Find out more about masculinizing hormonal treatment used to better align the body with a person's gender identity.
Masculinizing hormone therapy typically is used by transgender men and nonbinary people to produce physical changes in the body that are caused by male hormones during puberty. Those changes are called secondary sex characteristics. This hormone therapy helps better align the body with a person's gender identity. Masculinizing hormone therapy also is called gender-affirming hormone therapy.
Masculinizing hormone therapy involves taking the male hormone testosterone. It stops menstrual cycles and decreases the ovaries' ability to make estrogen. Masculinizing hormone therapy can be done alone or along with masculinizing surgery.
Not everybody chooses to have masculinizing hormone therapy. It can affect fertility and sexual function, and it might lead to health problems. Talk with your health care provider about the risks and benefits for you.
Masculinizing hormone therapy is used to change the body's hormone levels. Those hormone changes trigger physical changes that help better align the body with a person's gender identity.
In some cases, people seeking masculinizing hormone therapy experience discomfort or distress because their gender identity differs from their sex assigned at birth or from their sex-related physical characteristics. This condition is called gender dysphoria.
Masculinizing hormone therapy can:
Your health care provider might advise against masculinizing hormone therapy if you:
Research has found that masculinizing hormone therapy can be safe and effective when delivered by a health care provider with expertise in transgender care. Talk to your health care provider about questions or concerns you have regarding the changes that will happen in your body as a result of masculinizing hormone therapy.
Complications can include:
Evidence suggests that people who have masculinizing hormone therapy don't have an increased risk of breast cancer, endometrial cancer or heart disease when compared to cisgender women — women whose gender identity aligns with societal norms related to their sex assigned at birth.
It's unclear whether masculinizing hormone therapy raises the risk of ovarian and uterine cancer. Further research is needed.
To minimize risk, the goal for people taking masculinizing hormone therapy is to keep hormone levels in the range that's typical for cisgender men.
Masculinizing hormone therapy might limit your fertility. If possible, it's best to make decisions about fertility before starting treatment. The risk of permanent infertility increases with long-term use of hormones. That is particularly true for those who start hormone therapy before puberty begins. Even after stopping hormone therapy, your ovaries and uterus might not recover enough for you to become pregnant without infertility treatment.
If you want to have biological children, talk to your health care provider about your choices. They may include:
Although testosterone might limit your fertility, you still can become pregnant if you have your uterus and ovaries and you have sex with a person who produces sperm. If you want to avoid pregnancy, use birth control consistently. Talk with your health care provider about the form of birth control that's best for your situation.
Before you start masculinizing hormone therapy, your health care provider assesses your health. This helps address any medical conditions that might affect your treatment. The evaluation may include:
You also might have a behavioral health evaluation by a provider with expertise in transgender health. The evaluation may assess:
People younger than age 18, along with a parent or guardian, should see a medical care provider and a behavioral health provider with expertise in pediatric transgender health to discuss the risks and benefits of hormone therapy and gender transitioning in that age group.
You should start masculinizing hormone therapy only after you've had a discussion of the risks and benefits as well as treatment alternatives with a health care provider who has expertise in transgender care. Make sure you understand what will happen and get answers to any questions you may have before you begin hormone therapy.
Masculinizing hormone therapy typically begins by taking testosterone. A low dose of testosterone is prescribed, and then the dose is slowly increased over time. Testosterone usually is given through a shot, also called an injection, or through a gel or patch applied to the skin. Other forms of testosterone that may be appropriate for some people include testosterone pellets placed under the skin, a prolonged action injection and an oral capsule taken twice a day.
The testosterone that's used for masculinizing hormone therapy is identical to the hormone that the testicles and ovaries make naturally. Don't use synthetic androgens, such as oral methyl testosterone or anabolic steroids. They can harm your liver and cannot be accurately monitored.
After you begin masculinizing hormone therapy, you'll notice the following changes in your body over time:
If menstrual bleeding doesn't stop after you've taken testosterone for several months, your health care provider might recommend that you take medicine to stop it.
Some of the physical changes caused by masculinizing hormone therapy can be reversed if you stop taking testosterone. Others, such as a deeper voice, a larger clitoris, scalp hair loss, and increased body and facial hair, cannot be reversed.
While on masculinizing hormone therapy, you meet regularly with your health care provider to:
You also need routine preventive care. Depending on your situation, this may include: