Overview

A healthy adult woman's ovaries and adrenal glands make a small amount of testosterone. Masculinising hormone therapy raises blood testosterone into the typical male range, which is many times higher than normal female levels. At the same time, the high testosterone suppresses the ovaries, so estrogen falls. Both halves of this matter: some effects come from having too much testosterone, and others come from having too little estrogen.

Testosterone is an anabolic-androgenic steroid: the same class of drug that some athletes and bodybuilders misuse. In medical transition it is given at doses that produce male hormone levels in a body that did not develop with them. Unlike in a male puberty, the body's frame, heart, blood vessels and reproductive organs stay female while the hormone environment becomes male.

For the male equivalent, see estrogen and testosterone blockers in males. The wider hormones hub covers both.

What testosterone does to the female body

Effects appear on a rough timeline, though individual response varies widely with genetics, age and dose. Timelines below are drawn from clinical patient information such as University of California, San Francisco (UCSF) Transgender Care and the Mayo Clinic, and from the studies cited further down.

The pattern matters. Many of the changes people want first, such as stopped periods, a flatter shape and more muscle, are the reversible ones. The changes that arrive early and stay are the voice, the hair and the genital growth. Many female detransitioners describe exactly this mismatch: by the time doubts surface, the permanent changes have already happened.

Permanent effects from test happen SUPER QUICK… That throat tingling is your voice getting deeper and it may never go back. —WSB_Messiah

Voice

Testosterone thickens and lengthens the vocal folds. Once that tissue has grown, stopping testosterone or taking estrogen does not shrink it. A meta-analysis of 19 studies (Ziegler et al. 2018) found that after a year on testosterone, about 21% of trans men still did not reach typical male pitch, 21% reported their voice did not fully match their identity, and an estimated 46% had voice problems such as hoarseness, fatigue or cracking. The voice changes, but it does not reliably become a typical male voice. Someone who stops partway through can be left with a voice that is neither the old one nor a settled male one.

The most prevalent permanent change for me was my voice. I am now a woman with a masculine voice… Anyone who doesn't know me addresses me as male on the phone, or in online gaming chats. —detransburnerr

Since I stopped testosterone mid-puberty, I experience voice cracks like a teenage boy does… I am not sure it's ever going to go away. —Chelstrawberrymuffin, detrans female

Voice training can help some detransitioned women soften how they sound. It works on resonance and speaking habits, not on the size of the vocal folds.

Hair: face, body and scalp

Testosterone turns fine body hair into coarse, dark hair on the face, neck, chest, abdomen and back. Stopping testosterone slows growth, but the follicles stay changed. Detransitioned women describe years of shaving, laser and electrolysis.

Scalp hair loss is often underestimated. UCSF Transgender Care notes that most trans men see some frontal thinning, especially at the temples, and that some develop male-pattern baldness or complete hair loss. Several detransitioners say they were told it would depend on the men in their family, and then found it came fast regardless.

you're told to expect male pattern baldness, but information on when, and how fast is incredibly sparse and contradictory… my hairline receded over half an inch in the span of 14 months on T. i wasn't even 20 years old yet. —bean-jee, detrans female

Clitoral growth

Clitoral enlargement ("bottom growth") is often one of the first changes. After stopping, many detransitioned women report some shrinkage and less erectile firmness, but not a return to the original size. Feelings about it vary a lot. Some describe painful hypersensitivity and chafing while on testosterone. Others come to accept the change, or even prefer it.

Mine got a little bit smaller but it's still way more prominent than before T… it reminds me that I put chemicals in my body trying to become a man and never arrived there… But I will say… I have much better sex the way I am now. —L82Desist, detrans female

I do wish that doctors would warn their patients that taking T could permanently affect their sex life… I had no idea that I couldn't handle direct stimulation until after it had grown beyond the protective hood. —Sonderosity, detrans female

For more on libido, orgasm and pain, see sexual function.

