Risks

Talk to your doctor about the changes in your body and any concerns you might have. Complications of masculinizing hormone therapy include:

• Producing too many red blood cells (polycythemia)
• Weight gain
• Acne
• Developing male-pattern baldness
• Sleep apnea
• Developing an abnormal level of cholesterol and other lipids, which may increase cardiovascular risk (dyslipidemia)
• High blood pressure (hypertension)
• Type 2 diabetes
• Deep vein thrombosis and/or pulmonary embolism (venous thromboembolism)
• Infertility
• A condition where the lining of the vagina becomes drier and thinner (atrophic vaginitis)
• Pelvic pain
• Clitoral discomfort

Evidence suggests that transgender men have no increased risk of breast cancer or cardiovascular disease when compared to women whose gender identity and expression matches the stereotypical societal characteristics related to their sex assigned at birth (cisgender women).

Conclusions can’t be drawn about whether masculinizing hormone therapy increases the risk of ovarian and uterine cancer. Further research is needed.

Your fertility

Because masculinizing hormone therapy might reduce your fertility, you'll need to make decisions about your fertility before starting treatment. The risk of permanent infertility increases with long-term use of hormones, especially when hormone therapy is initiated before puberty. Even after stopping hormone therapy, ovarian and uterine function might not recover well enough to ensure that you can become pregnant without reproductive technology assistance.

If you want to have biological children, talk to your doctor about egg freezing (mature oocyte cryopreservation) or embryo freezing (embryo cryopreservation). Another option involves having ovarian tissue surgically removed, frozen and later thawed and reimplanted (ovarian tissue cryopreservation). Keep in mind that egg freezing has multiple steps — ovulation induction, egg retrieval and freezing. If you want to freeze embryos, you'll need to go through the additional step of having your eggs fertilized before they are frozen.

At the same time, while testosterone might limit your fertility, you're still at risk of pregnancy if you have your uterus and ovaries. If you want to avoid becoming pregnant, use an intrauterine device, a barrier form of contraception or a continuous progestin form of birth control.