37.3 Masculinizing Hormonal Therapy
2 min read•june 18, 2024
Masculinizing hormonal therapy is a key part of for transgender and nonbinary individuals. It involves using testosterone and other drugs to promote male secondary sex characteristics and suppress female ones.
Nurses play a crucial role in administering these treatments and monitoring for side effects. They need to understand the drugs' actions, potential complications, and how to educate clients on proper use and what to expect during their transition journey.
Masculinizing Hormonal Therapy
Key characteristics and actions of masculinizing hormonal drugs
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- Testosterone and its esters (, ) serve as the primary masculinizing hormone promote the development of male secondary sexual characteristics including deepening of the voice, facial and body hair growth, increased muscle mass and strength, redistribution of body fat, clitoral enlargement, and cessation of menses while suppressing ovarian function and estrogen production
- Gonadotropin-releasing hormone (GnRH) agonists (, ) suppress endogenous hormone production when used in conjunction with testosterone to achieve desired masculinizing effects and may be used to delay puberty in transgender and nonbinary youth
Common side effects and drug interactions
- Common side effects of testosterone therapy include , male pattern baldness, weight gain, mood changes (irritability, aggression), increased libido, and increased risk of (high red blood cell count), sleep apnea, and cardiovascular disease
- Testosterone may interact with increasing the risk of bleeding, decrease the effectiveness of and oral hypoglycemic agents, and interact with potentially exacerbating fluid retention
Essential nursing considerations
- Obtain a thorough medical history and perform a physical examination before initiating therapy
- Monitor for potential side effects and complications by regularly assessing cardiovascular risk factors (blood pressure, ), monitoring and levels to detect polycythemia, assessing for signs of sleep apnea, and monitoring liver function tests periodically
- Administer testosterone injections using proper technique to minimize discomfort and complications and educate clients on proper self-administration if prescribed
- Collaborate with mental health professionals to provide comprehensive care and support while maintaining a non-judgmental and supportive attitude to foster a therapeutic relationship
Important client education points
- Emphasize the importance of regular follow-up visits to monitor therapy effectiveness and potential side effects
- Teach clients how to recognize signs and symptoms of complications (polycythemia, sleep apnea) and encourage them to report any adverse effects or concerns to their healthcare provider
- Educate clients on the expected timeline of physical changes and the importance of patience and realistic expectations
- Discuss the potential impact of hormone therapy on fertility and reproductive options
- Emphasize the importance of maintaining a healthy lifestyle (balanced diet, regular exercise, stress management)
- Provide resources for emotional support and community connections (support groups, LGBTQ+ organizations)
- Reinforce the significance of consistent and long-term use of hormonal therapy to maintain desired masculinizing effects
Key Terms to Review (52)
Acne: Acne is a common skin condition characterized by the development of pimples, blackheads, and other blemishes, primarily on the face, chest, and back. It is often associated with hormonal changes and imbalances, particularly in the context of androgens, antiandrogens, and anabolic steroids.
ALT: ALT, or alanine aminotransferase, is an enzyme found primarily in the liver that is released into the bloodstream when the liver is damaged or inflamed. It is a key biomarker used to assess liver health and function in the context of various medical conditions and drug therapies.
Anticoagulants: Anticoagulants are a class of medications that help prevent the formation of blood clots by interfering with the normal clotting process. They are widely used to reduce the risk of stroke, heart attack, and other cardiovascular events in patients with various medical conditions.
AST: AST, or aspartate aminotransferase, is an enzyme found primarily in the liver and heart that is used as a biomarker to assess liver and heart health. It is a key term that is relevant in the context of understanding the mechanisms and effects of various lipid-lowering medications as well as the monitoring of masculinizing hormone therapy.
Basal insulin dosing: Basal insulin dosing involves the administration of long-acting insulin to maintain blood glucose levels within a target range during fasting periods, typically over 24 hours. It is essential for managing diabetes mellitus, particularly Type 1 diabetes.
