Hormone Replacement Therapy (HRT) is a critical component for those desiring a more complete transition, basically replacing the hormones from your given gender with those of the opposite sex. I consider HRT to be the first major step for a transexual in transitioning, but going this route is something to be taken very seriously.
When I first looked into HRT and transitioning, there were conditions in place as prescribed in the DSM 3 that prevented me from going this route. DSM stands for Diagnostic and Statistical Manual of Mental Disorders. The most current update is version 5. Although Gender Dysphoria is one of the mental disorders listed in the DSM, not all trans people suffer from GD.
Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
If you’re not mentally bothered by your own self-accepted gender and there are no issues then you’re really not suffering from a mental disorder. I am trying to get to that point, where transitioning will reduce the amount of unease I have with being queer.
But let’s face it, much of GD in trans folk is caused by social norms and the inability for society to accept trans folk to be as natural as any other human trait. You never hear of “blue eyes dysphoria” or “red hair dysphoria”. If someone is fine with their gender identity, thenin my opinion, the treatment for transitioning, i.e. HRT or Sexual Reassignment Surgery should not be managed through the guidelines of the DSM. Instead it should be no different than treating a head cold or a broken ankle.
The DSM 3 was published in 1994, and it outlined a condition that required any patient seeking HRT and/or sex reassignment surgery must live as the opposite sex for 2 years prior to any sort of medical treatments. Primarily manner of dress, name change, and mannerisms.
This was deemed a cruel and unattainable condition for many transexuals. It was near impossible for many of us to just flip a light switch and voila, I’m now the opposite sex. It isn’t as easy as rolling out of bed one day as a new gender, splash on some makeup and a new dress and voila. Especially when it comes to family, friends, and employment. Although many tried to conform to the condition, I believe it caused a lot of harm to others.
Fully transitioning is so much easier with HRT, where in my case the levels of testosterone were reduced, and replaced with estrogen and progesterone. But you need to remember my starting age and the fact that my body was exposed to testosterone for more than 50 years. Most of those effects were irreversible, but there were still some benefits in going on HRT at this stage.
I’ve attempted to transition with the use of HRT twice in my life. The first time was in 2010, where my family doctor sent me to an endocrinologist that had some experience with prescribing hormone replacement. First off the endocrinologist should have never been allowed to deal with HRT and transition. Why? Because of his belief that the main reason all of his male to female patients were going through HRT was the expressed desire of growing breasts. Maybe because he was 80 years old at the time and not up to speed on transitioning.
He said the same to me, so that’s how I know this as fact. There wasn’t much discussion on all the options, such as antiandrogens and the various forms of estrogen and progesterone recommended for transitioning. Simply estrogen. Androgens are responsible for producing both testosterone and estrogen, so medically speaking you can reduce these to also reduce testosterone, in my case.
The endo prescribed Estogel, and I’m sorry but I don’t remember the dose. The cream was applied daily to my stomach, and to be truthful had little to no effect. It was funny to note that I had difficulty in even filling the prescription. The dose was double that normally used by women for menopause and the pharmacist wasn’t familiar with HRT for transexual transitioning. After refusing to fill it, believing there was a gross error, I had to switch pharmacies completely.
I ended up stopping that first attempt at HRT because I suffered a TIA or a transient ischemic attack. Also known as a mini-stroke. The left side of my face, jaw and neck suddenly became numb, my lips drooping, and pain ran down my left arm. After an emergency room visit and several follow-ups with a neurologist it was determined that the level of atrial fibrillation I had caused the mini-stroke), requiring use of a blood thinner and beta-blocker to try to keep this from recurring.
Luckily there weren’t any long lasting side effects, besides not having any movement in my left shoulder and elbow for 6 months. Frozen is the term that was used. But after 6 months of intensive and painful physio the use of the left arm returned.
So I figured it best to stop the use of estrogen altogether, as there were coronary risks associated with hormone replacement therapy. Every drug, including hormones, has a risk of negative side-effects.. And I always seem to fall into that lower percentage.
We can fast forward to 2019, when after 2 grueling cardiac procedures, one in 2015 and one in 2017, it was deemed that the cause of the a-fib was actually corrected. Faulty wiring is the easiest explanation. In 2017 I went through bilateral catheter ablation, where the surgeon went up into the heart through the major artery in both legs and into both the left and right atria.
The treatment involved scarring the inside of the atria with a laser, which corrected the path of the electrical charge required for your heart to muscle to spasm, or beat as we say. In my normal state, the heart muscle never spasmed properly, the muscle quivered from the electric signal not reaching the proper target. Hundreds of times a minute, and my long term prognosis wasn’t good. I would die of a massive heart attack or stroke sometime in the very near future.