Periods, vaginal atrophy and the pelvis

Testosterone usually stops periods within a few months by suppressing the ovaries. Because estrogen also drops, the vaginal and vulval tissue can become thin, dry, fragile and inflamed. In postmenopausal women this is called vaginal atrophy. A best-practice statement from the British Association for Sexual Health and HIV (BASHH) calls testosterone-associated vulvovaginitis "under-recognised" and puts its five-year prevalence at 64–78%. It notes that evidence on how to manage it is lacking. A large US survey of 1,219 trans men and gender-diverse people born female (Tordoff et al. 2023) found that 64.6% reported genital pain or discomfort during sex in the past month. Current testosterone use was linked to more vaginal pain.

Symptoms that detransitioned women describe include pain during penetration, bleeding, symptoms like recurrent urinary tract infections (UTIs), bladder urgency and leakage. Some say these continue for years after stopping.

in my experience it was painful sex, bleeding during/after sex, intense pangs of pain in my lower abdomen, chafing, and UTI-like symptoms that still persist today. It's gotten vastly better since being off T, but I'll still need to deal with some of the issues for the rest of my life. —Ok-Cress-436, detrans female

Pelvic pain is debated. Early convenience-sample studies by Grimstad and colleagues reported that 58–69% of trans men on testosterone had pelvic pain, much of it new after starting. One later study reported 72% (summarised in this 2024 review). However, a larger national cohort (Tordoff et al. 2025) found chronic pelvic pain in 16% of current testosterone users and 19% of people who had never used it. Some participants still developed new pain after starting. The honest summary is that pelvic pain is common in this group, the role of testosterone is unclear, and the studies differ in how they recruited people. Pelvic pain is also one of the most common reasons trans men give for having a hysterectomy other than gender affirmation. Some detransitioned women describe being steered towards surgery for pain that eased when they stopped testosterone.

Immobilizing pain from severe uterine and vaginal atrophy. Felt like my insides were being fucking ripped out and my endo was absolutely no help. —watching_snowman, detrans female

Known risks

The risks below come from drug labelling, clinical guidelines and observational studies. Most of the evidence is low certainty: small samples, short follow-up, loss to follow-up, and few comparison groups. That cuts both ways. It means risks are uncertain, not that they have been ruled out.

One fact frames everything else. Testosterone products in the US are approved for males with low testosterone, not for women. The FDA-approved label for testosterone cypionate, one of the most widely used injections, has a warning headed "Not for Use in Women", which it explains by the "lack of controlled studies in women and the potential for virilizing effects". The same label lists the effects reported in women: "hirsutism, virilization, deepening of voice, clitoral enlargement, breast atrophy, male-pattern baldness, and menstrual irregularities" (FDA label, testosterone cypionate). In masculinising therapy, those warnings describe the intended effects. Prescribing to females is off-label, and the safety data in the label come from males.

The 2017 guideline of the Endocrine Society (the main professional body for US hormone specialists) classes erythrocytosis (haematocrit above 50%) as a "very high risk" of adverse outcomes for people on testosterone. It classes severe liver dysfunction, coronary artery disease, cerebrovascular disease, hypertension, and breast or uterine cancer as "moderate risk". It tells clinicians to watch for "erythrocytosis, liver dysfunction, hypertension, excessive weight gain, salt retention, lipid changes, excessive or cystic acne, and adverse psychological changes" (Hembree et al. 2017).

Unknowns. No randomised trial has tested masculinising testosterone against any alternative, and the label itself says it has not been studied in controlled trials in women. Nobody knows what 30 or 40 years of male-range testosterone does to the female heart, blood vessels, bones, pelvic floor, uterus, ovaries or breasts, or whether cancer risk changes. The cohorts with the longest follow-up started treatment in adulthood, so there is even less evidence for people who began as teenagers. People who stop treatment and leave clinics often drop out of the data, so harms after stopping are largely uncounted. The FDA's 2025 reassurance on heart attacks and strokes comes from older men with low testosterone taking replacement doses. It says nothing about young females taking doses that are far above their natural levels.