Bilirubin: Bilirubin is a yellow-orange pigment that is produced during the normal breakdown of red blood cells. It is an important component in the context of bile acid sequestrants, fibrates, and niacin, as well as masculinizing hormonal therapy.
Clitoromegaly: Clitoromegaly is a medical condition characterized by an abnormal enlargement of the clitoris, the small, sensitive erectile structure located at the anterior end of the vulva. This condition is often associated with hormonal imbalances or genetic disorders and can have implications in the context of masculinizing hormonal therapy.
Corticosteroids: Corticosteroids are synthetic drugs that mimic the effects of hormones produced by the adrenal cortex, primarily cortisol. They are used to reduce inflammation and suppress the immune system in various medical conditions.
Corticosteroids: Corticosteroids are a class of steroid hormones that are naturally produced in the adrenal glands or synthetically created to mimic their effects. They play a crucial role in regulating various physiological processes, including inflammation, immune response, and metabolism, making them an important therapeutic tool in the context of several medical conditions.
Cyclosporine: Cyclosporine is an immunosuppressant drug primarily used to prevent organ rejection in transplant patients and to treat various autoimmune disorders. It works by inhibiting the activation and proliferation of T-cells, a critical component of the body's immune response.
Delatestryl: Delatestryl is a brand name for testosterone enanthate, an injectable form of testosterone. It is used to induce masculinizing effects in transgender and nonbinary individuals undergoing hormonal therapy.
Depo-testosterone: Depo-testosterone is an injectable form of testosterone cypionate, a synthetic version of the naturally occurring male hormone. It is used to treat conditions caused by a lack of testosterone in men and for masculinizing hormone therapy in transgender individuals.
Dihydrotestosterone: Dihydrotestosterone (DHT) is a potent androgen hormone that is derived from the conversion of testosterone by the enzyme 5α-reductase. It is a key player in the development and maintenance of male sexual characteristics, and its actions are central to the topics of androgens, antiandrogens, and anabolic steroids, as well as masculinizing hormonal therapy.
Donepezil transdermal: Donepezil transdermal is a medication used to manage symptoms of Alzheimer's disease by delivering the drug through a skin patch. It inhibits acetylcholinesterase, thereby increasing acetylcholine levels in the brain.
Endocrinology: Endocrinology is the study of the endocrine system, which is responsible for producing and regulating hormones in the body. It focuses on understanding the intricate mechanisms by which hormones influence various physiological processes, including growth, development, metabolism, and sexual function, in the context of masculinizing hormonal therapy.
Erythropoiesis: Erythropoiesis is the process by which red blood cells, also known as erythrocytes, are produced in the body. This process is essential for maintaining adequate oxygen delivery to tissues throughout the body, as red blood cells are responsible for transporting oxygen from the lungs to the body's cells.
Female-to-male (FTM) transition: Female-to-male (FTM) transition involves a person assigned female at birth undergoing medical and/or surgical procedures to align their physical appearance and gender identity with that of a male. This process often includes masculinizing hormonal therapy, such as testosterone administration.
Gender Dysphoria: Gender dysphoria is a condition characterized by a strong, persistent discomfort or distress with one's assigned birth gender and the associated gender role, leading to a desire to transition to the preferred gender. It is a critical concept in understanding the experiences and healthcare needs of transgender and nonbinary individuals.
Gender-Affirming Care: Gender-affirming care refers to a holistic approach to healthcare that acknowledges, respects, and supports an individual's gender identity and expression. It is a fundamental aspect of providing comprehensive and inclusive care for transgender, non-binary, and gender-diverse individuals.
Glycosylated hemoglobin (A1c): Glycosylated hemoglobin (A1c) is a form of hemoglobin that is chemically linked to glucose. It reflects the average blood glucose levels over the past 2-3 months.
