About three years after infection shoots are again produced on the stem with either male or female flowers depending upon the gender of the seed. By this time the infection has changed the physiology of the stem and has directed the tree to send nutrients and water to the infected branch over other areas in the tree. This will appear as a swollen branch and multiple branches emerging from the stem. The infection at this site will continue to alter the tree's physiology and morphology. It is not uncommon for entire trees to have shoots emerging along the entire stem of the tree with little mistletoe shoots everywhere.
Brooms serve as food sinks for the mistletoe robbing food from the rest of the tree.
Thus, the tree begins to put on less height and diameter growth, crowns begin to thin. Eventually the tree dies from the numerous infections that have taken place. If the host is known, then the dwarf mistletoe infecting can be easily determined. Infestation of an area by dwarf mistletoe in recreational areas is problematic. There is some research using plant hormones to get the shoots to abort prior to releasing the seeds.