Ten things I wish someone told me when I started HRT:
euryale-dreams:
You can get hormone therapy in the United States without undergoing a long evaluation period or undergoing a ‘real life test’ if you seek out an ‘informed consent’ doctor or clinic. I waited over a year before seeking hormones because I did not want to place myself at the mercy of a mental health professional and I did not want a doctor ‘diagnosing’ my gender. Which brings me to…
They’re going to diagnose you anyway because they need an ICD code to bill your insurance company. I was furious when I found the diagnosis on my medical chart. It would have helped a lot if the doctor had asked my permission or explained that it was for insurance billing purposes only but he didn’t.
Hormone therapy drugs bought from overseas pharmacies are safe and will not cause ‘legitimate’ clinics to refuse treatment should you later decide to switch to a prescription. At the time the information I was able to find talked a lot about how trans women who use ‘black market’ hormones are not to be trusted and that a trans woman who uses such medications should be denied care until they can prove themselves ‘trustworthy,’ somehow. It is a lie.
There is absolutely zero evidence that injectable estrogens are more effective than oral estrogens. The fact is that the ‘advantage’ attributed to injectable estrogens is almost certainly placebo (and injectable placebo is known to be much more powerful than one administered orally). I could have saved myself a lot of discomfort and a serious leg injury caused by an improperly prepared injection.
Properly dosed, there is no reason that sublingual estradiol should be more effective than oral estradiol. The only thing that matters is that enough estradiol enters into your bloodstream and that is something that will be reflected in your labs.
Transdermal estradiol patches are itchy, smelly affairs that cost quite a lot of money and refuse to stay on. Knowing what I know now I would have avoided them entirely.
When I started hormone therapy my endocrinologist gave me conjugated equine estrogen because it came in smaller doses than 17β-estradiol. I was kept on conjugated estrogen for some time under the pretense that he was making sure I didn’t have any bad reactions to being on estrogen. Knowing what I know now I would have been able to argue that conjugated equine estrogen has a much worse side-effect profile than 17β-estradiol and that placing me on this drug unnecessarily endangered my body and my transition. Furthermore, the smallest doses available were far below a healthy dose needed to maintain bone and emotional well-being. Done again I would have insisted that I be started on a reasonable dose of 17β-estradiol.
Low progesterone is implicated in poor emotional health in women. Micronized progesterone is valuable to trans women for maintaining a healthy level of progesterone. I’ve personally benefited a lot, emotionally, from having it and I just wish I started using it sooner.
I wish someone had encouraged me to seek out other trans people as friends. At the time I first came out I didn’t really know there were other people out there that could really help me. The only thing I knew about being trans was what I was able to read online and in books and most of that firmly emphasized the idea that you should transition until you’ve had surgery and ‘pass’ and then disappear and that the people who ‘hung around’ the community were somehow failures. I know that’s not the truth, now, but it really messed me up early in my transition.
I wish someone told me to be cautious. I wish I was told that doctors and mental health professionals aren’t the last word and that if one decides that you’re a ‘failure’ or ‘actually a man’ it’s them that is wrong and not my own instincts regarding who I am. I also wish someone had given me a gentle nudge that some of the people I would meet in the trans community are not to be trusted and do not have my well being at heart. I feel that knowing those two things coming into that experience would have saved me a lot of grief.
Hey, would you know much about HRT for AMAB folks and not wanting all of the side effects of estrogen injections? (Namely breast growth) if not someone or somewhere I could ask/find out?
alicelovelace:
murbellas-musings:
alicelovelace:
murbellas-musings:
transmensch:
murbellas-musings:
agendermetalbender:
:
unfortunately there isnt that much information out there about this, at least not that I could find (and I’ve tried to look into it a few times).
from my experiences with AMAB nonbinary people who wish to transition in some way, most of them wind up taking other steps (epilating or getting laser to remove body hair, changing their hair style/way of dress, voice therapy etc.) rather than going on HRT, since HRT I believe has more side-effects for AMAB people and isn’t permanent (i.e. if you go off estrogen the effects revert).
