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Risks of Testosterone Therapy for FTMs: A Comprehensive Guide

risks of testosterone therapy ftm

Hormone therapy can profoundly impact one’s transition, though awareness of potential side effects allows prudent planning and risk mitigation if desired. This guide aims to have a pragmatic, solution-focused dialog. 

While risks naturally exist with medical treatment, many effects of hormone therapy are mild or can be managed proactively. 

The goal is empowering clients to feel well-equipped collaborating with providers on a customized, informed care plan tailored to individual goals and circumstances.

Potential Changes to Physical Health

Increased Risk of Polycythemia

Testosterone therapy can notably elevate levels of erythropoietin, a protein that stimulates red blood cell production in the bone marrow. This increased red blood cell count, known as polycythemia, is a common side effect for those on testosterone HRT

While some degree of polycythemia is normal and harmless with male hormone levels, tolerating excessively elevated counts can induce health issues by thickening the blood. 

Regular monitoring through complete blood count (CBC) lab tests enables early detection of polycythemia. For individuals experiencing high red blood cell levels, medical providers may suggest temporarily decreasing the testosterone dose or introducing phlebotomy to donate blood as a treatment. Staying well-hydrated also helps prevent complications.

Possible Cardiovascular System Changes

Testosterone therapy can slightly raise blood pressure and LDL (“bad”) cholesterol levels over time, contributing to an increased long-term risk of cardiovascular disease. However, most medical studies find this risk increase is relatively small. 

Far more influential lifestyle habits like smoking, inactivity, and obesity have a greater impact. To help mitigate potential cardiovascular changes, it is recommended for those on testosterone HRT to maintain a healthy diet, engage in routine exercise, avoid smoking/vaping, and keep blood pressure and cholesterol monitored as advised by clinicians. Some individuals may also benefit from blood pressure or cholesterol medications.

Liver Enzyme Level Changes

The male sex hormone testosterone is primarily metabolized by the liver. In most cases, healthy livers can easily process typical testosterone doses without adverse impact

However, for individuals with pre-existing liver conditions or other risk factors, HRT may occasionally cause slight, temporary elevations in certain liver enzymes measurable on blood tests. 

Any significant or persistent enzyme level increases could indicate the rare development of a liver problem. Regular monitoring through standard liver function blood panels enables prompt detection of potential issues to allow dosage adjustments or other interventions as needed before serious damage occurs.

Risk of Developing Acne or Oily Skin

Just as during male puberty, some receiving testosterone HRT may develop or experience acne breakouts or an increase in facial/body oil gland activity. This is due to testosterone’s ability to stimulate sebum production.

Those with sensitive skin or a history of severe acne may be more susceptible. For most cases, over-the-counter treatments are effective. But more stubborn cases could possibly warrant prescription medications under a dermatologist’s guidance. 

Proper hygiene, reducing stress, and avoiding heavily comedogenic skin/hair products can also help minimize acne risk.

Increased Appetite and Risk of Weight Gain

A rise in the male sex drive hormone testosterone may mildly enhance appetite in some individuals by subtly impacting metabolism and hunger hormones. 

While moderate muscle gain is common, those not careful about calorie intake and output could unintentionally gain body fat. Weighing oneself regularly and adjusting eating and exercise habits helps curb significant weight fluctuations that could negatively affect health.

Cessation of Menstruation (Amenorrhea) in those AFAB

For anyone assigned female at birth (AFAB) receiving testosterone, menstrual periods will eventually cease due to hormonal changes inducing amenorrhea, or lack of menstruation. 

Cessation of periods is a natural side effect rather than a problem for most. However, very rarely, underlying health issues could potentially be masked if proper annual OB/GYN exams including Pap tests are not continued as advised after starting HRT. Communication with medical providers allows addressing any concerns.

Impacts on Mental Health and Mood

Testosterone’s effects on brain chemistry may cause temporary emotional or mood changes for some as hormone levels stabilize in the male range. Potential impacts include:

Possible Mood Swings or Other Emotional Changes

Feelings of sadness, anger, or moodiness are normal possible short-term adaptations as the body adjusts to new hormone balances after starting or altering testosterone HRT. Consulting with a mental health professional can help distinguish normal transitional fluctuations from signs of an underlying mood disorder requiring separate treatment. Journalling moods may provide insight.

Increased Sex Drive or Alterations to Sexual Function

A spike in libido is common on testosterone for many. But others may initially struggle with arousal issues like low energy or difficulty achieving/sustaining erections due to internal psychological adjustment or aging-related concerns. 

Such changes usually stabilize positively within several months. But more long-running problems could signify an underlying medical concern like low testosterone levels warranting dosage adjustment or further investigation. Comprehensive sex education resources and clinical guidance helps address function and relationship worries.

Concerns Related to Medication Delivery Methods

Risks of Testosterone Injections

Intramuscular injections involve the usual minor risks of any medication injection like infection at the site. 

Extremely rare potential serious complications could include peliosis hepatis (blood filled liver cysts) potentially caused by oil-based injections, although evidence linking this risk is inconclusive. Overall injection remains very safe when performed or supervised by trained staff using proper sanitation following dosage instructions.

