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...
