I hope that this account of and commentary on my experience with hormone replacement therapy (HRT) will be informative if you are considering HRT or are generally interested in how it can improve a transgender woman’s life. I’ve had quite a few doctor consults for face and vocal surgery. That decision has yet to be made yet. But HRT has turned out to be fundamentally important for me. I have an Estradiol patch and take Spironolactone to suppress testosterone (I hope to someday eliminate testosterone altogether, but that’s a whole other blog post :)). HRT also comes with risks, but for me, those risks are overwhelmed by the benefits. I began HRT on December 9, 2022, so I am 8 months in as I write this (wow). I cannot express enough how life changing it has been in a positive way <3.
There is no prerequisite that anyone undergo any medical intervention, including HRT, to be a transgender woman. If your friends are anything like mine, you will be accepted – and celebrated – for who you are regardless. However, for me, HRT was an important step, and it is impacting me physically, psychologically, and emotionally in such positive ways.
Physically, I have seen the beginning of body fat redistribution. Subtle changes in my hips (much more subtle than I would like, sigh) and noticeably in my breasts. Breast development makes me very happy, as any transgender woman understands :). They are small to be sure, but I’m really happy about it. It takes a couple of years to realize the full impact of HRT on breast development, so hopefully there is a little more to come :)). I’m a bigger girl, and like a lot of other women, I would like breasts commensurate with my size :). They became tender after about a month. The expectation was that that tenderness would go away after a few months. As yet, it has not. Small price to pay :).
I think my muscle mass has finally begun to decrease, although my body seems to have a “memory” that makes it slow going. This is an interesting goal to be sure. There is, of course, nothing inherently wrong with being muscular. But for me, muscle mass increases my gender dysphoria. I would also like to lose weight. That is in my control, and it is my fault that it hasn’t occurred yet. I’m starting that diet tomorrow! You’ll see. Yeah. Lol.
But more importantly than the physical changes have been the psychological and emotional changes and just how I feel in general. I felt better Day 1 of taking HRT. Indeed, as soon as I swallowed that Spiro tablet and put that Estradiol patch on. Obviously, that was a psychological impact, but it was real.
The most impactful change has been emotional and how I feel in general. HRT is a lifeline for me. Regardless of anything else, I never, ever want to turn off this estrogen flow and open the testosterone tap again. My libido is significantly reduced, which would be considered a negative by many, but it is a huge positive for me. Although my sex drive has been significantly reduced, I still have a desire for contact and intimacy. It’s a good feeling all around. I interact with people differently. I am not as aggressive. I am gentler in many aspects of my life. Some of these change are not due solely to HRT and testosterone suppression, but it sure helps.
Oh, I also cry, like, a lot. Often, I will think about something or someone in my life, or recall a memory, and there it comes. I will feel my lip quiver and think that I have it under control, but then it breaks and I can’t stop it. A lot of this is likely felling like I have “permission” to cry after being conditioned for so long not to as a male. As a male, crying was a sign of weakness, and it was to be suppressed at all costs (especially in Oklahoma and Texas!). Now I’m free to express these emotions. But I believe that at least some of it is related to my new hormone profile.
As an addendum, a warning to those undergoing or considering undergoing HRT. We took baseline measurements of testosterone and estrogen at the time I was starting HRT. As you would expect, I had a lot of T and not much E. At the three-month mark, we took labs again and T had been cut in half and E had doubled. I was very happy about that, but it wasn’t where we wanted everything to be. We doubled the estradiol and increased spiro by 50%. I was very excited when it came time for my next three-month checkup! But then we got the results :(. E had dropped and T had increased. Wth?? I had travelled overseas (Paris) for two weeks and had labs done a week after getting back. My med compliance had been sloppy at best while travelling. That’s what caused it. I thought that the estradiol and spiro were a “build up in the system” kind of thing. But turns out that the effect starts reversing quickly if you are inconsistent. Interestingly, during the period of inconsistent med compliance, I had experienced some biological effects that distressed me and that I couldn’t explain. In retrospect, I realize that it was due to my hormone profile getting out of whack. I will never make that mistake again! I took my meds religiously over the next month and we redid labs. I just recently got those results back and E was back up and T was back down. T is almost to the desired target. But E has more to go, so we have increased estradiol by another 50% and will redo labs in another month (one month instead of three, at my request).
As a humorous aside, my endocrinologist always asks me “what are your thoughts” when she recommends increasing my estradiol dose. Uhm, lemme think about that for a moment… *yes, please*! Lol.
This is all highly personal information about me, but I want to provide some first-hand information on the effects of HRT. I hope this is useful to anyone that has begun HRT, is considering HRT, and those who want to better understand the impacts that HRT may have on their loved ones, many of those changes not visible.
All my love,
<3
Melissa
