HRT (Hormone Replacement Therapy)
Hormone replacement therapy, this is something that a lot of us have experience of during our transition and we welcome your experiences and comments about hormone replacement therapy (HRT).
It would be nice to read, with as much details as you feel comfortable to write down, everything you'd like to say on HRT.
For most transgender people, HRT is a solution to alleviate disphoria and better align with one's desired appearance. And like every solution it has its pros and cons. And it is just one of the possible solutions. Once one decides to go with the HRT solution, the next step is to find the appropriate combination and dose of hormones. Which ones, in what format and how much to take. An Endocrinologist should guide one through this. I do not recommend to go on your own. And the effects, specially the side effects, should be monitored regularly. It could harm one more than help. I have been in hormones since 1999. It took me around three years to find the best combination for my biology.
Montreal, Quebec, Canada
Thanks for your reply Katherine, those are very important points that you brought up. And they are also very much the basics of the basics, so them being said, I'd plunge deeper in the topic.
You know that there is no formation as per say to treat transgender people? That if we take the indications by-the-word from the hormone labels, transgender people wouldn't have access to them at all. It takes the healthcare professional to really be open and curious and to want to help his patients very much, with a good dose of humility, to do good service to this part of the population.
I mention humility because I've known one who presents as an expert in this domain, and who is also known to consistently under-dose his patients, to the point that he warns people that it's going to take several years before we notice a change in appearance, and he says that there's no other/better way. He completely opts for the "safest" route, as if the blood-work data was all that mattered, (and then some!) instead of listening to the distress of his patients and allowing a more normal dosage, which doesn't imply that much risks at all anyway when properly monitored.
For endocrinologists, they are mostly going to learn from their patients, and from the community. They can talk with other endocrinologists. A lot of the time, reality is that it's to the trans person to educate their endo, so having in hand some solid backup data can be key to a smooth transition. Educating your endocrinologist gently can also be a great help for his other patients who are going to come after you and also benefit from the knowledge.
(to be continued)
It's good to see we are having some discussion on 'HRT', we also have a recent article published on the 'Transgender Hub' website giving information on all aspects of transgender hormone replacement therapy.
We would also like to add a further resource to this discussion, ‘Healthcare of the transgender patient’ by the ‘Be Well Medical Center’ (Dr. William Powers). This is a slideshow about 'HRT' which contains authoritative information - you can access by clicking here.
Here are 5 of our most popular transgender hub articles: (Links open in new window)
What is Transgender? (The Recognized Definition and Meaning)
Transgender Hormone Replacement Therapy – HRT Guide 101
7 Transgender Voice Feminization MTF Coaching Tips
Create a Feminine Face Using Full Coverage Foundation - Makeup 101
10 Tips To Feel Like A Girl Prior and During Transgender Transition
The "be well medical center" article is so throughout and thoughtful and complete, and up to date... woa I'm so amazed, thanks for sharing it. It could be an incredible tool to help inform our healthcare practitioners.
About testosterone for ftm
There are some lesser known things that I find interesting to be aware of.
1-Learned from friends, community and personal experience: we really tend to be hasty and loose hope of things happening when starting T. What great encouragements we can get is to take measurements, weight, notes, pictures, voice recordings, and compare them on a timeline. That way we see the changes way early on and we know we're not imagining; to be honest, especially the measurements change very fast, most often beyond our wildest dreams...
2-The male pattern baldness can be helped and prevented with some products, for real! And so the facial hair growth can also be helped with more than just the T, so talking with your endocrinologist about those and you can be pleasantly surprised.
3-The "slight increase of size" of the clitoris is not true. The whole region morphs with the magic of the hormones into a point between vagina and penis, and you quickly find out why so many transmen are OK with their private parts remaining as they are after years on T. But it's more than stunning. Somebody not knowing what they're looking at wouldn't ever guess that it was once a clitoris. Never.
4-You grow an adam's apple. The vocal cords thicken in the throat making the voice as low as cisgender men's, sometimes lower than (but I'm guessing that it depends of genetics mostly), which presses the structures out, and makes, well, an adam's apple apear. Voice change comes slowly at first and then you catch this first ever-lasting cold, which you kind of enjoy in a way because it makes you sound rough and low, but then the cold goes away and you're already several tones lower than before. And it keep cracking years after you start T, just less often.
5-Expect your torso size to dramatically increase, especially if you're doing some physical activity. I've had to cut open shirts to get out of. Passed from sizes Medium to XX large. It especially expands from the armpits, so I wouldn't suggest to buy a whole new wardrobe of expensive shirts to celebrate your start of HRT. Oh and the neck too, and feet and hands, and fingers, so wait up for the rings...
6-The hair changes, on the head I mean. Not for every guy though, I'd estimate that it might be about 40% of guys who have noticed a real change in their hair. Mine grew coercer, more frizzy, more breakable and much thicker. It gets greasy much faster too, and if not properly washed everyday, the greasy gets down on my neck and creates even more pimples.
7-The cycle of the shots, if you're not taking a form of T everyday. It goes up and it goes down, and that can be really something roller-coaster-ish, but being aware of that is the first step towards solving the issue if it becomes one. This is also a good cue as to how trans-friendly your endocrinologist actually is; if they ask you to get the blood-draw at the top of your cycle that's because they're most concerned to not get you too high levels, and if they ask you to get the blood-draw at your low that's because they're most concerned about keeping a not too low level of T in you. I am of the mind that you should bring it up and possibly do both blood-draws to make sure both your high and your low stay inside the good range, and find solutions together if they aren't.
8-Hysterectomy, and T levels after. A lot of endos suggest to lower T intake after that surgery, but some of them suggest the opposite. See, we have a total level of sex hormone in us, and that surgery really brings that total down, which can lead us to depressed states. That's totally normal and can be countered by raising the T levels instead of bringing them down. Also, everybody needs SOME estrogen to metabolize fats and such, and after the hysto we actually produce less of those than cisgender men do. So upper T levels lets the extra T be turned into the needed estrogens.
9- Testosterone changes the insides too. It transforms our personality, so the whole puberty 2.0 means also getting to know the new us. I would have never believed it unless living it myself, and boy that is so true. Before, I felt like I was already 100% male in my head, so I didn't expect that much little things that have nothing to do with gender change in that thinking box. But it's really not an excuse to be a jerk to anyone, either. Every other boy has to learn to control themselves and so do we, just, erm, extra fast.