Hormones

In this post I’ll talk about how hormone replacement therapy has impacted my emotions, my body, and my sex drive.

The first time I started taking hormones was at the end of April of 2012. By that point, I’d made it far enough through my gender identity crisis to know I probably needed to transition, but I wasn’t quite ready to make the commitment to do it yet. I did feel like I needed to try hormones to understand what they felt like, though. I decided to go into it as an experiment. I was open to the possibility that I might like it or I might hate it. I was also open to the possibility that I might choose to stop taking hormones and that that didn’t have to mean I wouldn’t start back up again down the road.

Initially I started out with a very low dose of estradiol (which is estrogen). I can’t remember the exact dose but I think it was one 0.5mg pill per day. I took that for about a month and then my doctor bumped me to 1mg of estradiol per day as well as 200mg of spironolactone (aka “spiro”) per day to block the testosterone in my system. I was enjoying the feeling of the estrogen quite a bit, but at that point in my life work was very stressful and my personal life was also starting to get complicated. On top of that, 200mg of spiro was *way* too high of a dose to start me off with, so after about two days on the spiro, I freaked out and backed off. I stopped taking the spiro entirely and I dropped my estradiol back to 1/2mg per day. Within another week or two, more personal life stuff happened and I decided to stop hormones entirely. At the time, I was thrilled to no longer be confronting the stress of a gender transition, but I really missed the feeling of the estrogen in my system.

Over the next few months, my work situation settled down dramatically and things simplified and stabilized in my personal life and I got a chance to really evaluate whether a gender transition was right for me. I finally made the decision to do it in November of 2012, and by December I started seeing a new doctor who specializes in trans medicine (and who I love!) I started my new prescription for estradiol on Dec 31st of 2012. In late January of 2013, I also started a prescription for 50mg/day of spiro. I was pretty scared that I would hate the feeling of it and freak out like I had before, and then I’d be stuck. I knew I wanted to transition and I knew I intended to eventually have SRS, so if I’d hated the feeling of reduced testosterone in my system, I wouldn’t have known what to do.

Luckily, not only did I not hate spiro, I actually *loved* it. I slowly increased my spiro dosage every two or three weeks (by 50mg/day at a time) until I reached my current dose of two 100mg pills per day.  Throughout that period, my doctor kept my estradiol dosage steady at 1mg/day. We would have increased the estradiol dosage sooner but my prolactin level spiked after starting estrogen (which is apparently pretty common) and my doctor wanted to see it go back down before adding more estrogen. Luckily it did go back down, and a couple of weeks ago, I increased my estradiol dosage to 2mg/day.

So, as you can see, I’ve gotten the opportunity to feel the effects of my estrogen and testosterone levels going up and down independently of one another and I’ve gotten to feel a number of different levels of each, with two to four weeks at each level. That experience has been utterly amazing and it’s given me a profound appreciation for the impact of these two hormones on my functioning (and ultimately my identity) as a person. The primary psychological impact of estrogen for me has been a significant change in how my body feels to me and how my emotions relate to that feeling. When my estrogen level went up, my emotions immediately became more intertwined with the state of my body. My interoceptive sense also immediately became much stronger.

In other words, my body became “louder,” both perceptually and emotionally. For instance I notice much more subtle changes in my level of hunger now than I could before, and my hunger level also has a more obvious and (apparently) stronger impact on my mood than before. Hunger is just one of many examples. Warmth and cold feel like they matter more now (though I haven’t lost any body fat). I can also feel the “nutriousness” of my food more now than before. I could tell before that I felt bad if I ate junk food and good if I ate healthy food, but now it’s more sensually rewarding to eat healthy food. When I’ve had a good, wholesome meal, a wonderful feeling washes over my whole body.

In general, my experiences are much more sensual now than they used to be. It feels like my body “hums” in a way it never did before. (But not in literal, acoustic way!) Prior to taking hormones, it was very easy for me to “check-out” of my body, to ignore how it felt. In fact, it’s probably much more accurate to say that it was hard to check-in to my body and pay attention to how it felt before. But now it’s nearly impossible to ignore. My body is just too loud. In particular, my arms, specifically the muscles in my arms, are never “quiet”. I feel those muscles all the time. They don’t feel bad — in fact they feel wonderful. They just “hum” now in a way that I can’t fail to pay attention to. Overall my body “hums” now. It feels “warm” (by which I don’t literally mean warm, but rather something more like “emotionally pleasant and glowy”). Many times I’ve thought of the Calgon commercials from the 80’s when trying to explain how estrogen has felt to me. It’s a bit like I have a prescription for Calgon.

[youtube http://www.youtube.com/watch?v=sNgZFxAnKtA]

 

Anyway, this increased sensual volume and increased connectedness between my body and my emotions has had some interesting and surprising effects. At first I only noticed simple aspects of it. For instance, I might find myself in a bad mood and instead of needing to look for a potentially complex intellectual cause like I would have before, I would be able to tell right away that I was hungry or cold and that that was ultimately why I was unhappy. Then I could eat or turn the heat up and my bad mood would evaporate. This kind of thing rarely happend before, but it’s been a regular occurrence since starting estrogen.  Many of my emotions seem to make more sense and be simpler and more “down to earth” now than before. I don’t have fewer (or less intense) emotions, but my emotions seem more explicable by simple physiological causes than before.

