Time flies when one is sitting on one’s ass, soaking up the scents and sounds of summer and not writing a blog post before its time. Tempus fugit…it’s time. I spin for you today a medical odyssey, about why I decided to revisit the biochemical shitstorm of adolescence, what I gained and lost along the way and my best guesses about what lies ahead.
I speak, of course, about cross gender hormone therapy, which I will hereafter abbreviate as HRT.1 You have likely gathered that I am not especially reluctant to make personal disclosures2 about my gender identity. In fact, in this case, I find it preferable. After the experience of being closeted, I dislike secrets in general, and speaking about my medical choices openly not only spares me the nuisance of potentially having other people speculate about them privately, but also provides some comfort those who might otherwise might misinterpret some of the physical changes discussed below as illness.
I made the decision to start HRT in hopes of feeling better. Specifically, despite good I made the decision to start HRT in hopes of feeling bettersocial support, regular counseling and antidepressants I continued to experience fairly crippling gender dysphoria.3 Over the years I did my best to put a brave face on, but those closer to me tended to notice that I was anxious as hell and at best “getting by”. Short of hormonal therapy, I felt that I had done everything else I could to address my daily distress. Unfortunately, they didn’t solve my actual problem–the unrelenting sense that I was living the wrong life. Case in point:
I recall roughly 18 months ago, sitting in Dairy Queen with my son and his girlfriend. I was so strung out on antidepressants that I was falling asleep in my french fries. He grabbed my hand in almost a parental way and said, “Dad, why are you taking medicine when it only makes you feel worse?” I was just alert enough to realize that this was a damn good question. Not every day was such an exercise in misery, but I certainly got the sense, over the long haul, that I was painting over the cobwebs, caught in a downward spiral and unable to break my fall.4
Improved mental health was therefore my primary goal.. Still it is undeniable that I recognized that I would potentially be given a tantalizing opportunity to see life through different eyes. Regular readers might be thinking, “Wait! You have tended to dismiss most accounts of male/female brain differences as not only greatly overstated, but also carrying significant potential for justifying sexism.” Quite so. Still, the distinction I make is that while both men and women have versatile brains with amazing and essentially equal capabilities, it still might feel better for a brain which continues to recycle thoughts of being the opposite gender might feel better with the hormones associated with that gender.5 Well, along comes a chance to discover whether this opinion would hold up under the weight of personal experience.
Therefore I decided to keep, for my own edification and that of any other 50-ish transwoman6 who might be considering the same course, a symptom diary chronicling any changes I encountered as they happened.
Soon I learned that this was madness. The timescale of hormonally-influenced change does not lend itself well to real-time reporting. Within a couple of days, I realized that what I was doing was akin to watching the moon track from one horizon to the other. Sure, you can stare at it from east to west, but most of the time it looks like it’s just hanging there, and you might be better off taking a nap and coming back to check its progress later. It has now been a year–nap time is over. Here is what I noticed, roughly in order:
My nipples hurt. As in really hurt…starting within a week. For several days I assumed this was my imagination. Until, that is, I ended up clumsily juggling a box as I was carrying a load of junk into the garage. It bumped against my chest and produced an instantaneous stream of tears which clarified the situation. Something was already happening in my breasts.
My first thought was, “WTF.” Then, “One week? WTF?” Recall that my primary goal for HRT was improved mental health. Of course I knew that physical changes were just as likely, but my research had led me to believe that as a Way-Post-Adolescent patient, not much was going to happen in the mammary department. That much is probably still true, but I had more or less expected that I would be able to figure out whether estrogen was good for my brain long before it had much effect on my body. This, indeed, was my brilliant plan.
With that delusion safely in the wastebasket, I immediately had to reconsider under what conditions I would remain on HRT. I had not made a lasting and permanent decision to take estrogen. Now that I knew that physical changes were definitely going to proceed mental, I deftly reframed the “experiment” of therapy. I would give HRT a “reasonable amount of time” to work on my psyche, then decide whether or not to continue. “Reasonable amount of time”, in this context, now meant “Damned if I know”. Farewell, Caution, my dear friend.
Fortunately, I suppose, nipple-itis was the only thing that happened for quite some time. It also settled down to a dull roar after about 3 month. Although HRT produced more of a “flip of a switch” change in my hormonal balance than adolescent females likely experience, I assume that they experience something similar. Let’s just say that I overlooked this morsel of information the first time around and never got around to reading the memo. At any rate, I had re-entered puberty with reckless abandon. What could possibly be more quintessentially adolescent than awkward body changes followed by a big, fat juicy helping of nothing in particular? “Here you go, my child. I grant you proof that your body is changing and equally compelling evidence that it is not. Enjoy.”
