Alkaline phosphatase, hemoglobin and hematocrit, and creatinine may vary depending on the patient's current sex hormone configuration. Several factors contribute to these differences, bone mass, muscle mass, number of myocytes, presence or lack of menstruation, and erythropoetic effect of testosterone. Many transgender men do not menstruate, and those with male-range testosterone levels will experience an erythropoetic effect. As such an amenorrheic transgender man taking testosterone, registered as female and with hemoglobin/hematocrit in the range between the male and female lower limits of normal, may be considered to have anemia, even though the lab report may not indicate so. Conversely, the lack of menstruation, and presence of exogenous testosterone make it reasonable to use the male-range upper limit of normal for hemoglobin/hematocrit. Using the male-range upper limit of normal for alkaline phosphatase and creatinine may also be appropriate for transgender men due to increased bone and muscle mass, respectively. In these cases the provider should reference the male normal ranges for their lab.
Information from the Nurses' Health Study indicated that the combination of estrogen and androgen used to treat hypoandrogenism could increase breast cancer risk. However, other studies indicated androgens may decrease breast cancer risk. Follow-up studies on the Women's Health Initiative found women who received estrogen and no progestogen showed a significant decrease in cardiovascular disease (CVD) and breast cancer. This has caused a reconsideration of androgens added to estrogens. Still, the FDA requires demonstration of CVD and breast cancer safety for any product containing androgens or estrogen plus an androgen; that has not been done.
Genitals – Testes will lessen quite significantly in size. The production of testosterone and sperm is also greatly reduced. Penile size will also likely diminish. Sexual function will decrease, but the extent to which performance is affected is unpredictable. Erections may still continue, but will probably be less frequent, and not last as long, and in some cases may not be possible. Ejaculate will lessen, probably to the point of only producing a very small, clear discharge as a result of the prostate and the associated structures responsible for semen production being impeded. It is important to note, however, that the ability to orgasm is not dependent on either an erection, nor ejaculate. Anecdotally speaking, many transgender females report greater satisfaction with their orgasms after these changes occur in their genitals.