I will have to write more about that experience sometime, where the expected 2 hour procedure turned into 8 hours. My wife wasn’t kept in the loop and sat in fear in the small waiting room. A part of the procedure involved stopping the heart momentarily. The problem was the surgical team could not get it restarted and I died on the operating table…twice. Luckily the surgeon ignored my DNR, as afterwards he said he wasn’t about to let me go.
In 2019 I finally found a great family doctor that was very familiar with HRT and the need for a transexual to transition. He was helping 11 other trans people when we first met, all at varying stages of transitioning. Really the only way to win the battle over GD. Transition or die was my mantra. I had been dying a slow and painful death in simply denying who I am.
I was excited and happy to be starting HRT, my one regret is I waited too long. Waited for the right time, which I found out there never really was a right time. But now in my retirement, and stage in my life it was time.
I’ve written about the use of cyproterone acetate as an anti-androgen, to lower the levels of testosterone, and how the side effects required ceasing that route altogether. So we focused on using estrogen, along with progesterone.
The use of both had a lot of benefits, including a reduction in testosterone levels. Estrogen is available in numerous forms; pills, injectables and patches. Since there was still concern about my heart and the potential side effects of estrogen it was deemed the patch was the safest route of the three, having less of a chance for any cardiac issue.
The dose of the patch was gradually increased over a 6 month period until I reached the current level of estrogen by using Estrodot 100 containing estradiol 17b at a measured rate of release. I use 2 patches at a time, and apply them every 4 days. Sunday and Thursday are “patch days”. This will continue for life now that I think about it.
After the initial 6 months had passed, the doctor added progesterone, which would provide added physical benefits to the equation. Progesterone has many key side effects that are desired by most transitioning male to females, like a potential increase in breast size and reduction of body hair. Potential was strongly emphasized by the doctor, it doesn’t work the same for everyone.
Progesterone is only recommended for the first 3-4 years apparently, but this June it’s been 5 years for me. Why? I simply asked my new family doctor to continue it, as the side effects have been very beneficial, both mentally and physically.
I found the combination of the two feminizing hormones were quite beneficial in the physical sense of transitioning, with the addition of progesterone really making the difference. My testosterone levels went down significantly, and as it did I felt a sense of calm, more at peace with myself.
Of course the surgery was the final step in reducing my testosterone levels to zero, and that toxic effect, mentally and physically, is now out of my system. You can read more about my surgery here.
Results? I’m happy with most of the changes, although not that much that anyone sees what has happened. The major changes occurred with body hair, fat distribution and breast growth.
I had always found body hair to be offensive, and would shave my chest, stomach, legs (in the summer of course) and underarms. I had always shaved my face daily, except once when I thought I could shut down being trans and grew a scraggly red and gray beard. I would shave my arms, but not quite as often.
I know many men who are not queer do the same, so this isn’t necessarily unique to being transsexual.
Once I was on HRT, I continued to shave but found the hair that regrew was finer and fewer. Now my body hair is basically gone or to the point it’s not bothersome from a mental perspective. What grows back is much finer and light colored. This includes my legs, which is a major benefit. Any woman knows what a pain it is to shave your legs during the summer months!
This didn’t affect the hair on my head nor in my private areas. That’s basically the same as always, although the hair on my head has become fuller, thicker and grows faster, according to my hair stylist at least. My beard has diminished somewhat, but still requires shaving every morning.
I’ve been overweight off and on since that fateful summer in 1964. What happened to start this weight battle was never diagnosed, but it’s always been an issue. Nowadays I can’t blame the extra pounds solely on the hormones, some of it’s a side effect of antidepressants and most just plain bad eating habits. There has been a shift in weight distribution though. My hips and butt more than usual.
Out of all the changes, breast growth has been the most significant. The addition of progesterone is the main reason for the body changes, which is why I requested the additional year. I think it’s been a full cup size perhaps a bit more.
So that’s where I’m at today, and with Sexual Reassignment Surgery testosterone is non-existent. I am dependent on these hormones for the rest of my life. The body needs these hormones for other functions besides sex. These changes aren’t enough really to make me totally passable, but they’ve greatly helped me mentally. Body image is more in tune with my gender preference.
Due to my continued depression and unhappiness I have gained more weight than I like. My next step in transitioning is weight loss, to the point where I am happier with the Kyd who is still waiting to come out to the world.
Wait and see.
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