During the next few months my discoveries were few. I alluded to one of them in the preamble. I discovered that I was overthinking the issue. It was neither useful nor healthy to pick my brain for signs of new ways of thinking than it was to measure my chest regularly. This did not, of course, stop me from doing either, but I put the “symptom journal” away, thereby saving me a colossal waste of time7
The second came in a eureka moment while exercising. I did not smell like festering, putrid death. My spouse reports that she sometimes gets grossed out by her body odor after a workout, but in terms of acrid, buzzard-gagging funk, she has never been my equal. Rather abruptly, my sweat chemistry seemed to have changed. I do not sweat any less–at least I think I don’t8–but I clearly sweat differently. It was subtle, but undeniable. I now had two clear changes to report, and the second, like the first, was physical. Mostly physical, anyway. I took pleasure in the change in my scent. It felt distinctly positive.
I suppose by this time I was about 2 to 2 1/2 months into therapy. Everything else was business as usual. I continued seeing my counselor, thus affording an opportunities to reflect on the latest answer to the question, “What’s new?” I tried to exercise regularly, although I didn’t really keep up. I kept blogging. I wondered if HRT would ever be something I would want to disclose. I watched the leaves of summer turn to gold. I waited. And waited. And waited.
Perhaps waiting is too strong of a word. It would be closer to the truth to say that I forgot, at least to the extent that it is possible to forget something that involved giving oneself a weekly injection in the leg and taking a pill every morning and night9 which more or less guaranteed that the nights would involve quality time in the bathroom. Enter emotional observation #2. After several weeks of learning to get over the crazy-overblown fear of needles, I started to look forward to Wednesday mornings. As much as I hated the shot (it’s not bad–estrogen is a bit syrupy, but doesn’t sting), it felt worthwhile to do it. I’m not exactly sure why. Perhaps it was ritualism.10 I speculated at the time that perhaps I was patting myself on the back for the small potatoes bravery of doing something mildly uncomfortable for purposes of feeling better, even though I didn’t feel better yet.
Until I did. When it comes right down to it, I can’t put my finger on when precisely I noticed. My best guess is November, roughly four months in. Partially, this is because I had developed a recent ritual of going bat-shit crazy in November and this year I didn’t. Instead, I asked my psychiatrist if he had any objection to me tapering off my anti-depressants. When he asked my why, I said that I didn’t feel like I needed them any more.
I would beg the reader not to see this as a euphoric salvation story. I still struggle with my mental health rather fiercely. I am at least as prone to anxiety as before, for example. I’m just feel better overall.
Mission accomplished, as far as I am concerned. Barring some major development that forces me to reconsider, I intend to stay on HRT indefinitely. Physical changes ended up being fairly minimal, at least so far. They may or may not continue, but these were never the objective. The way I saw it, changing my body would be of no value whatsoever if it did not change my brain. In ways that are too vague to describe and too striking to ignore, my brain is changing–barely…I think. I described it to my friend thusly: “It’s still my same old brain, but now it’s marinating in the right sauce.”
That’s it, for the most part. I keep waiting for some biochemical shoe to drop. Supposedly, my body fat will redistribute. Ironically, I’ve lost a shit-ton of weight recently, and I just look a bit more gaunt.11 There is nothing to redistribute. This brings me back to boobs. Very little followed the initial discomfort. I transiently gained, but subsequently lost, about an inch on my “first measurement”. If it looks like my bust line has changed, it’s mostly that I have figured out how to dress.
I would be remiss if I did not add that for every action, there is indeed an equal and opposite reaction. Taking estrogen does’t make one’s penis fall off exactly, but let’s just say it’s not growth serum either. Needing to draw a curtain of privacy somewhere, I’ll not say more other than that decreased male sexual expression neither caught me by surprise nor bothered me much. Why would it? I’m transgender.
I remain curious. Will my second adolescence leave me feeling more at home in my skin than the first? Will I wake up some day having forgotten male privilege? Alas…these remain works in progress. Meanwhile, I wait. I reflect. I measure. But I should not look so often. The moon makes its way, ever so slowly toward the western horizon.
- Hormone Replacement Therapy–a term originally referring to post-menopausal administration of estrogen which has become convenient shorthand for hormone administration for purposes of medical masculinization/feminization.
- My choice, not to be ascribed to transgender people in general
- Discomfort arising from mismatch between one’s identity and birth sex. I wish I could explain what it feels like to someone who never experienced it. I suppose there is some similarity to the oft-cited low self-esteem, but thematically it is relentless and constant. I never (as in, not for 5 wakeful minutes over two or more decades) forget that I am, to some degree, lost in and bewildered by my body.
- And many other clichés as well.
- This is the theory behind HRT. In practice, it seems to work rather well in carefully selected patients.
- I have discovered that 20-somethings are prolific posters of the effects of HRT on YouTube. In my age group, not so much. There are plausible reasons to believe that the physical changes diminish significantly with age. Could mental changes follow the same pattern?
- Which I then found other ways to squander.
- I come from a family of world class flop sweaters on my mother’s side.
- Spironolactone. It is a diuretic (makes you pee) and also blocks the effects of testosterone. MTF HRT requires such blockage. FTM’s do not need to block their female hormone production. Testosterone does this already.
- At first, I considered the possibility that I was ill, but I’ve decided to modify this speculation somewhat. Now I consider the possibility that I am well.