GnRH Agonists: GnRH agonists are a class of drugs that mimic the action of the naturally occurring gonadotropin-releasing hormone (GnRH) in the body. They are primarily used in the context of hormonal therapy and masculinizing hormonal therapy to regulate the production and release of sex hormones, such as testosterone and estrogen.
Goserelin: Goserelin is a synthetic hormone that acts as a gonadotropin-releasing hormone (GnRH) agonist. It is primarily used in the context of hormonal therapy and masculinizing hormonal therapy to manage various medical conditions.
Grades of hypertension: Grades of hypertension classify the severity of high blood pressure based on systolic and diastolic measurements. These grades help guide treatment decisions and risk assessment.
HDL: HDL, or high-density lipoprotein, is a type of lipoprotein that is often referred to as the 'good' cholesterol. It plays a crucial role in the body's lipid metabolism and is associated with a reduced risk of cardiovascular disease.
Hematocrit: Hematocrit is the percentage of red blood cells in the total volume of blood. It is a crucial indicator of overall blood composition and is commonly used to assess the health and function of the circulatory system.
Hemoglobin: Hemoglobin is an iron-rich protein found in red blood cells that is responsible for transporting oxygen from the lungs to the body's tissues and carbon dioxide from the tissues back to the lungs. It is a crucial component in the processes of fluid volume regulation, oxygenation and gas exchange, as well as masculinizing hormonal therapy.
Hypertension: Hypertension, also known as high blood pressure, is a chronic medical condition in which the blood pressure in the arteries is elevated, increasing the risk of heart disease, stroke, and other health complications. It is a key term that is closely connected to various topics in pharmacology, including the management of cardiovascular conditions and the use of specific drug classes to control blood pressure.
Hypothalamic-pituitary-gonadal axis: The hypothalamic-pituitary-gonadal (HPG) axis is a complex hormonal system that regulates reproductive function and development. It involves the coordinated interactions between the hypothalamus, pituitary gland, and gonads (testes or ovaries) to maintain hormonal homeostasis and facilitate reproduction.
Hysterectomy: A hysterectomy is a surgical procedure in which the uterus is removed, either partially or completely. This procedure is commonly performed to treat various gynecological conditions, such as uterine fibroids, endometriosis, or uterine cancer.
Insulin: Insulin is a hormone produced by the pancreas that regulates blood sugar levels by facilitating the uptake and utilization of glucose by cells throughout the body. It plays a crucial role in maintaining homeostasis, managing electrolyte balance, and supporting various physiological processes, making it an essential consideration in drug administration, documentation, and the treatment of conditions like diabetes and weight management.
Intramuscular: Intramuscular (IM) refers to the administration of a medication or substance directly into the muscle tissue. This route of administration is commonly used for vaccines, certain medications, and hormonal therapies, as it allows for efficient absorption and targeted delivery of the substance into the body.
Intramuscular injections: Intramuscular injections involve administering medication directly into a muscle, allowing for rapid absorption into the bloodstream. Common sites include the deltoid, vastus lateralis, and gluteal muscles.
LDL: LDL, or low-density lipoprotein, is a type of lipoprotein that transports cholesterol from the liver to the body's cells. It is often referred to as the 'bad' cholesterol because high levels of LDL can contribute to the buildup of plaque in the arteries, increasing the risk of heart disease and stroke.
Leuprolide: Leuprolide is a synthetic hormone agonist that acts on the pituitary gland to suppress the production of testosterone and estrogen, making it a valuable therapeutic agent in the management of hormone-sensitive cancers and conditions related to hormonal imbalances.
Lipid Profile: A lipid profile is a blood test that measures the levels of different types of lipids, or fats, in the bloodstream. These lipids include cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). The lipid profile provides important information about an individual's risk of developing cardiovascular disease and other health conditions related to lipid metabolism.
Male-Pattern Baldness: Male-pattern baldness, also known as androgenetic alopecia, is a common form of hair loss that occurs in men. It is characterized by a receding hairline and gradual thinning of hair, typically starting at the temples and crown of the head.
