An update on Hormones… for the Male to Female



There I was sitting the consultant’s office at the gender Clinic, and I had just been told I was able to undergo hormone treatment. Apart from doing, cartwheels in my mind as you do… the first question that entered my mind “What Changes Can I Expect”.  I guess this is quite a natural thing to ask the consultant after all it was little old me asking them, the second question was blurted out without taking a pause from the first question, it was of course “How Soon Will I See the Changes”?

His answer was straight to the point just as my questions were. It went something like this…

If I have a ball of string in my office draw, do you know how big the ball of string is, and how long it entire length might be? Looking shot down I looked back at him waiting for the next line or phase to smack me back down to earth.

In fact, he said, if I told you I really had two balls of string would that make it any easier?

I thought for a brief second and answered how could knowing you had two balls of string help it’s just made my estimate of the lengths even harder as I don’t know if they are made up of used string new string  or a mix of the both…

Smiling he answered me by saying exactly!

That is what you have just asked me to tell you about how you will change on hormones. I know you will see and feel changes, but effects of the changes on everybody is different and happens at different speeds it’s down to each person. I could see his logic in it all so decided to do my research on line and just see what life brings me.  

 

Hormones for me have brought mind and body closer together, which of course eases gender dysphoria and helps me feel better about my body. I generally feel less anxious, less depressed, much calmer, and happier with the first few weeks of taking hormones.  I know for some people this psychological change happens as soon as they start taking hormones, and for others it happens as physical changes happen.

I now know the degree and rate of change depends on factors that are different for every person, including your age, the number of hormone receptors in your body, and how sensitive your body is to the medication. There is no way of knowing how your body will respond before you start hormones.

Taking anti-androgens alone (without oestrogen) has relatively mild effects. The changes you see/feel will be caused by the medication blocking the effect of testosterone in your body. I have been told most of the changes are reversible (i.e., they will reverse if you stop taking the medication).

Just like the consultant told me, typical changes from anti-androgens (vary from person to person), average timeline Effect of blocking testosterone 1–3 months you will notice,

• Decrease in sex drive starting anti-androgens

• Fewer instances of waking up with an erection or spontaneously erections; some MTFs also have difficulty getting an erection even when they are sexually aroused it varies that much between different people.

• decreased ability to make sperm and ejaculatory fluid

• Slower growth of facial and body hair (usually at least slowed or stopped “male”-pattern balding by around 2 years on the medication)

• Slight breast growth

Anti-androgens affect the entire body. It is not possible to pick some changes and not others. You don’t get prescribed just anti-androgens you normally get Oestrogen as well so here is some info on it.

Taking oestrogen has stronger physical “feminizing” effects, caused by the oestrogen’s direct influence on cells of your body that have oestrogen receptors and by an indirect suppression of testosterone production.

Typical changes to be expected from oestrogen vary of course from person to person but as a quick guide from my research, knowledge and personal experiences the timeline for oestrogen after 1–3 months of taking the medication is something like this

• softening of skin

• Decrease in muscle mass and increase in body fat and the redistribution of body fat to a more “feminine” pattern

• Decrease in sex drive

• Fewer instances of waking up with an erection or spontaneously having an erection; some MTFs also find their erections are less firm during sex, or can’t get erect at all

• decreased ability to make sperm and ejaculatory fluid

• Nipple and breast growth

• Slower growth of facial and body hair after 1–2 years

• slowed or stopped “male”-pattern balding

• Decrease in testicular size

Again, Oestrogen affects the entire body. It is not possible to pick some changes and not others.

I found breast and nipple growth starts early but it is gradual – the Clinic told me it can take two years or more for breasts to reach their maximum size.  As in non-trans(Cis) women, there is great variation in how large breasts grow from naturally produced oestrogen. In many MTF’s breasts do not grow beyond an A or B cup so don’t expect Pamela Anderson “Bay Watch” chest.  However if you are not happy with the size of your breasts after 18–24 months on oestrogen, you can consider surgical augmentation. The implants will look most natural if you wait to get as much growth as you can from hormones.

Most of the effects of hormones happen in the first two years. During this time, the doctor who prescribes your hormones will want to see you 3–4 times in the next year at first, then every six months.

At appointments in the first two years, your doctor will likely:

• look at your facial/body hair and ask how fast your hair grows back after you remove it

• measure your breasts, hips, and testicles, and examine your breast/nipple development

• ask about changes to your sex drive, erections, or other sexual changes

• order a blood test to see what your hormone levels are or ask you to have them prior to your appointment so they have current data at your appointment

• ask how you feel about the changes that have happened thus far.

Normally after two years have passed, you will likely just be asked if you notice any further changes from the hormones. I think most of the changes brought on by “feminizing” hormone therapy are not really 100% permanent. If you stop taking the medication, most of the changes will reverse or reduce themselves.

However, there are two types of changes that may well be permanent: breast growth and sterility. If you are taking anti-androgens without oestrogen because you don’t want visible changes, you should be aware that you may have some breast growth (although it will happen slowly, so you can stop early on if you need to). Breast growth from anti-androgens is usually minor and reversible, but in some cases, the breast tissue has remained even after anti-androgens had been stopped. Oestrogen causes permanent nipple development and breast growth. Even if you stop taking oestrogen, breast tissue will not go away and your nipples will not shrink. Both anti-androgens and oestrogen affect your production of sperm.