What detransitioners report

Health problems are a major reason women give for stopping. In Littman's survey of 100 detransitioners, 49% cited concerns about medical complications. In Vandenbussche's survey of 237 detransitioners, 62% cited health concerns. The accounts below come from /r/detrans and are a self-selected sample, not a measured rate. They show what the numbers in the table can mean in a woman's daily life.

Several women describe pelvic-floor and urinary damage that they say was never mentioned to them:

That testosterone would cause me to develop atrophy and a pelvic organ prolapse that I would be dealing with for the rest of my life, which prevents me from lifting anything heavy. I thought testosterone would make me stronger, and it did for a while, but then it made me permenantly weaker. —DetransLaura, detrans female

I was going to the doctor and receiving antibiotics for a "UTI" that was "undetectable" for months because my doctor was not trans-informed and didn't know about atrophy either… I would have not started T if I had known it would make me feel like I was going to piss myself 24/7. —charlescaster, detrans female

Others describe cardiovascular and metabolic warning signs at a young age:

terrible cholesterol, terrible blood pressure, terrible resting heart rate, high RBC… I had the labs of a 60-year-old man at 29, and I was otherwise healthy--not obese, not a smoker/drinker, vegetarian. —graybutch, detrans female

I stopped because I had high blood pressure, was pre diabetic all my hair fell out ( not like male pattern baldness, like a body abusing steroids) and developed a gi issues as well as autoimmune disease. It also made my mental health worse —thisonesathrowawway, detrans female

One woman who started at 15 lists what nearly ten years of testosterone did. Her account shows how risks build up when treatment starts in adolescence:

first, my blood pressure SOARED, at 16 i was getting readings of like, 150/90… i had vaginal atrophy and cervix prolapse when i was 17… i got my ovaries and uterus removed by encouragement of my doctor. i also started balding at 19, and then at 22 i was told my cholesterol was to high. —blitz-angel, detrans female

Some describe lasting loss of sexual function and pain that sent them to hospital:

I also cannot orgasm. I haven’t been able to orgasm since I was 17. Directly because of testosterone. It caused my clitoris to grow but the nerves did not. —ourladyofakita, detrans female

Spent 6+ hours in the ER because of unexplained godawful uterine cramping eventually due to the atrophy, sent home with acetaminophen… My voice is never coming back. I'm a singer and everything makes me feel insecure. —isteponmushrooms, detrans female

A recurring complaint is that a signed consent form is not the same as understanding the risks:

This smug attitude of “well, you knew the risks!” is unhelpful, because I doubt most of us really knew the risks when we started the hormones. We might have signed the paperwork. Someone may have gone over a list of side effects with us. —squidapedoyt, questioning own gender transition

Some of these attributions (an autoimmune disease, for example) cannot be confirmed from a single account, and the women themselves often say their doctors did not know either. That uncertainty is part of the problem they describe: when a symptom appears, no one has the data to say whether testosterone caused it. The sections below go through each risk in more detail.

Thick blood (erythrocytosis)

Testosterone stimulates red blood cell production. Too many red cells, called erythrocytosis or secondary polycythaemia, thickens the blood and is linked to clots, heart attack and stroke. In a Dutch cohort of 1,073 trans men followed for up to 20 years (Madsen et al. 2021), 11% developed a haematocrit above 0.50 L/L. The chance of reaching that threshold rose from about 10% after one year to 38% after ten years. Smoking, higher BMI (body mass index) and injectable testosterone raised the risk.

I got polycythemia on T… my blood was so thick that I was told to immediately stop taking the T… Crazier thing is when I saw a "Trans affirming" Dr later on and they told me that the other Dr overreacted. —throwawayeffoff, detrans female

Cholesterol, blood pressure and heart disease

Testosterone pushes blood lipids in an unhealthy direction. A review of masculinising therapy (Best Practice & Research, 2024) describes meta-analytic evidence of falling HDL ("good") cholesterol and rising LDL cholesterol and triglycerides within the first one to two years. A 2024 meta-analysis in JACC: Advances found the same pattern. Testosterone also consistently raises systolic blood pressure in trans men (2018 review).

