Patients should be educated on the symptoms and signs of thromboembolic disease and advised to present promptly for investigation, should these symptoms occur.
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.
Expected timing of masculinizing effects of testosterone
Onset in the first 1 to 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 feminizing effects of estrogen and antiandrogen therapy
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)
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