About four months ago I started Hormone Replacement Therapy (HRT), the effects are starting to assert themselves.
A note on hormones:
Hormones should not be taken without the supervision of a doctor who knows what they’re doing. Balancing hormones is an inexact science, and it requires regular blood testing in the early stages to guard against some possible complications (blood clot being one big one).
Transgender standards of care are an ever-evolving science, especially now. Doctors who not only specialize in the endocrine system but in trans patient care are the best thing if you can find one. Using community (LGBTQ community) resources is often the best way to locate the one nearest you.
What I take:
Spironolactone: A class of hormone blockers called antiandrogens, spironolactone blocks testosterone.
Estradiol: The main feminizing hormone, estradiol is synthetic estrogen and drives breast growth and fat distribution among other things.
Medroxyprogesterone: A form of synthetic progesterone, I was prescribed it because my doctor said in their experience patients have reported increased breast development as well as maintained libido. Estradiol and spironolactone have the ability to kill libido.
The use of progesterone is an option my doctor made based on his years of treating trans people. It is interesting because there are no quality studies to explain what it does to trans women. In cis women, progesterone is used to build up the lining of the uterus. Cis women start producing it shortly before their first period. When progesterone production tapers off the uterine lining thins, sluffs and drains out (aka menstruation), it also helps develop breasts during puberty. Since trans women don’t have a uterus it begs the question, what does it do? Medroxyprogesterone is also slightly different in chemical structure than organically produced progesterone, another factor that could affect its impact on the body. There have not been any studies to conclusively say that what effects (if any) synthetic progesterone has on trans women. Anecdotal evidence seems to support the idea that synthetic progesterone acts on the sex drive and breasts instead. So it counteracts the libido crushing effects of estrogen and apparently helps spur breast growth.
I would concur with both of those things, speaking from personal experience…
So here’s what Hormone Replacement Therapy (HRT) is doing overall:
Three weeks after starting HRT I had my first hot flash. The morning it happened I had inadvertently forgotten to take my hormones during my morning routine. Two hours later I was delivering some papers to a co-worker in her office when I broke out in a sweat, it intensified, so I borrowed her Kleenex to start mopping sweat off my face. She was one of the people in my office aware I was now on HRT, she was post-menopause, and she knew what was happening to my body.
So I worked through the rest of the morning a sweaty mess, then went home for lunch. It was -18 Celsius outside but I opened a window, wrapped myself in a blanket and turned a fan on pointed at my face. Some internet sleuthing later it was clear to me that the co-worker had been right.
Since then hot flashes have happened rarely, they typically correlate to me taking a dose later in the day than normal. In the late fall, there was a period where they were quite common. I suspect this was because the estrogen was settling into my system. About two weeks ago I started having them again, around that time my doctor called to follow up on a blood test I had. He said my estrogen levels were low so he was increasing the dosage. Since I started on the increased dosage I have had no hot flashes, so that’s great.
Breasts and body fat
My breasts have grown by a full cup size, which is great except they ache on and off (like when the growth is happening). It also means I had to throw out a bunch of bras and am now hesitant to spend too much money on replacements.
When I was a kid I definitely had gynecomastia (fancy word for man boobs) but because they never fully developed they just remained as little sacks of fat. It meant that before starting HRT I was a pretty solid 36A. In the last three and a half months though, they grew to a 36B, most of that growth happened in December.
Speaking of fat, I’ve also noticed that the breasts aren’t the only place my body has started storing more fat. My hips and thighs are also looking plumper, which is great.
Libido (CW Genitalia)
One of the sometimes reported side effects of HRT is decreased libido, this is a price I was willing to pay. Thankfully I have not had to. Impotence has definitely been a thing, which for me is actually a great thing. I have no use for an erection and without one a penis is basically just an oversized clitoris. The urge for sex is still there, pretty powerfully at times, so that’s great.
My body is starting to develop its own hormone cycle as well. Even though I take hormones on a consistent basis, the body still processes them cyclically, similar to a cis woman taking hormone-based birth control. That impacts a bunch of things, such as sex drive, general energy, at times there have also been acute abdominal cramps, lots of bloating, and acne.
I used to have a problem with acne, I had very oily skin and even with regular washing I had regular breakouts. HRT has more or less ended that. My skin is softer and less oily, it’s easier to keep clean. I love it.
My body hair is starting to not grow back in some places. It’s crazy, I used to shave my chest daily, with stubble growing back by the end of the day. Now it takes a good week for hair to grow back and it’s lighter and thinner. My face still has more visible stubble than I would like, however, it is noticeably lighter and bald patches are starting to become pronounced. To help speed up the process I also have a do-it-yourself laser hair removal kit.
The changes that have started to pronounce themselves should continue to develop over the next two to three years. At 16 weeks I’m really happy with how things have gone.