Oophorectomy: Oophorectomy is a surgical procedure that involves the removal of one or both ovaries. It is a common treatment option for various gynecological conditions, including ovarian cancer, endometriosis, and polycystic ovarian syndrome.
Polycythemia: Polycythemia is a condition characterized by an abnormally high number of red blood cells, which can lead to an increased risk of blood clots and other cardiovascular complications. This term is particularly relevant in the context of masculinizing hormonal therapy, as certain hormones used in this treatment can potentially stimulate the overproduction of red blood cells.
Sex Hormone-Binding Globulin (SHBG): Sex hormone-binding globulin (SHBG) is a glycoprotein produced primarily in the liver that binds to and transports sex hormones, such as testosterone and estradiol, in the bloodstream. It plays a crucial role in regulating the bioavailability and activity of these hormones within the body, particularly in the context of masculinizing hormonal therapy.
Spermatogenesis: Spermatogenesis is the process by which male germ cells, known as spermatogonia, undergo a series of mitotic and meiotic divisions to produce mature, motile sperm cells. This process is essential for male fertility and is closely regulated by hormones from the hypothalamus, pituitary, and testes.
Testopel pellet: Testopel pellets are subcutaneous implants containing testosterone used in masculinizing hormone therapy. They release testosterone steadily over several months to maintain therapeutic levels.
Testosterone cypionate: Testosterone cypionate is a synthetic version of the naturally occurring testosterone hormone. It is commonly used in masculinizing hormonal therapy for transgender and nonbinary individuals.
Testosterone Cypionate: Testosterone Cypionate is a synthetic testosterone ester that is commonly used in masculinizing hormonal therapy. It is an injectable form of testosterone that provides a slow, steady release of the hormone into the body, allowing for more consistent and controlled levels compared to other testosterone formulations.
Testosterone enanthate: Testosterone enanthate is a long-acting form of the hormone testosterone, used in masculinizing hormone therapy. It is administered via intramuscular injection to induce and maintain secondary male characteristics.
Testosterone Enanthate: Testosterone enanthate is a synthetic testosterone ester that is commonly used in masculinizing hormonal therapy. It is an injectable form of testosterone that is slowly released into the body, providing a steady supply of the hormone over an extended period of time.
Testosterone gel: Testosterone gel is a topical medication used to increase testosterone levels in individuals undergoing masculinizing hormone therapy. It is applied directly to the skin, where it is absorbed into the bloodstream.
Testosterone patch: A testosterone patch is a transdermal system that delivers testosterone into the bloodstream through the skin. It is commonly used in masculinizing hormone therapy for transgender and nonbinary individuals.
Testosterone undecanoate: Testosterone undecanoate is a long-acting injectable form of testosterone used in masculinizing hormonal therapy. It helps induce and maintain male secondary sexual characteristics.
Transdermal: Transdermal refers to the administration of medication through the skin, allowing the active ingredients to be absorbed into the bloodstream. This method of drug delivery bypasses the gastrointestinal tract and liver, providing a direct route for the drug to reach the systemic circulation.
Transgender Health: Transgender health refers to the specific healthcare needs and considerations for individuals who identify as transgender, meaning their gender identity or expression differs from the sex they were assigned at birth. This term encompasses the medical and psychological aspects of supporting the health and well-being of transgender individuals.
Virilization: Virilization is the development of male secondary sexual characteristics in individuals, typically females, due to an excess of androgens or androgen-like substances. This term is particularly relevant in the context of topics related to androgens, antiandrogens, and anabolic steroids, as well as masculinizing hormonal therapy.
Warfarin: Warfarin is an anticoagulant medication used to prevent and treat blood clots. It works by inhibiting the production of certain clotting factors, thereby reducing the body's ability to form blood clots. Warfarin is a crucial drug in the context of pharmacology, interdisciplinary teams, nursing practice, drug administration, anticoagulant therapy, and hormonal therapy.