Table 70-10 Side effects of cross-sex hormonal treatment

Anatomic males treated with estrogens and testosterone blockers
Side effect	Clinical likelihood
Prolactin elevation, mild	Common, reversible
Prolactinoma development	Rare, may require surgery
Blood pressure alterations	Frequent
Hypertension	~5%
Increased risk of osteoporosis	After orchiectomy, if estrogen dose too low
Hypothyroidism	Infrequent
Erectile dysfunction	Most patients
Decreased sexual interest	Common
Increased sexual interest	Reported by minority of patients
Changes in orgasm	Common; may be absent altogether
Negative social consequences	Often reported
Thromboembolism or other clotting abnormalities	~5% of those over age 40; higher in smokers and in those taking oral preparations
Weight gain (separate from fluid retention)	Common
Fluid retention; lower-extremity edema	Common
Breast cancer	Rare
Stroke	Possible; higher in smokers over age 40 years taking oral preparations
Headaches	Common
Anemia (below female range)	Uncommon
Decreased hematocrit and hemoglobin	Most patients
Skin rash	Localized with patch; uncommon
Generalized with oral; uncommon
Liver disease (elevated liver tests)	Not uncommon; may be transient
Shortening of the penis	Common
Testicular atrophy, shrinkage	Most patients
Infertility	Most patients; usually reversible
Anatomic females treated with testosterone
Side effect	Clinical likelihood
Headaches	Common
Oily skin, acne	Most patients
Infertility	Most patients
Increased aggressiveness	Common
Increased sexual desire	Common
Increased blood lipids	Common
Acceleration of baldness	Frequent
Side effect	Clinical likelihood
Increased axillary body odor	Most patients
Benign or malignant liver tumors	Unusual
Negative social consequences	Common
Increased risk of Alzheimer's disease	Possible, but unknown risks
Increased risk of cardiovascular disease	Most patients