If any of my followers know more about this and would like to share their experiences or resources it would be greatly appreciated!
(I’m an amab nb on estrogen and antiandrogen HRT for 1.5 years)
“Typical” trans woman HRT involves a combination of estrogen with a testosterone inhibitor/blocker (antiandrogen), because testosterone is normally too high and too potent for estrogen alone to have effects.
So, even without estrogen, you could still take antiandrogens like spironolactone and/or finasteride as HRT. They’re reasonably effective at lowering testosterone levels and helping to tone down its effects. Body hair does tend to thin out, sex drive often diminishes, things like that. Definitely worth investigating–look up HRT for trans women and just disregard the estrogens.
OOOO, I have knowledge on this as well! Disclaimer: 31 yo AMAB NB on ½ dose HRT for 1 year (2mg E + 200mg spiro per day, basically balanced 1/2way between cis male/female). From my personal findings on the matter, I’ve had all of the effects of HRT, body hair thinning, lowered sex drive, reduced erections, breast growth, body fat redistribution. I’m aiming for all the above, but not full on at cis woman standard ranges. No clue if this is just internalized trans or otherwise misogyny, but I’m happy with how things are going. Everything happens slow no matter what you do and can be slowed or stopped if things are going down an unintended path.
Spiro in and of itself does have mild estrogenic effects and can cause gynecomastia. So spiro alone will reduce T levels, but will result in some feminization. The other concern with an antiandrogen alone is basically bone loss and other mental/emotional effects from low sex hormone levels.
The other option is taking E alone without an AA, this will result in feminization to some extent. Due to the nature of all the feedback systems in the body, taking E alone will reduce T levels in your system so E alone will probably result in more feminization than taking spiro alone.
One option worth considering is adding a Selective estrogen-receptor modulator to an anti-androgen. SERM’s are a class of drug that stimulate estrogen receptors in some tissues, but inhibit them in others. They are traditionally used with post-menopausal women to prevent bone loss, or inhibit estrogen linked cancer in certain tissues. If you find an open minded informed consent endocrinologist, you might suggest this as a possibility as an option. Basically you could take a SERM and an AA and get the T reduction, avoid bone loss due to estrogen receptor stimulation in bone tissue, but avoid breast growth as those tissues will be inhibited. Again I caution, that a person should consult a doctor for this as these drugs are almost completely unstudied for this purpose.
I took spiro without estrogen for like six months plus. And estrogen+spiro (which ive been on it for a year) makes me feel good in a way just spiro didn’t. IMO just get on normal trans lady doses and then experiment with taking less and find what feels right, thats what I wish I just did. (Unless you’re deadset on avoiding breast growth in which case I can’t help you)
yeah, the negative mental effects of hormone imbalances can be huge and are very much important to consider if you plan on trying anything which lowers only T production/action along with the whole bone density issues.
I’ve heard from a lot of people that lowering T without taking E will cause negative mental effects, but I’ve never been really clear on what they are, and I don’t think I’ve noticed anything so far myself. (It also seems strange to me, because my impression is that historically eunuchs had no trouble being functional people?)
I’m very light on the topic of eunuchs so I wouldn’t be able to really get into that without some far better research…
As far as the symptoms of hypoandrogenism are pretty well understood. Basically the mental/emotional effects are understood to be depression, fatigue, anxiety, lack of motivation, and lack of sex drive. I will add a few caveats though. First, there is a great deal of marketing money going into attempting to get cis men to fear their possibly low testosterone levels and drive them to taking T for the profit of pharmaceutical companies. This does not mean the research is faulty, just that if you were to read media summaries of research, conclusions will be mildly weighted towards the negative effects, also since any possible chance at losing masculinity is unthinkable😜. Second, I would assume the data on symptoms of low T is generally coming from cis men and not trans AMAB people. Basically most of the mental and emotional effects of low T are coming from people who’s minds function best on standard cis male testosterone ranges. It would make sense that a trans AMAB person would fair better mentally and emotionally than a cis man in conditions of lower testosterone. I might even be safe to guess that hypogonadism (low sex hormone levels) might be emotionally beneficial for some agender or neutrois trans people.