Whether this leads to more heart attacks and strokes is less certain:

• A Dutch cohort of 1,358 trans men on testosterone (Nota et al. 2019) found a heart-attack rate about 3.7 times higher than in women from the general population, and similar to men's.
• A US survey analysis (Alzahrani et al. 2019) found about four times the odds of heart attack compared with women, and twice compared with men. However, it relied on self-reported data and could not confirm hormone use.
• Other reviews, such as Connelly et al. 2019, conclude there is no consistent evidence of more cardiovascular events in trans men.
• The 2025 systematic review of hormone therapy in under-26s (Miroshnychenko et al. 2025) rated cardiovascular events in natal females as its one high-certainty finding. About 4% had a cardiovascular event 7–109 months after starting.

A common reassurance on trans forums is that testosterone simply gives women "male-level" heart risk. Even if that is true, it means accepting a large increase in risk compared with being a woman, starting at a young age and continuing for decades.

My cholesterol was horrific, RBC was way too high… My doctor wanted me to go on statin drugs (at 29!!) or go off T. I chose to go off T. —graybutch, detrans female

Uterus and ovaries

For years, trans men were told that testosterone might raise uterine or ovarian cancer risk, and some were advised to have a hysterectomy as a precaution. A 2024 systematic review of uterine and ovarian histopathology covered 522 people whose tissue was examined at gender-affirming surgery. About 49% had atrophic endometrium and 47% proliferative endometrium. Precancerous endometrial changes were found in 2.3%, including one cancer. About 35% had polycystic-appearing ovaries, and no ovarian cancers were found. The authors concluded that the evidence does not show a higher risk of precancerous endometrial lesions. The evidence comes from surgical samples, often after only a few years of testosterone, so long-term cancer risk remains unknown rather than disproven.

Other risks

Clinical patient information (Mayo Clinic) also lists:

• Weight gain and type 2 diabetes: more fat is stored around the organs, which is metabolically worse.
• Sleep apnoea, which can start or get worse. A US health-record cohort of 22,745 people on testosterone found a higher risk of sleep apnoea than in women (Christ et al. 2025).
• Blood clots in the legs or lungs. A large US cohort found clear increases in trans women on estrogen, but its results for trans men were inconclusive because of small numbers (Getahun et al. 2018).
• Liver strain: linked mainly to oral 17α-alkylated androgens, whose slow clearance by the liver makes them more hepatotoxic than injected or transdermal testosterone (Niedfeldt 2018).
• Infertility: see fertility.

Bone density is a specific concern for those who started on puberty blockers or later have their ovaries removed, because estrogen protects bone. The 2025 review rated the evidence on bone density as very low certainty (Miroshnychenko et al. 2025). The Endocrine Society recommends bone-density scans "specifically in those who stop sex hormone therapy after gonadectomy" and notes that fracture data in this group are not available (Hembree et al. 2017).

Psychological effects

The mental effects of testosterone may matter as much as the physical ones, because they shape how people judge everything else about transition.

The "T honeymoon"

Many trans men and detransitioned women describe an immediate lift in mood, energy and confidence, sometimes within hours or days of the first dose. Trans communities often call this gender euphoria and treat it as proof that testosterone is the "right" hormone.