Dangers of Topical Testosterone Gel Application

Using prescribed testosterone gel as directed poses low risk for most. However, accidental transfer of even small amounts of gel to others, especially children and women, can cause unintended hormonal changes or virilization in extreme cases. 

Proper handwashing after application and avoiding skin-to-skin contact with others until fully dry minimizes this already unlikely scenario. Some individuals also experience local skin irritation at application sites rarely.

Potential Issues with Testosterone Skin Patches

Transdermal patches securely delivering steady hormone levels week-to-week also carry the potential, though exceptionally rare, risk of accidental transfer exposure like gel. 

Skin sensitivity where patches are applied, such as itching or redness is also possible. Overall transdermal patches are very convenient and safe for the vast majority when used exactly as directed by prescribing clinicians.

Long-Term Health Considerations

Future Fertility Implications

While testosterone HRT effectively induces desired physical changes, it usually also causes infertility within a few months for those assigned female at birth by suppression of menstruation and ovarian function. 

Sperm production likewise ceases in those assigned male at birth. Fertility may partially or fully recover if treatment is discontinued, but this is not guaranteed especially after long-term use. 

Preserving reproductive options before or during treatment requires meticulous medical guidance and coordination with fertility experts.

Risks in Adolescents Versus Adults

For minors, the potential long-term effects of testosterone on growth plates and mental/social development are still being studied. 

Effects also vary based on when treatment begins relative to typical male puberty timelines. Generally HRT is only considered for youth after cautious evaluation determines significant likely benefits outweigh uncertain risks based on individual circumstances. Close multi-disciplinary oversight helps maximize positive outcomes.

Managing Testosterone Levels for Overall Well-Being

Maintaining healthy testosterone, estrogen, and other sex hormone levels through compliant medication use and lifestyle habits optimizes both physical and psychological health and helps prevent potential long-term health risks. 

Working closely with medical providers enables detecting and addressing any concerns before serious issues emerge through regular clinical visits and lab monitoring. A balanced, harm-reduction approach serves patient wellness most effectively over the lifetime.

FAQ About Risks of Testosterone Therapy FTM

How will testosterone therapy affect my body hair and scalp hair?

Testosterone often causes an increase in body hair growth in patterns typical of one’s genetic male relatives. This includes more hair on the chest, back, arms and legs. 

Facial hair and scalp hair patterns are also influenced, though some may see increased scalp hair loss from hormonal changes if there is a family history of baldness. Most notice more oil gland activity and thicker coarser hair texture overall.

What are the potential effects on my breast tissue? 

While experiences vary, on average testosterone therapy leads to halted growth of breast tissue and possible shrinkage over time for most. However, there are no guarantees and genetics plays a role. 

Some may opt for surgical removal if significant breast size remains distressing to gender identity. It is rare but possible for small amounts of tissue to remain indefinitely without causing physical issues.  

How will testosterone impact fat redistribution and my weight?

Over 1-3 years, fat typically shifts from the hips/thighs and moves to more central locations like the stomach and back – the “apple shape.” Muscle may also become more prominent. 

Total weight often remains stable, but the body composition changes, which could impact clothing size and how weight is carried. Diet and exercise can help achieve desired figure changes. 

Does testosterone therapy cause clitoral growth? 

Minor growth of the clitoris is a common response to testosterone, but ranges greatly from minimal to 1-2 inches when fully erect. This typically involves internal tissue changes versus outward enlargement. 

Sensation usually remains fully intact if not enhanced by lowered inhibition. Appearance change is often gradual and may be irrelevant to one’s internal concept of self or sexuality. 

What are potential adverse effects or long-term health risks?

Most adverse effects are minor and manageable, but long-term health risks could theoretically include cardiovascular disease if other risks like smoking contribute. 

Regular checkups tracking hormone levels and preventing unmanaged risk factors like high blood pressure are advised. less common risks involve liver, fertility and psychological impacts according to individual and family medical history. 

Overall risks are generally quite low with responsible medical oversight of appropriate testosterone therapy forms and levels.

In conclusion, this comprehensive guide aimed to thoroughly inform about short and long-term potential risks of testosterone therapy for FTMs through extensive exploration of various perspectives found in medical research literature. 

While HRT no doubt improves lives, treatment requires diligent self-care and clinical oversight to help ensure safety and overall wellness for life. Continued rigorous investigation further illuminates optimal transgender healthcare protocols to minimize complications and maximize quality of life benefits.

If you’d like to learn more about whether testosterone is right for your transition goals, or simply discuss risk mitigation strategies, we encourage a direct yet compassionate consultation. Our dedicated clinicians at Physicians Rejuvenation Centers are committed to addressing all your concerns without judgment so you feel empowered in each next step of your journey. 

Schedule a no-obligation virtual or in-person visit today by contacting us at 561-783-5153. Working as a team, we’ll help ensure whichever path you choose supports not just the outer changes sought but inner peace as well.