That all said though, low sex hormone levels does result in several physiological negative effects in terms of muscle support and bone density which cause a person to have low energy and be at risk for injury which generally would not be advisable long term.
Thanks for the detailed response to this!
Given that I’ve been suffering from major depression for several years now, it’s hard to say for sure, but I don’t think that my depression and anxiety have gotten worse since I lowered my T levels most recently. I also don’t _think_ motivation has gone down. It is a bit worrying that it’s hard to tell, though, since I certainly don’t need to be doing things that could make my depression symptoms worse.
That said, I think I’m overall actually happier with the mental consequences of my current hormone levels. Certainly, I’ve gotten a significantly reduced sex drive, and that’s a huge relief, given how unpleasant I find having a male sex drive (and male orgasms/sexual response in general, honestly).
Sadly, yeah, know my current hormone regime (200 mg/day spironolactone, 5 mg/day finasteride, and no estrogen) isn’t a good long term plan for bone-density reasons, as much as I’ve been trying to not think about that fact. I’m a bit more surprised that it causes problems from low muscle support: I know that testosterone promotes more muscle development, but I didn’t realize that estrogen did as well, relative to a hypogonadal baseline?
I am starting to be increasingly convinced that I should start a low-to-moderate dose of estrogen when I have my next hormone appointment in January. I continue to have a bit of a worry about how I’ll react to breasts (and possibly not fitting into my pants), though…for the forseeable future, I seem to be living as male, especially since I’m living around my parents and not out to them. So I want physical changes, but I also want to be able to hide them. *frown*
phoenixcollective:
Transgender people may soon take do-it-yourself supplements using
genetically modified tobacco plants, which they can grow in their homes
to produce gender hormones like estrogen and testosterone. This comes
from a project of a biologist to develop transgenic tobacco plants due
to lack of access of many people to the healthcare they need.
The biologist and artist from Baltimore in the US, Ryan Hammond, is
aiming to produce supplements easier with the genetically modified
plants, Motherboard
reports. He found tobacco essential for the project due to earlier
discoveries of the capacity of the plant to produce pharmaceuticals.
The project comes from the growing concern that some doctors might be
transphobic and many experts lack the experience and skills to provide
patients the necessary medication.
Tobacco plants have already been used to produce collagen, hemoglobin
and Ebola vaccines. Hammond will insert genes into the tobacco using
plant pathogen Agrobacterium.
The first round of the tobacco products will not be distributed until
determined safe for human trials. Hammond wants to refine the process
based on its prototype to make the plants safe for human consumption.
Hammond has a background in art and has been exploring synthetic
biology and new techniques in a community biohacking lab in Baltimore
called BUGSS. The biologist has launched a crowdfunding to raise
US$22,000 (approx. AU$30,231) for the project, covering his training,
lab access and living costs for a year at Pelling Lab in Ottawa, Canada.
Please reblog, spread the word, and consider donating to make this a reality!
transgalactictittyfuck:
jramonap:
jramonap:
It blows my mind when I read posts by 24-year-old trans girls who are worried that it’s “too late” to transition, or that hormones “won’t make any difference.”
I started HRT at 37. I’m 39 now. I used to look more or less like a unkempt hobo. Now I’m a cute girl with a body more voluptuous and womanly than I ever could have imagined.
Know hope.
Damn! Well this post apparently struck a chord with people. 1700+ notes so far! :)
Well it is super fucking inspiring even for us younger transitioners to have hope for the future!!!
Anonymous:
Is it weird for me to be comfortable with my biological sex but still want to have a more feminine body? I am really unconfortable with my body because of my secondary sex characteristics (My bone structure, musculature, voice, etc) but I dont want to be female. More I want to be somewhere in between or a mix of different aspects of both male and female. Im realy unsure about how I should approch this issue and I'm kind of desperate for advice.
