Gender affirming hormone therapy (GAHT) is an important component of transition for some people. GAHT (testosterone) changes secondary sex characteristics to affirm one’s gender presentation and identity. While there are risks associated with any medication, including GAHT, GAHT can greatly improve quality of life, psychological well-being, and affirm identity.

What are the different types of gender affirming medications?

Testosterone is used to change a person’s secondary sex characteristics. While not considered GAHT, there are other medications that might be used with testosterone to help affirm one’s identity and counter possible unwanted effects of testosterone, including hair loss on scalp, clitoral (bottom) growth, and acne.

How will I respond to GAHT?

GAHT can cause both reversible (temporary) and irreversible (permanent) changes to a person’s body. Each individual person responds to GAHT differently, and it is difficult to predict how each person will respond. Taking more medication than is prescribed will not make the changes happen faster and may even increase your risks or side effects.

Potential reversible changes may include, but are not limited to:

• redistribution of fat (i.e., abdominal fat may increase while fat in the breasts/chest, buttocks, and thighs may decrease),
• increased muscle development,
• increased red blood cells,
• increased energy levels,
• acne, which may become severe and may require treatment,
• cessation of menstrual cycles (periods) and suspended ovulation (maturing of eggs),
• changes to/thinning of your vaginal/bottom tissue leading to increased potential for dryness and irritation (silicone or water-based lubricant, or localized estrogen cream can help reduce dryness and irritation), and/or
• increase in sex drive, sensation, and sexual function.

Potential irreversible effects may include, but are not limited to:

• thickening of the vocal cords, leading to a deepening of the voice,
  • Not all people experience a full deepening of their pitch and may desire voice or speech therapy to achieve their desired result.
• increased thickness and quantity, darker color, and wider distribution of facial and body hair,
• hair loss at temples and scalp may begin or worsen,
• fat redistribution,
• genital changes (enlargement of clitoris and labia/bottom growth).
  • If you are concerned about bottom growth, talk to your provider.
• increased bone density,
• reduced ovulatory function, and/or
• infertility.

What are the risks and possible side effects of GAHT?

GAHT is generally considered safe. Many of the risks associated with GAHT are reversible if you stop GAHT. Some of the long-term consequences and effects of GAHT are not fully understood. The risks and possible side effects associated with testosterone include:

• heart disease and high blood pressure,
• increased cholesterol and triglycerides,
• liver inflammation (abnormal liver enzymes).
• Polycythemia (increased hemoglobin/red blood cells).
  • If untreated, it can cause headache, dizziness, heart attack, confusion, visual disturbances, or stroke.
• sleep apnea,
• Type 2 diabetes, and/or
• weight gain.

We know GAHT is life-affirming care, but some side effects from GAHT are irreversible and could cause death in rare circumstances.

What if I desire children with my own genetic material?

There is currently no long-term data on the impacts of taking testosterone on a person’s eggs. Testosterone therapy usually leads to a stop in both periods and egg release. Once a person stops testosterone, fertility may return, but cannot be guaranteed. Even though testosterone can cause infertility, it should not be used to protect pregnancy, even if you are not getting a period.

How does GAHT affect my risk of sexually transmitted infections?

Testosterone should not be used to prevent pregnancy, even if your periods stop. Condoms are always recommended. A daily pill called PrEP (pre-exposure prophylaxis) can significantly decrease the risk of HIV infection. Talk to your provider if you want more information about PrEP.

What can increase my risks?

There are certain medical conditions and health behaviors that can increase your risks and side effects of GAHT. Risks and side effects may be increased by:

• pre-existing medical conditions (diabetes, high blood pressure, history of high hemoglobin/polycythemia),
• pre-existing psychiatric conditions,
• age,
• cigarette smoking, and/or
• alcohol use.

It is important to disclose your medical and psychiatric conditions, as well as health behaviors, to your provider. Having these conditions or behaviors does not mean you will not be allowed to have GAHT, but some forms and dosages of GAHT may be safer for you than others.

Can GAHT affect my mental health?
Many patients report significant improvement in overall quality of life. Changes in mood or pre-existing mood disorders such as depression, suicidal feelings, anxiety, and psychosis (disorganization and loss of touch with reality) may occur. Changes in relationships, academic, work, and other support networks can occur during transition. We offer support and connection to resources in the community.

What about my privacy and confidentiality?

Your health record is confidential at UHS. Notes and correspondence stay within UHS as part of your protected medical record. However, UHS has contracted with outside laboratories to process lab samples. Your legal name and lab results are protected health information stored by the laboratories on their electronic medical record (EMR), which includes Epic and MyChart. UHS does not control Epic or MyChart. If you have given a parent/guardian access to your MyChart account as an adult, and aren’t out to that person(s), revoking their MyChart access is recommended.

An outside organization, such as a hospital or provider may be able to access your lab results, including labs performed at UHS, through a system called CareEverywhere. UHS does not use/control data in the CareEverywhere system. If you use insurance to pay for your medication and you are a dependent on a parent or guardian’s insurance, they may be able to access your prescription information, including GAHT. If you are concerned about privacy, please speak with the pharmacy to make sure any refill alerts are sent to your device and not to a parent or guardian if you use insurance or pay out of pocket.