Patient discussions

Patients should be educated on the symptoms and signs of thromboembolic disease and advised to present promptly for investigation, should these symptoms occur.[1]

Patients receiving hormone treatment require information on the likely extent and timing of hormone-induced changes. Although the data on this is limited, and a large degree of natural variation can be expected, the following information from the Endocrine Society is helpful as a general guide.[30]

Expected timing of masculinising effects of testosterone[30]

  • Onset in the first 1-6 months:

    • Cessation of menses

    • Increased sexual desire

    • Increased facial and body hair (maximum effect 4-5 years)

    • Increased skin oiliness/acne (maximum effect 1-2 years)

    • Increased muscle mass (maximum effect 2-5 years)

    • Redistribution of fat to a more typically male pattern (maximum effect 2-5 years)

    • Vaginal atrophy (maximum effect 1-2 years).

  • Onset in the first year:

    • Deepening of voice (maximum effect 1-2 years)

    • Clitoromegaly (maximum effect 1-2 years)

    • Male pattern hair loss (some patients only).

Expected timing of feminising effects of oestrogen and anti-androgen therapy[30]

  • Onset in the first 1 to 3 months:

    • Decreased sexual desire (maximum effect 3-6 months)

    • Decreases spontaneous erections (maximum effect 3-6 months).

  • Onset in the first 3 to 6 months:

    • Redistribution of body fat to a more typically female pattern (maximum effect 2-3 years)

    • Decreased muscle mass and strength (maximum effect 1-2 years)

    • Softening of skin and decreased oiliness (maximum effect unknown)

    • Breast growth (maximum effect 2-3 years)

    • Decreased testicular volume (maximum effect 2-3 years).

  • Onset in the first 6 to 12 months:

    • Decreased terminal hair growth (maximum effect greater than 3 years).

  • Variable timing of onset:

    • Male sexual dysfunction

    • Decreased sperm production (maximum effect greater than 3 years)

    • Scalp hair.

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