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Pharmacology · chapter 37 · Transgender and Nonbinary Drugs

Masculinizing Hormonal Therapy

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Expected masculinizing effects

    The overall effects of masculinizing hormonal drugs on the female body include the growth of facial hair and increased body hair, deepening of the voice, redistribution of subcutaneous fat, increased muscle mass, hairline recession, and, possibly, male pattern baldness.

  2. Possible complications

    Possible complications include weight gain, acne, male pattern baldness, sleep apnea, elevated cholesterol, hypertension, polycythemia, type 2 diabetes, infertility, deep vein thrombosis, pulmonary embolism, increased risk for heart disease, drying and thinning of the vaginal lining, pelvic pain, and clitoral discomfort (Mayo Clinic, 2021b).

  3. Negative pregnancy test first

    Testosterone in particular is teratogenic, but other hormones are as well (Rodriguez-Wallberg et al., 2022). Thus, the nurse must ensure that a female client transitioning to male has had a negative pregnancy test.

  4. Electrolyte retention with androgens

    Androgens increase the retention of nitrogen, sodium, potassium, and phosphorous and decrease the urinary excretion of calcium.

  5. Androgens can lower blood glucose

    Androgens can decrease blood glucose levels in clients with diabetes. Dosages of insulin and other hypoglycemic medications must be monitored and possibly decreased to prevent dangerous hypoglycemic events.

  6. Danazol and fluid retention

    Danazol may cause some fluid retention, so it should be used cautiously in clients with conditions that may be affected by excess fluid, including epilepsy, migraine, cardiac or renal dysfunction, polycythemia, and hypertension.

  7. Testosterone target range

    A realistic target for hormone therapy for FTM transition is to administer testosterone until testosterone levels are within the typical male physiologic range (320–1000 ng/dL).

  8. Anabolic steroid adverse effects

    Contraindications and precautions include pregnancy; diabetes; and liver, renal, or cardiac disease. Adverse effects include acne, heart or blood vessel problems, stroke, liver problems, mental or mood problems, and infertility.

  9. Progesterone as an alternative

    For individuals who do not want therapies that contain estrogen, are at risk for thromboembolic complications, or have other contraindications, progesterone is an alternative to estrogen.

  10. Hematocrit and lipids

    Obtain a hematocrit and lipid profile before the client starts hormone therapy and at follow-up visits. Monitor virilizing and adverse effects every 3 months for the first year and then every 6–12 months.

  11. Peak and trough testosterone levels

    Peak levels for clients taking parenteral testosterone can be measured 24–48 hours after injection. Trough levels can be measured immediately before injection.

  12. Danazol and pregnancy

    Danazol can result in androgenic effects on the female fetus. If a client becomes pregnant while on therapy, the drug should be discontinued.

  13. Keep children away from gel sites

    Virilization has been reported in children who were secondarily exposed to topical testosterone gel/solutions. Children should avoid contact with adult application sites for these products.

  14. Observe 30 minutes after undecanoate

    This product is available through a REMS program and requires that clients be observed in the health care setting for 30 minutes in order to provide appropriate medical treatment in the event of serious reactions or anaphylaxis.

Terms to know

Androgens
Androgens are a group of male hormones, including testosterone.
Danazol
Danazol is a synthetic androgen that inhibits pituitary gonadotropins and in turn suppresses ovarian response to the pituitary.
Testosterone
Testosterone is a hormone responsible for the development of male sex organs and secondary sex characteristics.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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Every question here, with the answer

  1. A client assigned female at birth is about to begin testosterone for female-to-male transition. Which action must the nurse ensure is done before therapy begins?

    1. A serum potassium restriction
    2. A bone marrow biopsy
    3. A negative pregnancy test
    4. A chest x-ray

    Answer: A negative pregnancy test

    Testosterone is teratogenic, so the nurse must ensure the client has had a negative pregnancy test. The other tests are not described as required before starting masculinizing hormones.

  2. A client with type 1 diabetes has started testosterone for transition. Which problem should the nurse watch for?

    1. Hypoglycemia
    2. Hyperglycemia
    3. Hypercalcemia from increased calcium excretion
    4. Ketoacidosis from androgen use

    Answer: Hypoglycemia

    Androgens can decrease blood glucose in clients with diabetes, so insulin doses may need to be monitored and decreased to prevent hypoglycemia. Androgens decrease calcium excretion, and hyperglycemia or ketoacidosis are not the described effects.

  3. A client receives a testosterone undecanoate injection in the clinic. What should the nurse do next?

    1. Draw a trough testosterone level right away.
    2. Apply a warm compress and send the client home.
    3. Discharge the client immediately if vital signs are normal.
    4. Observe the client in the health care setting for 30 minutes.

    Answer: Observe the client in the health care setting for 30 minutes.

    Serious reactions, including anaphylaxis, can occur during or right after a testosterone undecanoate injection, so clients must be observed for 30 minutes. Trough levels are drawn immediately before an injection, not after.

  4. A client using topical testosterone gel lives with young children. Which teaching points are correct? Select all that apply.

    1. Keep the gel in a place children can reach so it is used daily.
    2. Children exposed to the gel can develop virilization.
    3. Report swelling of the lips, mouth or tongue to the provider.
    4. The gel is safe for children to touch once it dries.
    5. Children should not touch the skin where the gel is applied.

    Answer: Children exposed to the gel can develop virilization., Report swelling of the lips, mouth or tongue to the provider., Children should not touch the skin where the gel is applied.

    Virilization has been reported in children secondarily exposed to testosterone gel, so they must avoid application sites; serious reactions such as swelling of the mouth, lips or tongue should be reported. Nothing in the section says drying makes contact safe, and medications should be kept away from children.

  5. A nurse is planning follow-up care for a client taking testosterone. Which actions are part of the nursing implications? Select all that apply.

    1. Measure trough levels immediately before an injection.
    2. Stop screening clients who have a cervix.
    3. Obtain a lipid profile before therapy and at follow-up visits.
    4. Obtain a hematocrit before therapy and at follow-up visits.
    5. Monitor virilizing and adverse effects every 3 months in the first year.

    Answer: Measure trough levels immediately before an injection., Obtain a lipid profile before therapy and at follow-up visits., Obtain a hematocrit before therapy and at follow-up visits., Monitor virilizing and adverse effects every 3 months in the first year.

    The nurse obtains a hematocrit and lipid profile, monitors effects every 3 months in the first year, and can measure trough levels just before an injection. Clients with cervixes or breasts still need appropriate screening.

  6. A client wants a masculinizing regimen but has a history of deep vein thrombosis and does not want estrogen-containing therapy. Which drug does the section describe as an alternative to estrogen for such clients?

    1. Finasteride
    2. Danazol
    3. Progesterone
    4. Spironolactone

    Answer: Progesterone

    Progesterone is described as an alternative to estrogen for individuals who do not want estrogen, are at risk for thromboembolic complications, or have other contraindications. Danazol is contraindicated with a history of thromboembolic disease, and the other drugs are not named as alternatives here.

Where every quote comes from

Section 37.3 Masculinizing Hormonal Therapy of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.