Table 1 Expected effects of standard gender-affirming medical interventions1,11,12,26,136,137,138,139,140
From: Individualized and innovative gender healthcare for transgender and nonbinary youth
Intervention | Population | Potential effectsa |
|---|---|---|
GnRHa | Youth AMAB | Stop or slow: growth of facial and body hair12 deepening of the voice12 broadening of the shoulders12 growth of Adam’s apple12 growth of gonads (testes) and erectile tissue (penis)12 |
Youth AFAB | Stop or slow: breast or chest tissue development12 broadening of the hips12 monthly bleeding12 | |
Can cause12: internal genital (vaginal) dryness12 | ||
Youth AMAB and youth AFAB | Stop or slow12: growth in height (for those in early puberty)12 development of sex drive12 fertility12 bone mass accrual40 | |
Can cause: changes in mood12 hot flushes12 headaches12 fatigue12 muscle aches12 weight gain and insulin resistance27 injection reactions (sterile abscess)137 use of GnRHa with other medications can potentially increase the risk for prolonged QT syndrome26 idiopathic intracranial hypertension (rare)138 | ||
The full psychological effects of GnRHa treatment (such as on brain development) are unknown | ||
17β-Oestradiol | Youth AMAB | Can cause: breast or chest tissue development12 body adipose tissue redistribution12 reduced muscle mass and strength12 softening of skin12 thinning of facial and body hair12 reduced sex drive12 fertility changes12 smaller erectile tissue (penis)12 smaller gonads (testes)12 emotional changes12 weight changes12 increased risk of blood clots12 increased risk of high blood pressure12 elevation in levels of prolactin12 Other: changes to the levels of circulating lipids12 |
Testosterone | Youth AFAB | Can cause: body adipose tissue redistribution12 increased muscle mass and strength12 oily skin and acne12 increased facial and body hair12 scalp hair loss12 deepened voice12 increased sex drive12 cessation of monthly bleeding12 growth of erectile tissue (clitoris)12 changes to lining of internal genitals (vagina)12 emotional changes12 weight changes12 fertility changes12 increased risk of erythrocytosis12 Other: risk of aggravating sleep apnoea, increase in blood pressure, changes to the levels of circulating lipids, liver dysfunction12 |
Spironolactone | Youth AMAB | Can cause: breast or chest tissue development12 decreased facial and body hair12 increased urination12 orthostasis12 hyperkalaemia (rare)12 |
Cyproterone acetate | Youth AMAB | Can cause: low libido12 changes in mood12 breast or chest tissue development12 decreased facial and body hair12 increased relative risk of meningioma139 increase in prolactin levels12 possible increased risk of blood clots12 possible anaemia or thrombocytosis12 |
Progestins (other than cyproterone acetate; monotherapy or in combination with oestrogen) | Youth AFAB | Can cause: menstrual suppression12 contraception12 changes in mood12 a reduced rate of bone mineral accrual with some progestins (intramuscular medroxyprogesterone acetate); possible preservation of bone mineral density with others (norethindrone acetate)140,141 headaches12 bloating12 weight gain12 cramping12 abdominal pain12 |
Youth AMAB | Can cause: changes in mood12 headaches12 bloating12 weight gain12 cramping12 abdominal pain12 changes in sex drive12 enhancement of breast or chest tissue development (anecdotal) |