For me it was the sudden and complete removal of suicidal ideation that had been constant, every moment of every day, until I took my first shot. —am_i_boy, trans man (FTM)

Many detransitioned women later reinterpret the same feeling as the known mood-lifting effect of an anabolic steroid, which anyone might feel, trans or not:

What was actually happening was that I had just started taking an anabolic steroid, one of the known effects of which is improvements in mood. But no one explained that to me… The improvements in mood acted as such a significant placebo that it basically blinded me from doing an unbiased assessment of how I was feeling about the other changes I was experiencing… I didn't like my voice yet, but when it was more settled I would. —Quiet-County-9236, detrans female

This creates a real problem for knowing what is happening. If a drug reliably makes people feel better, feeling better cannot show that the person's identity is "male". A depressed young woman given an antidepressant-like steroid will often feel relief, whatever the cause of her distress. Several detransitioners say the honeymoon lasted from months to a year or two. They describe the comedown, and the urge to chase the feeling back with more testosterone or with surgery, in the language of dependence:

After quitting T for good, I learned that every urge I had to go back on it was fueled by the emotional high/confidence and energy I had on it… In all actuality, I was simply overcoming a testosterone addiction. —Soggy_Agency_7062, detrans female

Emotional flattening and the loss of tears

Losing the ability to cry is one of the most consistent themes in accounts from both detransitioned women and trans men. Some experience it as relief from overwhelming emotion. Others describe numbness that cut them off from their own feelings. This matters because it removes the very signals a person would need to notice that transition was not helping.

I couldn't cry at all past the 3 month mark, instead becoming frustrated or angry in place of tears… On hormones it felt like everything I feel now but quartered. —Ferali, detrans female

Trans men describe the same effect, sometimes as a reason they stopped:

my emotions felt stagnant and stuck. I couldn't come close to crying and it felt like there was no release for those emotions, unless I got extremely angry first… I also felt it harder to connect with my partner. —Ruelliabotanicals, trans man (FTM)

There is also a link to internalised misogyny. Women who saw their own emotional sensitivity as weak or "too female" may value its suppression at first, and only later grieve what they lost.

Anger, libido and impulsivity

Some women describe "T rage", sudden aggression and a sharply raised sex drive. Some describe the sex drive as compulsive and dangerous. A systematic review of seven prospective studies (Kristensen et al. 2021) found that the tendency to react aggressively increased in three of four studies at about three months. No changes lasted beyond one year. The studies had moderate to high risk of bias.

I expected a mild libido increase. Everyone told me hypersexuality wouldn't be a problem… I was hospitalized multiple times because of the shit I got up to. —quietlyphobic, detrans female

Mental health outcomes

Testosterone's long-term effect on depression, anxiety and suicidality is not established. The 2025 systematic review (Miroshnychenko et al. 2025) rated the evidence on gender dysphoria, depression and global functioning as low to very low certainty and concluded that "we cannot exclude the possibility of benefit or harm". For the wider debate, see evidence reviews and suicide and transition.

What female detransitioners describe

Accounts on /r/detrans about testosterone return to a few themes again and again. These are a self-selected sample, not a measured rate, but they line up with the small qualitative literature.

• Health worries as a reason to stop. In a qualitative study of six UK detransitioned women (Lomax & Butler 2025), concern about testosterone's long-term effects (heart risk, uterine atrophy, infertility) helped drive the decision to detransition. Participants felt they had not been properly informed.
• "Reverse dysphoria". The same study describes distress about masculinised features that were once wanted, a mirror image of the original dysphoria.
• Feeling like an experiment. Many describe going to doctors with symptoms that no specialist could explain.
• Not being warned. In Littman's survey of 100 detransitioners, 55% felt their evaluation before transition was inadequate.

It felt very experimental to me, when I had problems, mystery symptoms, and none of the specialists I went to had any idea about issues caused by testosterone in women. —RealityGirlZine, detrans female

I also wasn't warned about a single side-effect of T from my doctors… I also wasn't warned about hair loss, which I am really angry about because I really loved my hair. —hobbittoisengard, detrans female

Not every account is entirely negative. Some detransitioned women make peace with a deeper voice or clitoral growth, or note side benefits. But even those who come to terms with the changes often say they wish they had never started.