As time has gone on, the impact of this has been more complex and surprising. The heightened causal connection doesn’t just go from my body to my emotions, it also seems to go the other direction as well. Recently, I got into a pretty bad fight with a friend — worse than we’ve had in years. I’m pretty sure that one part of what made the fight so bad was me being disoriented by my new emotional make up. In many ways I’m still learning what “happy” and “sad” and “angry” feel like now, as well as what I need when I feel those things. None of these emotions are drastically different than before, but all of them are different enough in subtle ways that it can be a little confusing. During the fight it turned out to be difficult for me to know what I needed to feel peace and resolution. My friend and I worked through a lot of the relevant intellectual parts of the disagreement, but my body was still very tense and angry. It wasn’t until I got a fair amount of physical affection (and a professional massage) that I started to feel more emotionally calm.

In addition to the other changes, my body also seems to be able to carry some of the cognitive load of processing things that I used to have to process in more intellectual and theoretical ways. I’m guessing this post probably seems pretty didactic, but I’m actually spending much less of my time lately “in my head” thinking in explicit, verbal ways. I can’t say for sure that it’s because I’m able to use my interoceptive sense to cogitate, though. It may be more that I’m sufficiently disoriented by the changes happening in myself that my nervous system is just busy rewiring some of my basic concepts and once that’s done, then I’ll have more access to those concepts (and more spare energy) to use to think abstractly and “intellectually” again. I’m not sure. What I can say is that I’m much less verbal in my thinking process these days, and that my process feels much “fuzzier” in some way, though still quite productive. I feel like I’m learning by leaps and bounds, but I’m not internally “discussing” what I’m learning and I’m not organizing it in the structured way that I’m used to. Though, somewhat to my surprise, the things I’ve learned lately all seem to be available at my fingertips as I’m writing this post, so it seems that my experiences are organized and retrievable. I’m just not doing that organization explicitly in the way I historically have. And it feels like this change has everything to do with my body being so much louder and “hummier” than before.

One of the (seeming) consequences of all of this is that I don’t talk as much, particularly about myself or my internal goings on, as I did before (this post to the extreme contrary). Again, I have no idea if this change is actually a result of the hormones changing my thinking in some sort of permanent way, or if this is more about me just being quiet because I’m disoriented right now. Whatever the case, I’m definitely much less verbal/didactic lately than I’ve been in ages, maybe ever.

Ok, so that’s a lot of stuff about estrogen. The more abstract stuff I got into at the end there is probably largely affected by the spiro as well (assuming it’s actually a result of the hormones at all), but the basic stuff at the beginning (about my emotions being more tied to my body and my body being louder and humming all the time) is definitely a result of the the estrogen. Those parts correlate very well with exactly when I started and stopped estrogen each time.

The main effect I’ve noticed that I can confirm being specifically from the spiro is a reduction in… I’m not exactly sure what to call it. You might call it “energy” or you might call it “panic” or you might call it “sex drive” or maybe “stress”. In a way, it also might be semi-accurate to call it “urgency”. It’s not quite a reduction in urgency because I can certainly still feel like something is urgent. I just have a significantly reduced amount of unmotivated urgency. By “unmotivated urgency” I mean a sense of energetic, driven urgency that is not the direct result of something external to one’s self or some idea or some bodily sensation — i.e. spontaneous, seemingly uncaused urgency.

For instance take my sex drive. Before, I would get horny “by the clock”, sort of like how one starts to need to pee as time goes by. Ignoring extreme factors like being asleep or highly distracted, my need to pee is fairly proportional to the amount of time since I last peed. If I just peed 10 minutes ago, then I probably don’t need to pee again yet. But if I last peed 10 hours ago, I would probably urgently be in need of a bathroom. Similarly, barring distractions (or specific motivations), my level of horniness used to be pretty proportional to the amount of time since I’d last had an orgasm. If my last orgasm was an hour or two before, then I wasn’t likely to be horny. But if it had been a couple of days, then I’d have a pretty difficult time thinking about anything else for more than a few minutes before the urgency of being horny would resurface, front and center in my mind. Unlike needing to pee, however, being horny wasn’t exactly a physical feeling. It was more of a disembodied/abstract urgency. As a side note, I have no idea how similar other males’ experiences of being horny are to what mine were. It’s possible that people who feel comfortable being sexual in male bodies also feel a more somatic and embodied sense of erotic arousal from testosterone than I did.

It’s been odd to adjust to the changes in my sexuality as my hormone levels have shifted. There’s a way in which being sexual has less of a “Hot damn! That’s *exactly* what I was craving!” feeling now than it did before. At the same time, though, it’s a big relief not to feel like I’m strapped to a constantly-burning rocket of male sex drive. Being that horny, that frequently is an intense and often difficult experience. As my attention has shifted onto my heightened interoceptive sensory stream, I’m glad I’ve been able to shift a similar amount of attention away from the intense sexual urgency I used to have with testosterone. I wonder if some part of my brain that was responsible for paying attention to being horny before is now getting repurposed to pay attention to my interoception. If so, that might explain some of why my bodily feelings so often strike me as not just sensory, but specifically sensual in a semi-sexual way.

