research ways to masculinize themselves as well as those who wish to understand more about how puberty masculinizes the body.

This page also has a summary of some of the currently guidelines used to induce feminization through hormone replacement therapy.

If you wish to add a new article to the masculinization category you can do so simply by adding [[Category:Masculinization]] to the bottom of the page.


Masculinizing HRT Guidelines
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The following tables are compiled from our article on the Endocrine Society Guidelines and were originally transcribed from The journal article "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". Which is an up to date review on the clinical practice guidelines for the treatment of gender dysphoria.

Masculinizing Effects in Transgender Males[1][2][3][4]

Effect

Onset

Max

Skin oiliness/acne

1–6 mo

1–2 y

Facial/body hair growth

6–12 mo

4–5 y

Scalp hair loss

6–12 mo

a

Increased muscle mass/strength

6–12 mo

2–5 y

Change in body fat distribution

1–6 mo

2–5 y

Cessation of menses

1–6 mo

b

Clitoral enlargement

1–6 mo

1–2 y

Vaginal atrophy

1–6 mo

1–2 y

Deepening of voice

6–12 mo

1–2 y


aPrevention and treatment as recommended for biological men.
bMenorrhagia requires diagnosis and treatment by a gynecologist.


Masculinizing Effects in Transgender Males[1][2][3][4]

Effect

Onset

Max

Skin oiliness/acne

1–6 mo

1–2 y

Facial/body hair growth

6–12 mo

4–5 y

Scalp hair loss

6–12 mo

a

Increased muscle mass/strength

6–12 mo

2–5 y

Change in body fat distribution

1–6 mo

2–5 y

Cessation of menses

1–6 mo

b

Clitoral enlargement

1–6 mo

1–2 y

Vaginal atrophy

1–6 mo

1–2 y

Deepening of voice

6–12 mo

1–2 y


aPrevention and treatment as recommended for biological men.
bMenorrhagia requires diagnosis and treatment by a gynecologist.

Medical Risks Associated With Sex Hormone Therapy

Transgender male: testosterone

Very high risk of adverse outcomes
  • Erythrocytosis (hematocrit . 50%)
  • Severe liver dysfunction (transaminases . threefold upper limit of normal)
  • Coronary artery disease
  • Cerebrovascular disease
  • Hypertension
  • Breast or uterine cancer

Transgender male: testosterone

Very high risk of adverse outcomes
  • Erythrocytosis (hematocrit . 50%)
  • Severe liver dysfunction (transaminases . threefold upper limit of normal)
  • Coronary artery disease
  • Cerebrovascular disease
  • Hypertension
  • Breast or uterine cancer



Baseline and Follow-up Protocol During Induction of Puberty[5]

Every 3–6 mo
  • Anthropometry: height, weight, sitting height, blood pressure, Tanner stages
Every 6–12 mo
  • In transgender males: hemoglobin/hematocrit, lipids, testosterone, 25OH vitamin D
  • In transgender females: prolactin, estradiol, 25OH vitamin D
Every 1–2 y
  • BMD using DXA
  • Bone age on X-ray of the left hand (if clinically indicated)

BMD should be monitored into adulthood (until the age of 25–30 y or until peak bone mass has been reached). For recommendations on monitoring once pubertal induction has been completed, see Tables 14 and 15.

Abbreviation: DXA, dual-energy X-ray absorptiometry

Protocol Induction of Puberty[5]

Induction of male puberty with testosterone esters increasing the dose every 6 mo (IM or SC)
25 mg/m2/2 wk (or alternatively, half this dose weekly, or double the dose every 4 wk)
50 mg/m2/2 wk
75 mg/m2/2 wk
100 mg/m2/2 wk
Adult dose = 100–200 mg every 2 wk
In postpubertal transgender male adolescents the dose of testosterone esters can be increased more rapidly:
75 mg/2 wk for 6 mo
125 mg/2 wk


Abbreviations: IM, intramuscularly; SC, subcutaneously.

Protocol Induction of Puberty[5]

Induction of male puberty with testosterone esters increasing the dose every 6 mo (IM or SC)
25 mg/m2/2 wk (or alternatively, half this dose weekly, or double the dose every 4 wk)
50 mg/m2/2 wk
75 mg/m2/2 wk
100 mg/m2/2 wk
Adult dose = 100–200 mg every 2 wk
In postpubertal transgender male adolescents the dose of testosterone esters can be increased more rapidly:
75 mg/2 wk for 6 mo
125 mg/2 wk


Abbreviations: IM, intramuscularly; SC, subcutaneously.