Voice change is permanent… Other permanent changes I've had to endure, facial hair (lots of it). Painful clitoral growth. Vaginal atrophy and bladder weakness. Facial structure like furrowed brow and jutting jaw has not gotten much softer since stopping T. —feed_me_see_more, detrans female, after seven years on testosterone

Females stop testosterone more often than males stop estrogen. In US military health records (Roberts et al. 2022), 64% of transmasculine patients were still filling prescriptions at four years, compared with 81% of transfeminine patients. Prescription data cannot say why people stopped.

Trans men's perspectives

Trans men describe many of the same physical effects. Some describe them very differently, because the changes are wanted. A deeper voice, facial hair and stopped periods are the point of treatment. Many describe testosterone as life-changing and report less anxiety and better mood. Trans men's forums are also frank about the downsides: acne, sweating, hairline loss, voice cracks, constant arousal and difficulty crying.

Cons: more shaving… im horny all the time and i cant escape, my hairline is kinda looking like the mcdonalds symbol these days, i am so sweaty and oily my skin is crazy. —tcan1110, trans man (FTM)

A common view in trans communities is that testosterone's health risks only bring women up to men's risk levels. As shown above, that is partly supported for some outcomes, uncertain for others, and still means a real increase compared with staying female. The difference between trans men's and detransitioners' accounts is often not the effects themselves but how people interpret them, and whether they still want them years later.

Coming off testosterone

What happens after stopping is covered in detail in testosterone cessation. In short, as reported in the literature and by detransitioners:

• Periods usually return within months, though not always regularly at first.
• Fat and muscle gradually shift back over months to years.
• Voice, body and facial hair, hairline loss and most clitoral growth stay.
• Many go through a difficult hormonal "low" for some months, with fatigue, low mood and sometimes worse atrophy symptoms, before things settle.
• Blood pressure, cholesterol and red blood cell counts often improve, according to many personal accounts.

A 2022 survey of 237 detransitioners (Vandenbussche 2022) found that medical help with stopping or changing hormones was among the most common unmet needs. Many said their healthcare providers dismissed them or did not know how to help.

Some people take testosterone obtained without a prescription, with no blood monitoring at all. See DIY hormones.

The informed consent problem

Most clinics present the risks above on a consent form. Detransitioned women's accounts point to a deeper problem than missing paperwork:

• The permanent effects come early. Someone can be permanently changed in the time it takes to find out whether testosterone helps.
• The drug distorts the judgement needed to assess it. A mood lift and emotional numbing can hide growing doubts.
• Long-term female-specific data barely exist. The research on testosterone's effects on women's hearts, pelvic organs and bones over decades has mostly not been done. Lomax & Butler (2025) call for exactly this research.
• Risks get framed as "the same as men's". This hides a real increase compared with the person's own baseline.

Clinician Sarah Jorgensen (Jorgensen 2023) argues that detransitioners should be recognised as people harmed by medical treatment, and that major guidelines largely ignore them. For a fuller discussion, see informed consent critique and iatrogenic harm.

Questions worth asking

Questions that detransitioners and clinicians raise, for anyone considering, taking or coming off testosterone:

• Which changes are permanent, and could I live with them if my feelings change?
• Could the mood lift I expect come from the drug itself rather than from "gender euphoria"?
• Have other causes of distress been explored, such as depression, trauma, autism, eating disorders, internalised misogyny or same-sex attraction?
• What does my family history say about heart disease, blood clots and hair loss?
• What is the plan for vaginal and pelvic health, and for fertility?
• Do I have medical and emotional support if I decide to stop?

The support directory lists gender-exploratory therapists and detransition support groups. First-hand accounts are in the video archive, and the research is collected in the study archive.