Which brings me to the topic of what I’ve gained sexually. While I’ve lost a disembodied, chronologically regular, and fairly intense sexual urgency, I’ve gained a wonderful increase in sexual sensuality. Physical contact with skin on skin feels so much better now than it did before. Even just rubbing my hands along my arms is delightful. I haven’t had sex with anyone since I started hormones this second time, but I’m very curious to find out how it will feel. It certainly felt good last time, and now that I have higher and more sustained amounts of estrogen, I can imagine myself spending ages just doing things like touching and being touched.

Beyond just changes to my sexuality, the reduction in my testosterone level has had other effects as well. I used to frequently panic. I would just suddenly be very wound up and stressed for no easily identifiable reason, but that’s completely gone now. I didn’t realize how bad that feeling of constant background stress punctuated frequently by bouts of panic actually was for for me until my first week of taking spiro in early February this year. The first pill I took felt almost like a mild form of vicodin. At first I was surprised by how chill I felt and I wasn’t sure if it was the spiro or just a really strong cup of camomile tea I’d had earlier that day. But the next day, the same thing happened for a few hours after taking the spiro pill, and again the next day as well.

Within a few days, I got used to feeling more calm. Each morning, as the previous day’s dose of spiro would start to wear off, I would start to feel an inexplicable panic and that’s what reminded me it was time to take my pill. I *loved* the feeling of spiro. I still love it, but now I’m used to it and it’s the new normal. I once heard a trans person talk about suffering from “testosterone poisoning”. At the time, I thought it was a funny phrasing, but now I feel like that’s the best way I know of to describe what testosterone feels like to me. It feels pretty bad, almost like if I were allergic to it. I’m fairly committed to continuing through with my transition, but even if I were to stop trying to present as female, I can’t really imagine stopping hormones. I couldn’t go back to being so out of touch with my body and so stressed all the time.

Anyway, at this point I’ve practically written a book of a post here and I’ve still not said anything about the actual physical effects of the hormones, so I suppose I should go ahead and do that now.

Within two or three weeks of starting estrogen (both the first time and the second time) the skin on my face started to look much better. My pores shrunk and multiple people commented that I looked younger and that my face looked “creamier” or “softer”. The skin on my face started to actually feel softer to the touch as well. I didn’t notice the skin on my body feeling softer until more recently though, maybe in the past month or so. It seems like it may still be changing, so we’ll see how soft it ends up. My skin is also drier now (I need to put lotion on my hands and my face regularly) and I also seem less prone to acne.

Soon after starting spiro, I stopped losing as much hair when I showered. My doctor said I might even start re-growing some hair on top of my head, but I can’t tell whether that’s happening or not. My hairline might also be un-receding but I can’t quite tell. I’m at least not losing very much hair at this point, especially compared to what I was losing before. I’ve heard many people who were transitioning from male to female say that they experienced a decrease in body hair. I’m not sure if I’ve noticed any decrease in thickness or density of body hair, but oddly I have noticed that the hair on my arms and on my stomach (just below my navel) seems to grow longer than before. Overall, I didn’t have much body hair to begin with, so whether it thins much or not I’m not too worried.

I also noticed body fat shifting, both the first and second time I took hormones. In both cases, I lost a little bit of fat in my stomach and started accumulating more on my chest where breasts would be. I’m probably 20 to 30 pounds overweight at the moment, so I have plenty of fat to move around. :-/ The first time I was on hormones, enough body fat moved up to my chest that my mom said she could feel the difference when I hugged her. It didn’t look too extreme, just very slightly gynecomastic. The second time I started hormones, more body fat moved to my chest and it also started to move to my butt (which has historically been quite flat and could really do with a bit more). While I’ve been mostly been very happy with the fat redistribution, I’m getting more anxious to lose some weight at this point.

Around 3 months on hormones, I experienced some testicular pain. This was a “kicked in the balls” kind of ache and it lasted for about a week straight. (That was not a fun week.) This pain is apparently pretty common and many people have it for a longer period of time than I did. It’s likely (though not certain) that the pain correlated with the lack of testosterone in my system causing my testicles to lose their functionality and become sterile. Most people who have testicles and who take sufficient doses of spiro for long enough, become sterile. This is something I knew about long in advance and I made sure to bank some sperm before starting any hormones so that I could still have kids.

Around 4 months on hormones, I also started to develop actual breast tissue beneath the fat on my chest. Small knots developed beneath my nipples and these are slowly getting bigger and filling out into very small, more “fleshy” feeling breasts. These knots are very tender. So much so, that reaching across my chest to my right side using my left arm is enough to make my left breast hurt. This tenderness is also apparently very common, both for genetic males transitioning to female, and for genetic females going through puberty.

OK, this post is now a million miles long and that’s all I can think of to say about hormones, so I’m going to call it done. I hope this was interesting for you and not too long-winded. I promise to write something more story-like next time.

:-)

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