Hormone Regimens in Transgender Persons

Transgender males
Testosterone
Parenteral testosterone
Testosterone enanthate or cypionate
100–200 mg SQ (IM) every 2 wk or SQ (SC) 50% per week
Testosterone undecanoate c
1000 mg every 12 wk
Transdermal testosterone
Testosterone gel 1.6% d
50 – 100 mg/d
Testosterone transdermal patch
2.5 – 7.5 mg/d

Abbreviations: IM, intramuscularly; SQ, sequentially; SC, subcutaneously.

cOne thousand milligrams initially followed by an injection at 6 wk then at 12-wk intervals.
dAvoid cutaneous transfer to other individuals.

Hormone Regimens in Transgender Persons

Transgender males

Testosterone
Parenteral testosterone
Testosterone enanthate or cypionate
100–200 mg SQ (IM) every 2 wk or SQ (SC) 50% per week
Testosterone undecanoate c
1000 mg every 12 wk
Transdermal testosterone
Testosterone gel 1.6% d
50 – 100 mg/d
Testosterone transdermal patch
2.5 – 7.5 mg/d

Abbreviations: IM, intramuscularly; SQ, sequentially; SC, subcutaneously.

cOne thousand milligrams initially followed by an injection at 6 wk then at 12-wk intervals.
dAvoid cutaneous transfer to other individuals.

Monitoring of Transgender Persons on Gender-Affirming Hormone Therapy:

Transgender Male

  1. Evaluate patient every 3 mo in the first year and then one to two times per year to monitor for appropriate signs of virilization and for development of adverse reactions.
  2. Measure serum testosterone every 3 mo until levels are in the normal physiologic male range:[6] [7]
    1. For testosterone enanthate/cypionate injections, the testosterone level should be measured midway between injections. The target level is 400–700 ng/dL to 400 ng/dL. Alternatively, measure peak and trough levels to ensure levels remain in the normal male range.
    2. For parenteral testosterone undecanoate, testosterone should be measured just before the following injection. If the level is, 400 ng/dL, adjust dosing interval.
    3. For transdermal testosterone, the testosterone level can be measured no sooner than after 1 wk of daily application (at least 2 h after application).
  3. Measure hematocrit or hemoglobin at baseline and every 3 mo for the first year and then one to two times a year. Monitor weight, blood pressure, and lipids at regular intervals.
  4. Screening for osteoporosis should be conducted in those who stop testosterone treatment, are not compliant with hormone therapy, or who develop risks for bone loss.
  5. If cervical tissue is present, monitoring as recommended by the American College of Obstetricians and Gynecologists.
  6. Ovariectomy can be considered after completion of hormone transition.
  7. Conduct sub- and periareolar annual breast examinations if mastectomy performed. If mastectomy is not performed, then consider mammograms as recommended by the American Cancer Society.


References

  1. 1.0 1.1 Price TM, Blauer KL, Hansen M, Stanczyk F, Lobo R, Bates GW. Single-dose pharmacokinetics of sublingual versus oral administration of micronized 17b-estradiol. Obstet Gynecol. 1997;89(3): 340–345.
  2. 2.0 2.1 Asscheman H, Gooren LJ, Assies J, Smits JP, de Slegte R. Prolactin levels and pituitary enlargement in hormone-treated male-to-female transsexuals. Clin Endocrinol (Oxf). 1988;28(6):583–588.
  3. 3.0 3.1 Gooren LJ, Harmsen-Louman W, van Kessel H. Follow-up of prolactin levels in long-term oestrogen-treated male-to-female transsexuals with regard to prolactinoma induction. Clin Endocrinol (Oxf). 1985;22(2):201–207.
  4. 4.0 4.1 Wierckx K, Van Caenegem E, Schreiner T, Haraldsen I, Fisher AD, Toye K, Kaufman JM, T’Sjoen G. Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: results from the European network for the investigation of gender incongruence. J Sex Med. 2014;11(8):1999–2011.
  5. 5.0 5.1 5.2 Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ 3rd, Spack NP, Tangpricha V, Montori VM; Endocrine Society. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–3154.
  6. Lapauw B, Taes Y, Simoens S, Van Caenegem E, Weyers S, Goemaere S, Toye K, Kaufman J-M, T’Sjoen GG. Body composition, volumetric and areal bone parameters in male-to-female transsexual persons. Bone. 2008;43(6):1016–1021.
  7. >Ott J, Kaufmann U, Bentz EK, Huber JC, Tempfer CB. Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy. Fertil Steril. 2010;93(4):1267–1272.