Increased activity of oil and sweat glands. 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. 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[ edit ] 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. There are two forms of this enzyme: However, type 2 is the form that is most important to the development of male pattern hair loss.
Facial changes[ edit ] 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: Males tend to develop heavier bony brows than females. 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. The tips of the nasal bones tend to grow more in males than females, creating a larger longer or wider nose. The jaw in males tends to grow wider and more deeply sculptured than in females.
At puberty, the bones and cartilage of the voicebox tend to enlarge less in females than males. In some males, the larynx becomes visible as a bony "Adam's apple. Females tend to have thicker, fleshier lips than males of the same size due to estrogen. Gynecological changes[ edit ] 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. 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 your 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. Testosterone dose can frequently be decreased after oophorectomy. The risk of endometrial cancer is similarly unknown. However, a high prevalence of endometrial hyperplasia has been noted in a small study of transgender men undergoing hysterectomy. Transgender men who have any bleeding after the cessation of menses with androgen therapy should have an endometrial biopsy and possibly an ultrasound done to rule-out endometrial cancer.
Some sources recommend endometrial ultrasounds every two years. Testosterone usually causes atrophy of the endometrium. Any transgender man with an endometrium that is not thinned on ultrasound should have a biopsy to evaluate for endometrial cancer and possibly use progesterone to cause sloughing of the endometrium.
Vaginal bleeding from progesterone may be emotionally uncomfortable for a trans man, but is medically preferable to developing endometrial cancer. This interval might be increased to every 2—3 years for certain people on the advice of a gynecologist. However, recent research has linked cervical cancer to a sexually transmitted virus; trans men who have never had vaginal sex may not be at risk.
However, since the long-term effects of testosterone on cervical tissues are not well understood, Pap smears may be considered a general precaution. 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. Natural testosterone levels peak in women just before ovulation which may account for the mid-cycle increase in libido many women experience.
Reproductive changes[ edit ] As the age at which transgender people begin therapy decreases, retention of reproductive potential becomes more important. 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. 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.
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. 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[ edit ] 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. 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. Male hands and feet tend to be larger than female hands and feet in persons of equal height. The upper arm in females tends to be significantly longer about 1" than in males of the same height.
Females tend to have smaller heads than males of the same height. Female rib cages tend to be narrower than those of males in the same height. Neurological changes[ edit ] Headaches: Pre-existing migraine headaches can be significantly worsened with androgen therapy.
Headaches can also become problematic in men without prior headache disorders. These may be worsened or very rarely unmasked with androgen therapy. Sleep deprivation worsens almost all seizure disorders, so concurrent obstructive sleep apnea caused or worsened by androgen therapy may also be responsible. Recent studies have found that cross-hormone therapy in trans men results in an increase in brain volume up to male proportions.
This fact alone has a significant psychological impact, which is hard to distinguish from hormonally induced changes. Most trans men report an increase of energy and an increased sex drive. Many also report feeling more confident. While a high level of testosterone is often associated with an increase in aggression , this is not a noticeable effect in most trans men.
HRT doses of testosterone are much lower than the typical doses taken by steroid-using athletes, and create testosterone levels comparable to those of most cisgender men. These levels of testosterone have not been proven to cause more aggression than comparable levels of estrogen. It is assumed that the effect of the start of physical treatment is such a relief, and decreases pre-existing aggression so much, that the overall level of aggression actually decreases.
Some transgender men report mood swings, increased anger, and increased aggressiveness after starting androgen therapy. Many transgender men, however, report improved mood, decreased emotional lability, and a lessening of anger and aggression. Cardiovascular changes[ edit ] In cisgender men, testosterone levels that are either significantly above or below normal are associated with increase cardiovascular risk.
This may be causative or simply a correlation. A single retrospective study in the medical literature of trans men treated with testosterone range of 2 months to 41 years by the Amsterdam Gender Dysphoria Clinic from to showed no increase in cardiovascular mortality or morbidity when compared with the general female Dutch population. As with all scientific studies, this does not conclusively prove that no causal link exists. A small to moderate detrimental effect remains a possibility, though a very large effect is more unlikely.
Androgen therapy can adversely affect the blood lipid profile by causing decreases in HDL good cholesterol , increases in LDL bad cholesterol, and increases in triglycerides.
Androgen therapy redistributes the fat toward abdominal obesity , which is associated with increased cardiovascular risk rather than fat carried on the buttocks and hips. Androgen therapy can cause weight gain and decreased insulin sensitivity perhaps worsening a predisposition to develop Type II diabetes. Androgen therapy effects are not all negative, however. Acutely it causes dilation of the coronary arteries, and in men with testosterone levels within the normal physiological range, higher levels are actually associated with a slight decrease in cardiovascular disease.
Supra-physiological levels of androgens generally due to abuse are associated with significantly increased risks of strokes and heart attacks even in the young.