Today I completed one year of Hormone Replacement Therapy or HRT as it’s popularly known. There is HRT for post-menopause women as well but that’s not what I am talking about. I am talking about the HRT for trans people. Basically replace Testosterone in your body with Estrogen, if you are a male to female transgender or Estrogen with Testosterone if you are a female to make transgender. I wanna share some of my thoughts, moments and feelings as I have gone on this journey in the last one year. And it is definitely a journey as I am still seeing many changes even after a year and I hope to see many more in the next few years.
What is HRT
As I have mentioned before, trans people experience a certain dysphoria all their life. It manifests in different form for different people. For me it was a lot of anxiety and un-explained depression. To improve their condition, they need to transition and typically the first step is HRT. For trans women (and I am mostly going to talk about us from here on) it involves adding estrogen to their body and also suppressing testosterone. This gives your body a chance to feminize but more importantly, it gives your mind the fuel it always craved for and find peace and understand it’s suffering better. The objective of HRT typically is to get a trans woman’s hormonal levels in the range of cis-women. The dosage is gradually ramped up over the first few months. The first 3 months or so really are like a trial run and it’s easy to back out if you don’t feel that you have made the right decision.
If they do decide to continue, Trans women have to take estrogen their whole life since they don’t have ovaries and so their bodies can’t produce enough estrogen. They can stop the testosterone blocker if they ever have the full sex reassignment surgery or an orchiectomy.
Long term estrogen is pretty safe. The blocker usually has unpleasant side effects so it’s generally a good idea to get off it if you can.
HRT is the litmus test for being trans
Honestly, it’s quite confusing to be trans. Especially if you haven’t grown up around trans people. Once you have a hunch that you are trans, you find all kinds of reasons to deny it. I am part of the asktransgender community on reddit and I see the same questions of self doubt over and again. The recommend approach is to talk with a therapist that specializes in diagnosing gender dysphoria but then start HRT. HRT in the first few months is a way of understanding your transness. Sure, there are some physical changes (like softening of skin and loss of sex drive) but they are reversible. However, HRT gives you a mental clarity and understanding that most trans people have never had. In my case it helped me understand that my depression wasn’t all that abstract. It came from my gender dysphoria. For example, a strong trigger for me was seeing women dressed up and enjoying their lives. It would pull me down since I wanted to be them but couldn’t. Before I could never understand why seeing women would pull me down often. It also helped me make peace with my confusing sexuality. I also found all the physical changes very soothing. I didn’t anticipate them but when they arrived, they would always leave me feeling happier. This trend continues to this day. Before starting HRT being trans was an intellectual debate but after HRT it became my reality. A reality I was very happy to be part of.
The challenges with HRT
However HRT is also physically and mentally quite challenging. Physically you find yourself out of energy, a lot. My body was used to running on testosterone for over two decades and it struggled for months before finding it’s groove again. I lost a lot of my strength and stamina and the loss affected my day to day life. Before starting HRT I had reached my peak performance as an athlete. Thanks to Medellin, I got obsessed with biking an I could go out on 60–100 km long bike rides every weekend, sometimes climbing 2km vertically. After starting HRT there were days where I found walking uphill to my house quite challenging! It wasn’t until I added the controversial progesterone a few months back to my HRT regiment that I regained some of my strength and drive. In comparison, when trans men go from Estrogen to Testosterone, they find themselves with a lot more energy and sex drive.
Emotionally it is a challenging ride too. Once you start to see and accept yourself as a woman a lot of your priorities in life change. You start valuing different things and find yourself in a life built for someone else and many aspects of it are suddenly very disturbing. As a kid, I had a lot of acne and I never took care of them. They left their marks on my face (trans people call such effects testosterone poisoning) but I didn’t really worry about it. That is until I started transitioning. Suddenly my perspective changed and I got a lot more conscious of their presence. It’s like being a teenage girl with the body and life of an adult man. It’s quite a mentally challenging (and probably funny) situation to be in.
HRT and Emotions
One of the first changes I noticed on HRT was it giving me access to a much wider range of emotions. Before, I had pretty much two emotions — excited and depressed. After HRT, I can be excited, happy, calm, sad, contemplative and depressed. It also made it much more easily to get emotionally overwhelmed and cry. A lot of trans women report the same. We cry more in a year of HRT than we have probably done in our whole lives. I eventually did get a grip on it :)
I also find my bonds of attachment to my friends and family a lot stronger than before. I think I always appreciated these relationships but now they feel a lot stronger and deeper. I am able to cherish them a lot more.
HRT and Sexuality
Unlike it’s effect on trans men, HRT kills the sex drive almost completely for trans women, at least initially. In my case, I had a strange hacked up sexuality before my discovery that I am trans. It was my conscious mind’s way of making peace with a reality it didn’t understand and certainly didn’t enjoy. Once I realized I was trans, even before I started HRT, my sexuality kinda disappeared into thin air. I was left with a blank canvas. My therapist at the time told me that it’s quite common and that it will be replaced by something else in time. She was right. It took a long time (I think 6–9 month) before it started coming back to me. It’s still shaping up and I don’t know where it will go but it’s pretty incredible to watch the whole process.
One year of HRT has helped me get to the point where I can see myself as a woman most of the time. I still struggle but not as much as I did earlier. I guess in many ways I struggle like a lot of other women struggle in accepting themselves. A lot of it comes from society’s idea of what it is to be an attractive or a successful woman. I’ll write more about it in another post. In the meantime, if you are questioning your gender, definitely talk to a therapist and try out HRT for a few months. Don’t keep struggling.