Which physical change would the nurse tell the female patient (transitioning from female to male) beginning testosterone therapy to anticipate? Select all that apply.

A. Deepening voice: Testosterone promotes thickening of the vocal cords and changes in the larynx, leading to a deeper voice. This is a common and usually permanent masculinizing effect experienced during gender-affirming hormone therapy. B. Hypogonadism: Hypogonadism refers to reduced function of the gonads. Testosterone therapy is used to treat gender dysphoria, not to induce hypogonadism. This is not a typical or expected outcome of initiating therapy in transgender men. C. Vaginal dryness: Vaginal tissues become thinner and drier with testosterone due to decreased estrogen levels. Clients may notice discomfort, especially during sexual activity, and may require additional care or lubrication products. D. Menstruation cessation: One of the expected early effects of testosterone therapy is the cessation of menses, usually within 6 months. This occurs as testosterone suppresses the hypothalamic-pituitary-ovarian axis. E. Decrease libido: Testosterone usually increases, not decreases, libido. Many clients report heightened sexual desire as one of the early effects of masculinizing hormone therapy.