Related pages

• Testosterone cessation: what happens when you stop
• Sexual function
• Fertility
• Mastectomy and top surgery regret
• Hysterectomy
• Internalised misogyny
• DIY hormones
• Informed consent critique
• Detransition and healing and recovery

References

• Miroshnychenko, A. et al. (2025). Gender affirming hormone therapy for individuals with gender dysphoria aged <26 years: a systematic review and meta-analysis. study page, source.
• Lomax, J. & Butler, C. (2025). Narratives of Adults Registered Female at Birth Who Started a Medical Transition and Later Detransitioned. study page, source.
• Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. study page, source.
• Vandenbussche, E. (2022). Detransition-Related Needs and Support: A Cross-Sectional Online Survey. study page, source.
• Roberts, C. M. et al. (2022). Continuation of Gender-affirming Hormones Among Transgender Adolescents and Adults. study page, source.
• Jorgensen, S. C. J. (2023). Iatrogenic Harm in Gender Medicine. study page, source.
• Madsen, M. C. et al. (2021). Erythrocytosis in a Large Cohort of Trans Men Using Testosterone: A Long-Term Follow-Up Study on Prevalence, Determinants, and Exposure Years. J Clin Endocrinol Metab. source.
• Ziegler, A. et al. (2018). Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review. International Journal of Transgenderism. source.
• Tordoff, D. M. et al. (2023). Testosterone use and sexual function among transgender men and gender diverse people assigned female at birth. Am J Obstet Gynecol. source.
• Tordoff, D. M. et al. (2025). Chronic pelvic pain among transgender men and gender diverse adults assigned female at birth. Andrology. source.
• Is there an association between pelvic pain and gender-affirming testosterone therapy in trans masculine adolescents? An exploratory cross-sectional study (2024), including a review of Grimstad et al. 2019/2020 and Zwickl et al. 2023. International Journal of Transgender Health. source.
• BASHH. Best practice statement on the management of testosterone-associated vulvovaginitis. source.
• Uterine and Ovarian Histopathology After Testosterone for Gender Affirmation: A Systematic Review (2024). source.
• Nota, N. M. et al. (2019). Occurrence of acute cardiovascular events in transgender individuals receiving hormone therapy. Circulation 139(11):1461–1462. Data as tabulated in Cardiovascular Risk in Transgender People With Gender-Affirming Hormone Treatment.
• Alzahrani, T. et al. (2019). Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population. Circ Cardiovasc Qual Outcomes 12(4):e005597. source.
• Connelly, P. J. et al. (2019). Gender-Affirming Hormone Therapy, Vascular Health and Cardiovascular Disease in Transgender Adults. Hypertension. source.
• Cardiovascular health in transgender people (2018). source.
• Metabolic and cardiovascular risks of hormone treatment for transgender individuals (2024). Best Practice & Research Clinical Endocrinology & Metabolism. source.
• Impact of Gender-Affirming Hormonal Therapy on Cardiovascular Risk Factors in Transgender Health: An Updated Meta-Analysis (2024). JACC: Advances. source.
• Kristensen, T. T. et al. (2021). Effects of testosterone therapy on constructs related to aggression in transgender men: A systematic review. Hormones and Behavior 128:104912. source.
• UCSF Transgender Care. Information on Testosterone Hormone Therapy. source.
• Mayo Clinic. Masculinizing hormone therapy (via Mayo Clinic Health Library). source.
• U.S. Food and Drug Administration. Testosterone Cypionate Injection: prescribing information (2022), sections 5.6 "Not for Use in Women", 6 and 9 "Drug Abuse and Dependence". source.
• U.S. Food and Drug Administration (2025). FDA issues class-wide labeling changes for testosterone products. source.
• Hembree, W. C. et al. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 102(11):3869–3903. source.
• Getahun, D. et al. (2018). Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study. Annals of Internal Medicine 169(4):205–213. source.
• Christ, A., Loria, M., Tabernacki, T. & Chiang, A. (2025). Sleep apnea risk in transmasculine individuals on testosterone therapy: a population-based cohort study. International Journal of Transgender Health. source.
• UCSF Transgender Care. Bone health and osteoporosis. source.
• Hormone replacement therapy in young women with surgical primary ovarian insufficiency. Fertility and Sterility. source.
• Niedfeldt, M. W. (2018). Anabolic Steroid Effect on the Liver. Current Sports Medicine Reports 17(3):97-102. source.