It sounds like you’re experiencing dysphoria, which people can experience to varying degrees. It is totally fine to be comfortable with your biological sex and still feel like you want to make changes to other characteristics! It is not weird at all.
It sounds like your ultimate goal is a more androgynous figure, which is definitely attainable. Hormones might be something to look into since the changes you want would be brought on by that. But by no means are you obligated to transition to the other side of the binary, or identify as female, even if you take hormones. Your identity is separate, unique, and determined you. My own plan is to take hormones until my body looks the way it feels best.
The first step in this process is to find a gender therapist (if possible, someone who is comfortable with non-binary identities) and talk this over with them. They’ll be able to give you a letter that you give to a doctor to start the process, if that is what you desire. I hope this was helpful!
-Kai
Anonymous:
Is your dose very high? Like, how are you deciding how much is enough for nonbinary transition? Taking T is something I want to do in the future, but I don't want to transition ftm, I want to transition ftn, being more neutral. Is there a standard you're going by, or are you just taking half the dose or??? This would be really helpful to know for when I do go through with it, so please and thank you. ;3;
Absolutely. The standard dose for ftm transition is a .5cc injection of testosterone weekly, I am doing the same amount bi-weekly so the transition is more gradual and I can stop whenever I want.
-Kai
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I started off at 50mg (0.5cc) a week injections, which was WAY too high for me. I got a new doctor who didnt really know what she was doing. it’s a common FTM dose but they didnt take into account my (very small) body size.
after being on 50mg/week for a month or so I started to feel out of control of the changes that were happening and went down to 50mg every two weeks. i was considering stopping altogether when I wound up having to stop anyway because I was getting surgery and would have to be testosterone-free for 3 months.
when I was feeling like going off hormones I felt like kind of a failure, especially since I knew other people who were on my prescribed dose and doing fine. I encourage you not to base your dosing standards on other people - it is completely individual and depends on your body type, your goals, and how your body feels about the testosterone.
during that time i did more research into FTN transition (there isnt much out there but neutrois.me is a good one) and decided that a much lower dose would be better for me and that I did want to go back on testosterone.
i’ve been on 50mg/month (¼ of original dose) for 2 months now and feeling MUCH better about my transition. I still experience active changes but I dont feel like they are happening too quickly or that I’m out of control.
I do plan on stopping eventually, but I dont know when, and I’d probably step down my dose one more time before I went off completely.
Unfortunately, although some NB people are lucky enough to get more progressive doctors, a lot of doctors arent trained/dont have experience in treating NB people and are thus hesitant to prescribe hormones to them. I told my doctor I was a nonbinary trans guy and she still hesitated on the “nonbinary”. I talked to my gender therapist about being fully nonbinary (after I’d been on hormones for a while) and we had a good conversation about it, but to my physician I’m just a trans guy.
unfortunately that may be something you have to do too, but I would encourage you not to feel bad about it. Everyone should be entitled to HRT if they want it, and it’s not our fault if doctors are gate-keeping our access to hormones. we do what we have to to get the treatment we need.
like I said, there is no standard dose. what I (and a few others I know) have done is basically start at the dose they prescribed you (usually FTM dose) and then self-adjust to what feels comfortable. that sounds dangerous, but considering the fact that you are going to a lower dose than prescribed, not a higher one, it’s pretty risk-free. Still, I wouldnt mess around with your dose too much. I would start at the dose you were prescribed and then step it down slowly every 2 injections or so until you find a dose where your body feels comfortable and stay there. you’ll know when you’ve reached a comfortable dose.
also, if you’re transitioning FTN you’re probably going to want to stop T at some point. luckily, most of the changes of testosterone are permanent. dont be afraid to stop at any time or just take a break for a few months if you start to feel uncomfortable. a lot of nonbinary people and even binary trans guys have to do that. remember that you arent just going through the motions in some pre-set transition narrative - this is YOUR transition and YOU are in control. do what feels right.
-newt
