Hormone Replacement Therapy (HRT) for transgender individuals is a very long and involved process. The myriad of physical and psychological changes can be almost overwhelming. As a woman assigned male at birth, I will give my personal experience of the first 6 months of HRT.
When I took my first dose of estradiol, I was incredibly excited for the days to come, and within a week of my first dose, I already began to experience changes. The very first thing I noticed was a sensitivity forming in my breasts. They were still the same size and shape, but they began to receive sensation. As the first month continued, I noticed a lot of changes to my breasts including growth. Almost immediately after beginning HRT, I noticed my libido rapidly decline and stay almost completely diminished for the next 6 months. Near the end of the first month , I noticed a change in my body odor— it lost the masculine smell and got sweeter and lighter.
For the next two months, the changes from HRT slowed down, and I began to suffer from low testosterone. I didn’t have enough estradiol in my body to be dominant, so I experienced a complete loss of motivation as well as spikes in my depression. After about three months, my estradiol prescription was raised to 4mg a day, and the symptoms of low testosterone gradually improved. My breasts began to grow rapidly at this point. Within the next 3 months, I gained a cup size and the sensitivity of my breasts increased. Somewhere around this time I noticed a heightened emotional reaction to things such as shows on TV. Also around this time, I finally reached the point when I could look in the mirror and no longer see a man. The other biggest change that appeared was in my sexuality when I finally regained my sex drive. It was different, though. I no longer felt that it was a chore or something that my body forced me to do. It became something that I wanted to do because of how it feels. Now I want to talk about my dysphoria. Dysphoria infects every facet of my life, from the way I socialize, to my own self image. Throughout my life this pain has manifested itself in many forms. At the beginning of my first puberty, my dysphoria first emerged in the form of confusion. I didn’t understand what gender meant, but I wanted to be a girl. However, whenever I deviated from my assigned gender, society rejected it. I couldn’t understand why it had to be that way. The next year dysphoria took a different form. I had false ideas that I was a powerful psychic, which I’m sure
middle schoolers experienced, but the key difference is that I used it to rationalize my feelings of being female. This wasn’t the last time I used a weird belief to rationalize things. In high school, I held a belief that if I suffered through life as a man, in my next life I could be born female in an attempt to avoid facing reality. Also in high school, I experienced a period of time where I behaved in a hyper masculine way doing anything and everything to try to appear male. However, I couldn’t do it forever and became a loner.
I tried so hard to make it without transitioning, to be normal, and for a little bit I won, but nobody wins for long. After I finally found the truth within myself, the dysphoria that previously only had visible effects finally showed itself and became direct. The feeling that you are somehow inferior to the entire female population due to the circumstances of your birth cuts deep but eventually fades. Hormones seriously changed how my dysphoria functions yet again.
Most of these days I can go without experiencing dysphoria and am able to leave it at the back of my mind. Occasionally I’ll experience things that trigger it, such as having to use the gender neutral changing room because of my body. It’s triggered by things that remind me that I was once a man or tell me that I still am in some way. Dysphoria is at its worst when it comes to my genitals. This part of my body is so foreign to me that contact with it leaves me quite dazed. It's something that I would give anything to get rid of because it has serious effects on my mental health.
Hormone Replacement Therapy Explained
Hormone Replacement Therapy, commonly known as HRT, a clinical treatment supported by the World Professional Association for Transgender Health, helps transgender individuals achieve the secondary sexual characteristics of their gender. While not all transgender people choose to undergo this therapy, many do to alleviate gender dysphoria. It does this by changing their secondary physical characteristics and also by making their biological functions similar to those of the sex commonly linked with their gender identity. Transgender women, transgender men, and other transgender identities take different types of hormones and blockers customized for their particular goals.
For transgender women and other gender identities seeking to be more feminine, taking a combination of androgen blockers, estrogen, and progesterone is common. These will often result in breast growth, thinner and softer skin, hot flashes, headaches, fat redistribution to the hips, thighs, buttocks, and face, body hair thinning and slower growth, decrease in muscle size, and moodiness and emotional fluctuation. Some describe it as a second puberty. It is also important to note that this type of HRT will render those with male gonads infertile, which is often a difficult and painful consideration for those before beginning HRT to make themselves more feminine.
For transgender men and other gender identities seeking to be more masculine, testosterone is used to achieve the secondary sex characteristics that are desired. The changes that commonly occur include voice deepening, body fat that typically starts growing closer to the abdomen and internal organs, increase in muscle mass, increase in body hair, baldness, thicker and more oily skin, mood fluctuations, increased bone density, end to menstruation, but individuals engaging in coitus can still get pregnant, and the clitoris will become more sensitive and possibly grow. This type of HRT is also often described as a second puberty.
It is important to note that hormones affect each individual differently and that the changes listed above are only the most common that not every individual will experience. Also, hormones take time to work. Many transgender individuals become frustrated with the time it takes for their bodies to change and with the extent that they do. They often desire more dramatic results than what HRT can provide. These beliefs are reinforced when transgender people get inaccurate information from the internet because many in the medical community have not been properly trained on HRT or because they are not affirming of transgender identities.
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Wren Erickson and William G. Fleck
Wren Erickson (she/her) is a student studying computer science at NDSU. William Fleck (he/him) is a student studying computer science with an emphasis in cybersecurity at NDSU. He is an unapologetic liberal feminist who cares deeply about transgender people.
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