Then we have the female virilization effects; virilization referring to the promotion of masculine traits in women; such effects can include body-hair growth, a deepening of the vocal chords and clitoral enlargement. For this reason, staying in the time frame of use mentioned in the benefits section is extremely important, and low doses should be used as well. If you do this, most women will be fine, but if virilization symptoms begin to show for any reason all hope is not lost. If symptoms begin to show, you should discontinue use at their onset, and if you do they will fade away rapidly. If they are ignored, this is where a problem will occur, and you may be stuck with them for the rest of your life.
There is considerable controversy over the earliest age at which it is clinically, morally, and legally safe to use GnRH analogues, and for how long. The sixth edition of the World Professional Association for Transgender Health 's Standards of Care permit it from Tanner stage 2 but do not allow the addition of hormones until age 16, which could be five or more years later. Sex steroids have important functions in addition to their role in puberty, and some skeletal changes (such as increased height) that may be considered masculine are not hindered by GnRH analogues.
Testosterone, an essential precursor of estrogen in women, is made in the ovaries and adrenal glands. There is a steady decline in testosterone levels from the 20s through menopause. With surgical menopause, the level of testosterone drops precipitously. No clear lower limit of testosterone has been established; however 15 ng per dL ( nmol per L) commonly is used. One study 38 found that women with 0 to 10 ng per dL (0 to nmol per L) had markedly decreased sexual desire in all situations and absent or markedly decreased orgasms. Because of studies like this, supplemented with anecdotal evidence, many women have been started on testosterone therapy.