I believe the long-term effects on fertility are not fully understood and the ability to make sperm may or may not come back even if you stop taking the medications.

So what won’t change and the list is quite long?

Hormone therapy won’t solve all body image problems. The point of hormone therapy is to feel more comfortable with your body by bringing physical characteristics closer to your internal sense of self. This relief can increase self-esteem and make you feel more confident and attractive. However, you will find that there are also attractiveness standards after hormone therapy, and you may not fit them.

Hormone therapy won’t make you into somebody else. Many people experience positive emotional changes with hormone therapy. However, you will likely find, after the excitement wears off, it does given time, and you have incorporated the changes into your day-to-day life, that if you were shy you’re still shy, if you didn’t like your laugh you still don’t, and you’re still afraid of spiders. Whatever things you think of as your strengths and weaknesses will still be there. I hope that you will be happier, and that is good for anyone.

Hormone therapy may help you to be more accepting of yourself I know it has for me so far. However, if you are expecting that all your problems will pass away, and that everything is going to be easy emotionally and socially from here on in, you are probably going to be quite disappointed.

Transgender people who were depressed because of gender dysphoria may find that taking hormones greatly alleviates their depression. However, please note if you have depression caused by biological factors, the stresses of transphobia or unresolved personal issues, you may still be depressed after you have taken hormones. Hormones will not get rid of those problems and you should have realised this prior to taking hormone treatment, if you truly don’t have gender dysphoria taking these hormones will screw you up totally, be really sure of what you wish for!

Some MTFs hope that after they make physical changes they will be validated as “real” women, or feel more accepted by the trans community well it doesn’t always work that way in life. However, the idea that trans people aren’t “real” unless they’ve changed their bodies is transphobic, and communities or groups that have this belief are not likely to be fully respectful in terms of trans people’s identities and bodies. During the various stages of transition, it is common to dream about finding an ideal community of trans people. When starting hormones there can be a particular drive to find other people who have gone through similar experiences.

There are I guess a lot of very cool trans people to talk with about hormones. Nevertheless, having taken hormones doesn’t automatically make all trans people welcoming, approachable, or sensitive to the needs of others, and despite having some experiences in common you will likely find that no trans person will exactly mirror your personal experiences, identity, and beliefs I know I didn’t or should I say I haven’t yet. So being realistic about the likelihood that you will at times feel lonely and alone after you start taking hormones is part of emotionally preparing for hormone therapy.

Hormone therapy will not remove all “male”/“masculine” aspects of your body; some physical characteristics are not and cannot be changed by hormone therapy, or at best are only slightly changed. My father would often be heard saying about something or other, “you can’t make a silk purse out of a sow’s ear” and this old saying of course can be used when it relates to taking hormones when your transgender. Once your bones have stopped growing after puberty, feminizing hormone therapy won’t change the size or shape of your bones. Facial feminizing surgery can be used to change the shape of the skull and facial features, and to reduce a prominent Adam’s apple. There are no treatments you can take to reduce your height or the size of your hands/feet.

Hormone therapy may make facial and body hair grow more slowly and be less noticeable, but hair will not go away completely. Electrolysis and/or laser treatments are used by many MTFs for hair removal it is expensive and a slow process.  NHS in England will cover the cost of 6 or 8 treatments but these are best left for genital surgery, my consultant advised me.  While “male”-pattern baldness may slow down or stop; (I hope my research is correct at this point) bald areas will not regrow hair, but dormant hair follicles may start growing again and give you less of a male pattern hair loss. Some MTFs use wigs or weaves, while others get hair transplants or other medical treatments.

Also “Feminizing” hormone therapy does not change voice pitch or speech patterns. Speech therapy can help change pitch and other aspects of speech associated with sex/gender. Some MTFs have surgery on their vocal cords or the surrounding cartilage to try to further raise voice pitch.

Most of importantly and the reason I keep this blog is please be informed.

Understanding how hormones work, what to expect, possible side effects/risks, and guidelines for care gives you the tools to be in charge of your health and to make informed decisions.

 

Do your own research and ask questions loads of questions if you have to. There are a lot of health risks associated with taking hormones and loads of side effects to be aware of only through knowledge can we be sure to arrive at the point we want to be at. I use the Plan-Do-Check-Act cycle this is a four-step model for carrying out change. PDCA was made popular by Deming and I use it in my day job and in life as you can see.

It puts you in the driving seat of change, my thoughts were simple, do I need to come out as trans  my answer was, YES and how do I do that? I needed to "Plan" what was need to be thought about and done, I then started the "Do" bit and came out, "Checked" it was what I needed to do and "Acted" upon it and then started planning the next phase and so on... As I move on in my transition I just repeat the PDCA cycle over and over. Its working well and I'm in control as much as I either need or want to be and the results keep on happening day by day.

 

Recent update on my hormones

 

The Gender clinic has upped my dose to 3mg oestrogen from 2mg and moved the blocker injections closer together now at 10 weeks and not the 12 weeks I was having the injections at, fingers crossed it all helps and doesn't cause an issue, but with hormones you never know! That's why I'm against self medication of a transition, you need the all the checks done and regular blood work to highlight and up's or down's in your body.  If I was self medicating from internet bought drugs my levels could be all over the show and I would realise until something happened to me, so please don't self medicate I know it's very tempting but equally very dangerous and could easily kill you, or stop you from transitioning completely. What a thought,  you couldn't be who you should be because you didn't do it right...