“I stared far back into my past and remembered the child who couldn’t be catalogued by Sears.  I saw her standing in front of her own mirror, in her father’s suit, asking me if I was the person she would grow up and become.  Yes, I answered her. And I thought how brave she was to have begun this journey, to have withstood the towering judgements” –Leslie Feinberg 

In our last post we discussed MTF transgender people, people born male who feel and desire to appear female, and hormone treatment they can receive as teenagers that moves them closer to this goal. This post discusses FTM transgender people, and the hormone treatment available to them.

As we discussed, the key hormone for MTF patients is estrogen, and for FTM patients it is testosterone. Testosterone is what gives a biologically male adolescent his deep voice, body and facial hair, and body shape. Biologically female patients who want to transition towards a traditionally masculine appearance can be prescribed testosterone, either after a course of pubertal suppression or after they have gone through a female puberty.

Testosterone comes in many forms, but usually FTM patients are prescribed injections or a patch. Let’s look at some of the effects of testosterone:

  • Skin: An FTM patient’s skin will get more oily, and acne may develop or worsen.
  • Body fat: Body fat will redistribute to a more traditionally “masculine pattern”, with extra weight around the abdomen instead of the thighs and buttocks.
  • Facial & body hair: Eventually thicker and darker hair will begin to grow on the patient’s face and body; it can take a few years to get a full beard. Some patients are never able to to grow a one, but most will need to shave (unless they want their facial hair to grow.)
  • Menstruation: For FTM patients, menstruation can be a frustrating ordeal and a monthly reminder that their body remains female despite their inner identity being male. Within the first six months of hormone treatment, they will stop getting their periods, which is often a huge relief.
  • Clitoral and vaginal changes: The clitoris will enlarge and eventually measure up to an inch long. It can become erect, but will not have an erection like a penis would. The vagina will become dry and lack lubrication.
  • Voice: Within a year, an FTM on hormones will develop a deeper, more traditionally masculine voice. They may go through a voice “cracking” period similar to a young biologically male adolescent.
  • Fertility: Testosterone may make patients unable to become pregnant, but not always. As some FTM people will have sex that could lead to pregnancy, it’s vital that they have access to birth control.
  • Emotions: Testosterone may cause patients to feel irritable, aggressive, or unbalanced. There are ways to help address this without going off testosterone; talk to your provider if this occurs.

 Many of these changes may be irreversible. It’s very important that a patient starting FTM therapy be sure this is the course they want to follow. In addition, taking testosterone long-term may cause an increase in the likelihood of developing certain cancers. Unfortunately, we don’t have enough research on transgender health to have good information on this.

Next week we’ll discuss safety measures for transgender teens, as  in our society transgender teens do need to take some additional steps to try and ensure their safety.