HRT, part one – will it reduce my dysphoria?

Dear Reader,

I recently reached my one-year anniversary of beginning Hormone Replacement Therapy (HRT).  To say that this has changed my life would be an understatement! I thought I’d give you a little peek into what HRT has done to and meant for me.

Why did I pursue HRT?

The months following the discovery that my gender didn’t match my body were really rough. It seemed like all I had were questions and no answers. Gender dysphoria was eating me alive, and I was trying everything I could think of to bring it under control: cognitive behavior modification, anti-anxiety medications, distractions, research, writing, wearing feminine clothing, letting my hair grow… The only things that seemed to help were the things which weren’t trying to resist/replace the dysphoria – the things which instead, accepted and affirmed the femininity I was experiencing. And even those things were of limited help.

I searched for other peoples’ experiences with gender dysphoria and how they dealt with it – especially those few people who claimed to have mastered it well enough that they did not need to transition. I tried the things they suggested – using a mantra to try to refocus my attention away from the pain and avoiding potential triggers seemed the most promising.  But I found myself walking through life with my head down – literally looking at the ground a few feet in front of me to make sure I didn’t trip on anything, but otherwise avoiding looking any anything or anyone.  And the dysphoria didn’t stop!

I researched more, begged my therapist for help, searched for something – anything – to make this pain go away! One solution kept appearing – HRT. I didn’t want that solution. But it kept appearing in the stories I saw: other people desperately trying everything they can to relieve the dysphoria, and finally trying HRT and having it work. When I started having panic attacks, my wife suggested that I try HRT, and I finally agreed to give it a shot.

How do you get on HRT?

It turns out that there are actually a lot of options for how to access HRT, and a lot of options with HRT itself. I found that there are basically three options to access HRT: Do It Yourself (DIY), Informed Consent, and the more traditional approach – get a referral. DIY is a popular option, since you largely bypass medical professionals and acquire the medications through third parties – offshore pharmacies or the black market. The legality of this approach is questionable, as is the safety: with either an offshore pharmacy or the black market, it’s hard to know that what you’re buying is what you’re actually getting.

Informed Consent is a relatively new option. In this approach, you visit a medical professional (or group) who explains the effects and risks of HRT, have you sign acknowledgements that you accept these risks, and then prescribe and manage your HRT. These providers do not require documentation from other healthcare/mental professionals confirming your condition. This option is newer because a few years ago, WPATH – the medical professional association which sets worldwide Standards of Care (SoC) for the treatment of transgender people – updated the SoC to allow for informed consent as an option which would not prevent a transgender person from accessing other services or procedures.  This removed the need for a formal diagnosis of Gender Identity Disorder (a term which has since been removed from the DSM) for a person to access medical care. In other words, a transgender person doesn’t have to get diagnosed with a mental condition to get treatment.

But in my case, I already had the diagnosis – Gender Dysphoria – so I had access to the third option. I asked my therapist to provide a letter and set out to select an endocrinologist (endo). I scoured my resources for information on providers near where I live, and found a few who were well regarded by their patients. I went with the one with a reputation of being very good, but also very cautious and careful. I made an appointment for 3 weeks later, but soon realized that my dysphoria was getting even worse, so I called and moved my appointment earlier, taking advantage of a cancellation. Armed with a letter from my therapist, I went to my first appointment.

My endo is also a gynecologist, so on top of my questions and anxiety about just getting onto HRT, I felt very uncomfortable in the waiting room. My wife was with me and offered to take care of checking in and even have them call her back so that it would appear that I was just a supportive husband accompanying my wife to her appointment. I decided that I needed to own this – this is my condition – so I thanked her, but declined. It turns out my fears were largely unfounded; the office staff handled everything wonderfully and respectfully, and did not call attention to an obviously male-bodied person having an appointment with a gynecologist.

We went back to the examination room and the doctor soon came in. She was very down-to-business and matter-of-fact, which I appreciated. I voiced my concerns about HRT and told her that I was trying this to see if it could help with the dysphoria. I wanted to avoid the feminizing effects of HRT and just reap the mental benefits. So she started me out on a low dose of spironolactone – a diuretic which also suppresses testosterone production. She sent me off with orders for a blood test to check my hormone levels and instructions to get clearance from my primary care doctor to begin the estrogen. So for the first two weeks, I was only taking the spiro (and only addressing testosterone production). The dysphoria didn’t improve, but it didn’t get worse, either.

Once I was cleared by my MD, I got the go-ahead to begin taking estrogen. In my case, my endo started me on transdermal estradiol patches. About two weeks after that, I noticed that I wasn’t experiencing the dysphoria quite as frequently or intensely as before. HRT appeared to be working!

But the effects of HRT were limited – I was still experiencing painful dysphoria, just not as debilitating as before.  It turns out that my pre-HRT hormone level check showed that my testosterone levels were at the very high end of the normal range for males. But my estrogen levels were also within the typical range for males, and after two months of estrogen patches, I had only seen a modest increase in my estrogen level. So at my 3-month check-up, she increased my dose by adding an estradiol pill, while also increasing the dose of spiro. This helped further reduce the dysphoria, but didn’t eliminate it.  But it turns out that it did help me in another way…

Next time, I’ll get more into the effects of HRT on both my brain and my body, and how HRT helped me. Until then, I’m interested to find out what you think being on HRT would be like. What would it be like to suppress the hormones which have been dominant in your life so far and replace them with the hormones that a person of the opposite sex would have? Would the new hormones change the way you think? The way you act? The way you look? Post your answers and any thoughts or questions in the comments below.

Hormonally yours,

Me